2. Priority and Special Population

2.1 Priority Population 

NAMI advocates for the most effective and appropriate care and treatment and provision of services for people who experience a mental illness. NAMI's priority populations are children, youth and adults with serious mental illnesses who need services and support, often throughout their lives. These include children and adults who have diagnoses that are considered major mental illnesses that significantly impair major life activities, interpersonally, vocationally, educationally, and in managing activities of daily living.

Diagnosis of serious mental illness includes schizophrenia, schizoaffective disorder, bipolar disorder, major depressive disorder, obsessive-compulsive disorder, panic and other severe anxiety disorders, borderline personality disorder, post traumatic stress disorder (PTSD), autism and pervasive developmental disorders, and attention deficit/hyperactivity disorder as well as co-occurring substance use disorders. These disorders represent those diagnoses that current scientific data and consensus conclude are identifiable, disabling medical illnesses, with significant biological underpinnings, and require treatment.

(2.1.1) Other mental illnesses that result in:
( seriously disabling consequences; or
( a high risk of co-morbidity or mortality: and
( have a long term course.

2.2 Additional Support

NAMI believes that individuals with serious mental illnesses often require additional support to have their specific needs met and to ensure their access to integrated systems of care, education, and rehabilitation.

2.3 Cultural Diversity

(2.3.1) Persons of different ages, and of varying cultures, racial, religious, ethnic, sexual orientation, gender, gender identity, disability, including person who are deaf and hearing impaired, and those for whom English is not the primary language have unique characteristics that sometimes cause them to be partially or poorly served or excluded from existing treatment, training, and rehabilitation programs, which are not relevant to their needs. These differences must be respected, embraced, and accorded appropriate representation in mental health care policy, administration, diagnosis, treatment, services, and support in provider and governmental organizations, as well as throughout the organization and operation of NAMI.

(2.3.2) NAMI supports expanded efforts toward recruitment and training of professionals from these groups, the development and distribution of culturally and linguistically appropriate materials for use in education, encouragement of their participation in programs and services, and outreach efforts targeted to these underserved and excluded groups.

(2.3.3) NAMI urges the incorporation of ethnic and cultural perspectives and competence into the design and implementation of programs and procedures for persons with mental illnesses so that diagnostic evaluations, consumer and family communications, and the provision of treatment and services will be free from bias and cultural impediments.

(2.3.4) NAMI believes that providers must have training and sensitivity to cultural diversity.

(2.3.5) NAMI deplores the higher rates among minorities of involuntary commitment and incarceration in penal facilities that occurs among minorities with serious mental illnesses versus non-minorities with similar diagnoses.

2.4 Older Adults with Mental Illness

(2.4.1) NAMI recognizes that the proportion of older adults with mental illnesses will increase as the proportion of older adults in the overall population disproportionately increases. Older age presents added challenges for persons with mental illnesses, especially serious mental illnesses. Treatment must be monitored and adjusted with respect to the metabolic changes coming with aging. Treatment and support need to take into consideration limiting physical, social, economic and other conditions associated with aging. Certain circumstances of aging, such as loss of family, social isolation and infirmity can be triggers for the onset of mental illnesses, including alcoholism and serious depression, among older people. Older persons with mental illnesses also face the loss of family and other caregivers as well as the insufficiency of geriatric health practitioners, including mental health practitioners.

(2.4.2) NAMI calls for Medicare, Medicaid and all public and private health care coverage to provide a suitable, non-discriminatory continuum of community-based treatment, housing and support for older adults with mental illnesses integrated with overall wellness. This should always be based on the least restrictive alternative and should only include nursing homes, and skilled nursing facilities if based on medical conditions other than mental illness. NAMI opposes the practice of indiscriminately administering psychotropic medications to older adults for purposes of sedation or behavioral compliance.

(2.4.3) NAMI supports expanded research on mental illness and aging as well as expanded recruitment, education and training for health and mental health care providers, family members and other caregivers with respect to the specialized needs of older adults with mental illnesses.

(2.4.4) NAMI calls for more effective collaboration between advocates for persons with mental illnesses and advocates for older adults at the national, state and local level.

2.5 Adults Who Are Veterans and Active Duty Military

(2.5.1) NAMI believes that persons with mental illnesses who are veterans, on active military duty, in the National Guard, or in the Reserves, as well as their families, should receive the same full range of integrated diagnosis, treatment services, and supports across a continuum of care as should be available to all people with serious mental illnesses.

