WASHINGTON -- Identifying individuals with serious mental illness early, keeping them out of emergency rooms and jails, and increasing their access to quality care formed the basis of the recommendations of a new committee charged with improving mental healthcare across the country in a released Thursday.
"I can tell you as a physician who's worked in the system for many, many years, that the emergency room is not a place for people that are experiencing exacerbations of mental health conditions," said Elinore McCance-Katz, MD, PhD, assistant secretary for Mental Health and Substance Use at the Substance Abuse and Mental Health Services Administration (SAMHSA) and chair of the committee that authored the report.
The solution, she said, is a "national system of crisis intervention services."
"We need a continuum of care with outpatient services as alternatives to inpatient care ... because we don't have enough beds in this country to accommodate people with serious mental illness."
And if the right system, one that included community interventions and adequate resources, were in place, "we might not need so many beds," she added.
McCance-Katz chaired the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC), a 24-member body that includes researchers, clinicians, law enforcement officials, individuals with "lived experience" of mental illness, one judge, and representatives from eight federal departments.
The group was established by Congress under the 21st Century Cures Act and tasked with improving the way federal programs and agencies serve people with mental illness.
The goal of the committee's report is to examine the state of government programs for people with Serious Mental Illness (SMI) and children and youth with Serious Emotional Disturbance (SED) in the U.S., and make recommendations for improving that care, explained McCance-Katz.
The committee's goal isn't just to increase the volume of services: "What we want is a holistic approach that provides a continuum of care that meets individual needs."
The 45 recommendations included in the report span five key areas:
- Strengthening federal coordination of care
- Identifying problems early and making "good" care more accessible
- Improving access to effective treatment
- Diverting those with SMI or SED from the criminal justice system (and improving services for those who do become incarcerated)
- Making care more affordable
Some of the committee's core recommendations are the following:
- Urge federal departments to assess and harmonize their policies and ultimately design an "interdepartmental strategic plan" to better serve this population
- Increase early identification and intervention for those with SMI or SED, particularly children
- Educate providers, people with mental health conditions, and their families regarding the Health Insurance Portability and Accountability Act (HIPAA) and other privacy laws
- Leverage telehealth to maximize the reach of behavioral health providers
- Demand that "trauma-informed, whole person healthcare" be delivered in all of the systems that engage people with serious mental health issues
- Re-evaluate "civil commitment standards and processes"
- Train all first responders in best practices for responding to people with SMI and SED
- Create an integrated crisis response team to help keep people with SMI and SED out of the justice system
When it comes to early intervention, McCance-Katz noted that it currently takes an average of 2 years before a person with a psychotic disorder receives medical attention -- the longer it takes to receive medical attention, the more likely an individual is to develop a disorder that is "refractory' to current medications and psychosocial services, she said.
The report specifically recommends mandating screening for mental illness in all primary care setting and making specialty care for first-episode psychosis available nationwide.
In addition, McCance-Katz highlighted the Certified Community Behavioral Health Clinic (CCBHC) program, which has been piloted in eight states as a model of integrated mental, behavioral, and physical health services.
The ISMICC, in its report, recommended nationwide expansion of the CCBHC program.
Lastly the report advises the proper enforcement of parity laws to ensure that behavioral health services are reimbursed at rates matching those for physical health.
Mary Giliberti, JD, CEO of the National Alliance on Mental Illness and an ISMICC non-federal member, who spoke at a SAMHSA press conference following McCance-Katz, noted that this is not the first commission to issue a blueprint for reforming mental healthcare: "Too many of them are gathering dust on shelves rather than serving as catalysts for change," Giliberti said. "True success will require sustained attention and commitment, eliminating the policies that are barriers to progress and implementing practices through policy development, quality measurement and financing, and enforcement of the law. In short, it will take action."
"I sincerely hope that a year from today, 5 years from today, 10 years from today, we will look back on this committee and we will say it played a key role in changing the paradigm of today from neglect and tragedy to one of care and compassion for ... all people with serious mental illness and their families."
The ISMICC will continue to meet twice each year, and a final report, summarizing the accomplishments and noting future recommendations, is due to Congress in December 2022.