Commentary: Improving the Lives of Individuals With Serious Mental Illness

As Dr. Satel’s Open Forum essay (1) illustrates, much has been said and written lately about the need to more adequately address the needs of people with serious mental illness and their families. Addressing these needs is a critical part of the overall mission of the Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA is also charged by Congress with helping to build resilience and emotional health, prevent substance abuse and mental illness and their disabling effects, implement current evidence-based practices, cultivate new practice models, and support individuals who are in recovery from mental and substance use disorders.

SAMHSA has significant leadership responsibilities for substance abuse and mental health issues for children, adolescents, adults, and families. For example, SAMHSA is working with federal, state, and local partners to implement the Affordable Care Act and federal parity law, which together offer more than 60 million Americans expanded access to behavioral health treatment and services. This is the single largest expansion of mental health and substance abuse benefits in a generation.

SAMHSA also works to improve available treatments for people with schizophrenia, bipolar disorder, depression, and other serious conditions through policy making, distribution of grants, collection and dissemination of data, and clinician and public education. SAMHSA provides funds to address homelessness and criminal justice involvement, support mental health courts, create employment opportunities, provide outreach, and engage individuals with serious mental illness who might otherwise be in jail, on the streets, in emergency rooms, or not in treatment.

Less than a third of SAMHSA’s budget is for mental health issues. The rest is appropriated to address substance use and addiction. Almost 80% of the mental health portion is targeted for persons with the most serious mental disorders. According to 2009 data, most of the funds spent in the United States for mental health services come from Medicaid (27%), private insurance (26%), state and local governments (15%), and Medicare (13%).

The SAMHSA-administered mental health block grant is part of other federal spending on mental health care. Congress allocates these funds by formula to states for individuals with the most serious mental illnesses and allows states to determine the proportion to be used for adults and for children and the specific community-based services to fund, as each state considers its Medicaid and other available funding. Congress recently implemented a 5% set-aside for individuals who are in the early stages of serious mental illnesses, including psychotic disorders. SAMHSA and the National Institute of Mental Health are providing states with guidance and assistance for this program.

SAMHSA also funds grants to support family involvement in mental health care. To address treatment needs when traditional medications and psychiatric care are not effective or when they only partially help manage symptoms (2), a small portion of SAMHSA’s funding supports an annual conference about promising alternatives and adjunctive therapies. In addition, SAMHSA’s work in suicide prevention and disaster response saves thousands of lives each year, including the lives of many who do not have serious mental illness but who do have severe emotional responses that need attention to prevent devastating outcomes.

Some critics have implied that SAMHSA should focus primarily on adults who meet criteria for certain diagnoses and who do not accept that they have a mental illness and do not agree to medical treatment. This group is one of the many SAMHSA is charged to address. As one commentator noted, all mental illness is serious, especially when symptoms cause concern or are not controlled (3). SAMHSA recognizes that behavioral health is essential to health and that mental and substance use disorders should be treated like any other health condition—when they are in a serious stage, when they are disabling, or when symptoms are under control.

SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP) includes more than 330 model programs of all types and is just one part of SAMHSA’s commitment to disseminating evidence-based and promising practices. Any program developer—including those who create mandated treatment programs—can submit a program for review. If it is found to have sufficient research backing and is able to be replicated, it can be listed in NREPP.

Through these and other initiatives, SAMHSA is changing the way mental illness is understood and treatment is provided. The recovery model advanced by SAMHSA and articulated by the President’s New Freedom Commission on Mental Health in its 2003 report (4) includes helping those who are experiencing mental health conditions and their families receive the treatment, services, and support they need to lead fulfilling lives. The concept of recovery is not the antithesis of treatment, nor is it the cause of the nation’s mental health system woes. Rather it expresses the hope and the reality that with the right treatment and services and with caring communities, persons with mental illnesses can and do lead successful lives.

The renewed interest in mental health by the media and Capitol Hill presents an opportunity to address long-standing barriers to mental health care. The common purpose is clear, even if the proposals vary: America needs to do more for persons with serious mental illness and their families.