(2.5.2) Individuals who are veterans, on active military duty, in the National Guard, or in the Reserves, as well as their family members must receive the same level of care and treatment regardless of the provider.

(2.5.3) NAMI calls for effective diagnosis, treatment and referral for active military duty personnel with serious mental illnesses, upon induction and throughout the period of military service.

(2.5.4) NAMI recognizes the need to make effective, integrated treatment programs for co-occurring disorders, including medications, available to veterans and active duty military personnel.

(2.5.5) NAMI recognizes that women, who are a more substantial proportion of veterans and active duty military personnel than ever before, may present mental health care needs differently and require treatment appropriate to their special needs.

(2.5.6) NAMI urges action by the Department of Defense, by executive order of the President of the United States or by act of the United States Congress to authorize that the Purple Heart Award for military service resulting in combat related, medically documented related serious mental illnesses, including post-traumatic stress and mental illnesses induced by traumatic brain injury.

(2.5.7) NAMI recognizes that returning veterans, National Guard members and reservists with mental illnesses face discrimination as well as higher rates of unemployment and underemployment than in the general population. Effective treatment and support for these veterans must include access to effective education, training, referral services, hiring preferences, supported employment, professional credentialing and other resources needed to return to work. NAMI also supports recognition of military training credits in qualifying for civilian employment.

2.6 Persons Who Are Homeless and/or Missing

NAMI believes appropriate treatment for persons with serious mental illness leading to recovery, resiliency and wellness cannot be realized without appropriate housing. Persons with serious mental illnesses have the right to safe, decent and affordable housing that meets their needs.

(2.6.1) NAMI advocates for the right to treatment for persons with serious mental illnesses who are homeless and for those at risk of becoming homeless. These citizens have the same needs and rights to shelter and treatment as all other persons with serious mental illnesses. NAMI believes that persons with serious mental illnesses who are homeless should have individualized treatment plans that are integrated into existing systems of care and related health and human service systems.

(2.6.2) NAMI urges that service providers, professionals, and others assisting persons with serious mental illnesses who are homeless show them and their families common courtesy, compassion, and respect.

(2.6.3) When helping to reunite families, NAMI appeals to service providers, professionals, and others assisting persons with serious mental illnesses who are homeless to do what is in the best interest of all concerned, consistent with ethical and medical practices and applicable legal guidelines.

(2.6.4) NAMI deplores the commonplace use of jails and prisons to warehouse persons with serious mental illnesses who are homeless.

(2.6.5) NAMI believes that an adult who once served his or her country in uniformed military service should never become homeless. NAMI urges federal, state and municipal governments to make special efforts to address homelessness in the veterans population through better dissemination of information and coordination of programs that provide treatment, support, assistance and housing options.

2.7 Persons Infected with the HIV Virus

(2.7.1) NAMI believes that all persons with serious mental illnesses should be encouraged to be tested for HIV. NAMI believes that persons who test positive should receive appropriate treatment for both their serious mental illnesses and HIV-related illnesses in the least restrictive setting that is safe for all concerned. The results of testing should be shared only on a "need to know" basis and should include families if they are primary caregivers. If families are not primary caregivers, persons with serious mental illnesses should be encouraged to share this information on a voluntary basis.

(2.7.2) Persons with serious mental illnesses living in institutional settings have been identified as high risks for HIV infection. Therefore, NAMI believes that all persons with serious mental illnesses in institutional settings should be offered HIV testing and strongly encouraged to participate in testing.

(2.7.3) NAMI urges that education, counseling, and peer support should be made available to the person with a serious mental illness who tests HIV positive and, whenever possible, should be offered to their family and staff as well.

2.8 Children with Serious Mental Illnesses

(2.8.1) NAMI believes that children and adolescents with serious mental illnesses have the right and must be offered the opportunity to thrive in nurturing environments.

(2.8.2) NAMI believes that, at the earliest possible time in their lives, all children and adolescents with serious mental illnesses deserve to be diagnosed, appropriately treated, and offered the services necessary to achieve and maintain their recovery.

