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A number of special reports were published in 2003 that are vitally important to Psychiatry and Mental Health from both a national and international perspective.
A Vision for the Mental Health System by the American Psychiatric Association
The APA has published a blueprint of suggested ways to save America’s problematic mental health system in April, 2003. In summary, APA advocates the following 12 Principles for a Vision for Our Nation’s Mental Health System:
1. Every American with psychiatric symptoms has the right to a comprehensive evaluation and an accurate diagnosis which leads to an appropriate, individualized plan of treatment.
2. Mental health care should be patient and family centered, community based, culturally sensitive, and easily accessible without discriminatory administrative or financial barriers or obstacles.
3. Mental health care should be readily available for patients of all ages, with particular attention to the specialized needs of children, adolescents, and the elderly. Unmet needs of ethnic and racial minorities require urgent attention.
4. Access to mental health care should be provided across numerous settings, including the workplace, schools, and correctional facilities. An emphasis should also be placed on the early recognition and treatment of mental illness.
5. Patients deserve to be treated with dignity and respect. When they are clinically able, they are entitled to choose their physician or community-based agency and to make decisions regarding their care. When they are incapable to do so, they should receive the treatment they need and when able, they should choose future care.
6. Patients deserve to receive care in the least restrictive setting possible that encourages maximum independence with access to a full continuum of clinical services, including emergency/crisis, acute inpatient, outpatient, intermediate level, and long-term residential programs.
7. Since mental illness and substance abuse occur together so frequently, mental health care should be fully integrated with the treatment of substance abuse disorders and with primary care and other general medical services.
8. Support must expand for research into the etiology and prevention of mental illness and into the ongoing development of safe and effective treatment interventions.
9. Efforts must be intensified to combat and overcome the stigma historically associated with mental illness through enhanced public understanding and awareness.
10. Health benefits, access to effective services, and utilization management must be the same for people with mental illness as for other medical illnesses, preferably funded by integrated financing systems. Although states are the ultimate locus of responsibility for the public safety net, the federal government and the private sector employers must also support an increased investment in the mental health of Americans.
11. Funding for care should be commensurate with the level of disability caused by a psychiatric illness. Disability occurs both in the severely and persistently mentally ill and in patients with other unforeseen psychiatric conditions who suffer despite having previously been productive and functional.
12. More resources should be devoted to treatment and to training an adequate supply of
psychiatrists, especially child psychiatrists, to meet the current and future needs of the population.
Presidential Commission
In May 2003, the final report of the President’s New Freedom Commission on Mental Health was published. From June 2002 to April 2003, the 22 Commissioners met monthly to analyze the public and private mental health systems. They visited innovative programs across the country and heard testimony from the systems’ many stakeholders, including dozens of consumers of mental health care, families, advocates, public and private providers and administrators and mental health researchers. The Commission received feedback, comments and suggestions from nearly 2,500 people from all 50 states via personal testimony, letters, emails and a comment section on their website.
Goals of the Commission for Mental Health include:
Americans Understand that Mental Health Is Essential to Overall Health.
Mental Health Care Is Consumer and Family Driven.
Disparities in Mental Health Services Are Eliminated.
Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice.
Excellent Mental Health Care Is Delivered and Research Is Accelerated.
Technology Is Used to Access Mental Health Care and Information.
First Practice Guideline on Suicide
The American Psychiatric Association recently (Dec 2003) issued its first guideline on the assessment and treatment of patients with suicidal behaviors. The guideline is intended to help reduce individual patient's suicide risk by giving psychiatrists tools to assess for risk and formulate treatment strategies. The new guideline provides recommendations for assessment and treatment interventions based on evidence from research literature and clinical consensus. The Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors is available online.
WHO Publications
The World Health Organization has published a number of mental health publications in 2003. The most recent of which is called Investing in Mental Health which summarizes the global impact of mental illness. It points out that neuropsychiatric conditions account for 13% of disability adjusted life years (DALYs) - the highest percentage of any disability. It also reminds us that: "more than 150 million persons suffer from depression at any point in time; nearly 1 million commit suicide every year; about 25 million suffer from schizophrenia; and more than 90 million suffer from an alcohol- or drug-use disorder." Other alarming statistics and relevant issues describe that as many as 450 million people suffer from a mental or behavioral disorder, four of the six leading causes of years lived with disability are due to neuropsychiatric disorders (depression, alcohol-use disorders, schizophrenia and bipolar disorder), one in four families has at least one member with a mental disorder, family members are often the primary caregivers of people with mental disorders. The extent of the burden of mental disorders on family members is difficult to assess and quantify, and is consequently often ignored. However, it does have a significant impact on the family’s quality of life. In addition to the health and social costs, those suffering from mental illnesses are also victims of human rights violations, stigma and discrimination, both inside and outside psychiatric institutions.
Other WHO mental health publications for 2003 include:
The Mental Health Context
Mental Health Policy, Plans and Programmes
Mental Health Financing
Mental Health Legislation and Human Rights
Advocacy for Mental Health
Quality Improvement for Mental Health
Organization of Services for Mental Health
Planning and Budgeting to Deliver Services for Mental Health
Mental Health Policy and Service Guidance Package
International Guidelines for Estimating the Costs of Substance Abuse
Caring for Children and Adolescents with Mental Disorders
Neuroscience of Psychoactive Substance Use and Dependence
This has been a rich year of reports and publications concerning the major issues in caring for individuals with mental illness and neuropsychiatric disorders. Lets hope that in 2004, we can begin to translate all of this wisdom into action.
10:44:19 PM 
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