News & Notes

The Clinton Administration unveiled nearly a dozen initiatives to improve treatment of mental illness, accelerate progress in research, and ensure parity of coverage for mental and substance use disorders at the first White House Conference on Mental Health, held June 7 at the Howard University campus in Washington, D.C.

Chaired by Tipper Gore, the President's mental health adviser, and attended by President and Mrs. Clinton and Vice-President Gore, the daylong conference was linked via satellite to more than 1,000 sites in communities throughout the nation, allowing participation in a town-hall format by consumers and their families and mental health professionals. At Mrs. Gore's invitation, more than 500 mental health advocates from across the country came to Howard University, as did several members of Congress and nine federal department and agency heads.

At the plenary session, Mrs. Gore called on participants to fight against the stigma that surrounds mental illness, which she called "the last great stigma of the 20th century." She stressed the importance of breaking the silence "by talking about mental illness in our homes, our workplaces, in the schools, with our colleagues, and everywhere we can." She described her own successful treatment for clinical depression, which she said developed as a delayed reaction after her son recovered from serious injuries sustained in a 1989 car crash.

Vice-President Gore pointed out that just as families provide support when a relative becomes mentally ill, the community must help families who need information and services. When families seek help, he said, "they must find a waiting ear, not a waiting list." He focused on the creation of school-based services to ensure that parents of emotionally ill children do not become isolated by stigma and hopelessness, and he called on business leaders to implement early-intervention programs for workers with mental health and substance abuse problems.

Mrs. Clinton drew attention to research in the past two decades that has greatly increased understanding of brain diseases and that has begun to break down myths about mental illness. She said that policymakers and clinicians have an obligation to ensure that new scientific knowledge is quickly disseminated to improve prevention, early intervention, and treatment.

President Clinton said his view of mental illness was deeply changed in 1990 when he read Darkness Visible, a personal account of recovery from clinical depression by his friend the novelist William Styron. Calling the loss of human potential from untreated mental illness "staggering," the President briefly described the mental health initiatives either under way or soon to be implemented by his Administration.

The centerpiece of the initiatives was the President's announcement that by next year the 285 health plans that provide care to all nine million federal government employees will be required to cover mental health and substance abuse treatments at full parity with medical treatments. The President said that as an employer the federal government must lead the parity challenge, and he called on other employers to examine the accumulating evidence showing that parity can be achieved with no significant cost increases. He also announced that the Department of Labor will launch a new outreach campaign to inform Americans of their rights to equal coverage under an existing law, the Mental Health Parity Act of 1996.

President Clinton also announced a national school safety training program being launched by the National Education Association. The public-private partnership, which will include the Departments of Education, Justice, and Health and Human Services (HHS), will link schools by satellite in a year-long instructional effort to train teachers and school personnel to identify and help troubled children and address other safety issues. EchoStar, a company based in Littleton, Colorado, is donating satellite dishes to more than 1,000 school districts, and Future View, EchoStar's partner, is donating free time for programming. The President called on other members of the business community, including cable companies, public television stations, and other media outlets, to donate resources so that every school district will have access to the instructional program.

Noting that 36 years ago President Kennedy called for returning mental health to the mainstream of American health care, President Clinton challenged Congress to hold hearings on the mental health parity law to review its strengths and weaknesses. He also challenged Congress to pass the Work Incentive Improvements Act enabling people with disabilities to return to work by ensuring access to affordable health insurance, to pass a strong and enforceable patients' bill of rights, to fund the historic $70 million increase in the mental health block grant to states requested in his fiscal year 2000 budget, and to pass comprehensive legislation eliminating discrimination based on genetic testing.

Other initiatives unveiled at the conference are summarized below.

Accelerating progress in research. Beginning in July, a $7.3 million nationwide study sponsored by the National Institute of Mental Health (NIMH) will explore the prevalence and duration of mental illness as well the types of treatment most commonly used. NIMH will invest about $61 million in two new five-year clinical trials—one to examine the relative effectiveness of available antipsychotic agents in community treatment settings, and the other to examine long-term effects of different sequences of drug therapy and psychotherapy for refractory depression.

Encouraging states to provide more coordinated care for Medicaid beneficiaries with mental illness. The Health Care Financing Administration (HCFA) will announce that Medicaid will reimburse for services provided in assertive community treatment programs. HCFA will also remind states that Medicaid beneficiaries are entitled to all medications approved by the Food and Drug Administration for the treatment of serious mental illness and will ask states to examine their formularies to ensure that these medications are available.

Helping SSDI beneficiaries return to work. Of the 4.7 millions Americans receiving Social Security Disability Insurance, it is estimated that one in nine—about 500,000 people—has an affective disorder. The Administration will launch a $10 million demonstration project to provide treatment for this group and examine whether it allows them to return to work.

Educating elderly Americans about their risk for depression. NIMH and the Administration on Aging will collaborate on an outreach program to educate the elderly and their health care professionals about mental illness. It is estimated that five million people over age 65 suffer from some form of depression, which is often undiagnosed and untreated. The Department of Veterans Affairs (VA) will launch a study at six new sites to test two modes of primary care for older Americans with mental and substance use disorders.

Reaching out to homeless Americans. The Department of Housing and Urban Development will implement an initiative to encourage communities to create safe havens where homeless people with mental illness can get treatment. HHS will launch a two-year, $4.8 million grant program to study the treatment, housing, education, training, and support services needed by homeless women and their children, many of whom have mental and substance use disorders. VA will double its number of outreach programs to homeless veterans with mental illness.

Meeting the mental health needs of crime victims. The Administration announced a new interagency partnership between the Department of Justice's Office for Victims of Crime and the Center for Mental Health Services (CMHS). This partnership will help ensure that the federal response to community crises such as terrorist acts or mass violence includes a strong mental health component.

Developing new strategies for addressing mental illness in the criminal justice system. Later this summer the Substance Abuse and Mental Health Services Administration and the Department of Justice (DOJ) will host a conference to focus on crime prevention among people with mental illness and to address the needs of offenders with mental and substance use disorders. After the conference DOJ will launch an outreach effort to educate the criminal justice community on how to better serve citizens with mental illness. Communities interested in pursuing these approaches can get technical assistance from the National GAINS Center for People With Co-Occurring Disorders in the Justice System. GAINS is a partnership between the Center for Substance Abuse Treatment, CMHS, and the National Institute of Corrections to collect and disseminate information about effective treatment in the justice system.

Implementing a new approach to combat stress in the military. The President announced that he will direct the Department of Defense (DOD) to report back within 180 days on implementation of a more comprehensive program for combat stress in all service branches. DOD will hold a fall conference to develop new strategies and educate military leaders and medical personnel about enhancing current prevention efforts.

Expanding the Caring for Every Child campaign. A new $5 million, five-year effort in targeted communities will highlight the needs of the estimated 10 percent of American children with behavioral problems and mental disorders.

Improving the mental health of Native American youth. A $5 million collaboration of the Departments of Interior, Justice, Education, and HHS in ten Native American communities will study effective strategies for improving mental health among Native Americans between the ages of five and 24. The suicide rate in this group is three times higher than in the general population.