(2.8.3) NAMI believes that children and adolescents with serious mental illnesses should be treated in their homes and in their communities whenever that level of treatment is appropriate to their clinical need and they should be offered a full array of demonstratively effective services at that time.

(2.8.4) NAMI urges parents and caregivers to become well informed about the array of treatments and services that are or should be available in their community. They should be aware of the special education services that are available for the child who may require those services because of a developmental disability (DD) and/or serious mental illness.

(2.8.5) NAMI calls on all school administrators, teachers, and other education professionals to follow the requirements of the Individuals with Disabilities Education Act (IDEA) in order to ensure that students with serious mental illnesses receive an appropriate education and related services as mandated by the law and to ensure that these students have the opportunity to lead independent and productive adult lives.

(2.8.6) NAMI calls on federal, state and local education officials to immediately address the low academic achievement and unacceptably high drop-out and failure rates of students in the “emotional disturbance” category of the Individuals with Disabilities Education Act (IDEA). Students living with serious mental illnesses are included in that category.

(2.8.7) NAMI calls for strong interagency collaboration between all child- and family-serving agencies, including state and local mental health systems; public and private schools; child welfare systems; and juvenile justice systems.

(2.8.8) When children and adolescents are detained for mental health care or juvenile justice custody due to behavior that might be caused by a serious mental illness, their clinical status must first be evaluated by a qualified mental health professional and must be taken into account before establishing the appropriate conditions for treatment or detention. When detained, children and adolescents with serious mental illnesses must never occupy the same waiting area, living quarters, evaluation and treatment spaces as adults being served in that setting. Girls who are detained should always be supervised by a female attendant.

(2.8.9) When children and adolescents appear to be experiencing a crisis associated with a serious mental illness, qualified mental health professionals should always be among the first responders contacted. Families should not be directed to law enforcement when a child is experiencing a psychiatric crisis at home or in the community. Every community must have access to an effective and appropriate crisis response system for children and adolescents with serious mental illnesses.

(2.8.10) Schools should not call law enforcement as the first responder in a psychiatric crisis. The intervention of law enforcement personnel either in schools or the community should always be a last resort and should only occur when it is the only option to protect the child and/or the public. School personnel should be trained to effectively de-escalate a psychiatric crisis and schools should have appropriate links to crisis services in the community mental health system.

(2.8.11) In the event that a child exhibits or threatens aggression or self-injurious behavior during a crisis and transportation to a treatment facility is necessary, a qualified mental health professional and/or appropriately trained law enforcement officer must first de-escalate the crisis and then arrange for transportation, preferably in a family vehicle if appropriate or in the least threatening and stigmatizing vehicle available. Adult family members, caregivers, persons known to and trusted by the child, or qualified mental health service providers should accompany the child in transit. When being transported for psychiatric evaluation, psychiatric care or juvenile detention related to a mental health issue, children and adolescents should never occupy the same vehicle or detention areas as adults. Girls who are being transported should always be supervised by female attendants. Using the appropriate vehicle and ensuring appropriate conditions for transportation, during psychiatric crisis, can avoid re-traumatizing the child, the adolescent and the family.

(2.8.12) NAMI believes that families should never be coerced to relinquish custody of their dependent children with serious mental illnesses in order to obtain care, treatment, on an education. The health care service system must be restructured to ensure that children and families are never forced to seek mental health services in the child welfare and juvenile justice systems.

(2.8.13) NAMI recognizes the critical role that families play in the recovery and development of their children. Therefore NAMI supports the right of families of children who have serious mental illnesses to visit and otherwise maintain as normal contact as appropriate with their children when they are being served in hospitals and other residential facilities. These facilities must not impose overly restrictive visitation limits that prohibit families from visiting their child.

(2.8.14) NAMI calls on national, state and local leaders to take immediate action to end the workforce shortage in children’s mental health services.

(2.8.15) NAMI believes that all primary care providers, including pediatricians, family practice physicians, and advanced practice nurses must be trained to recognize the early warning signs of serious mental illnesses in children, to provide effective treatment as necessary and to develop collaborative agreements with child psychiatrists to whom they can refer children and families for specialized services.

2.9 Minor Children of Parents with Serious Mental Illnesses

NAMI recommends that NIMH study the special problems of minor children whose parents have serious mental illnesses. The diagnosis of a serious mental illness alone is not sufficient grounds for losing custody of one's children.