New Freedom Commission on Mental Health
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The New Freedom Commission on Mental Health was established by U.S. President George W. Bush in April 2002 to conduct a comprehensive study of the U.S. mental health service delivery system and make recommendations based on its findings. The commission has been touted as part of his commitment to eliminate inequality for Americans with disabilities.
The President directed the Commission to identify policies that could be implemented by Federal, State and local governments to maximize the utility of existing resources, improve coordination of treatments and services, and promote successful community integration for adults with a serious mental illness and children with a serious emotional disturbance.[dead link] The commission, using the Texas Medication Algorithm Project (TMAP) as a blueprint, subsequently recommended screening of American adults for possible mental illnesses, and children for emotional disturbances, thereby identifying those with suspected disabilities who could then be provided with support services and state-of-the-art treatment, often in the form of newer psychoactive drugs that entered the market in recent years.
A broad-based coalition of mental health consumers, families, providers, and advocates has supported the Commission process and recommendations, using the Commission's findings as a launching point for recommending widespread reform of the nation's mental health system.
Opponents of the plan have questioned the motives of the commission, largely from a civil liberties perspective, asserting the initiative campaign is little more than a thinly veiled proxy for the pharmaceutical industry, which, in its pursuit of profits, is too eager to foster psychotropic medication interventions. Some opponents contend that its objectives are to foster chemical behavior control of American citizens. However, no commission recommendations specifically call for increased drug use and the commission did call for closer scrutiny of psychiatric drug treatment, months before the Food and Drug Administration (FDA) started taking these steps in the wake of reports of increased rates of suicide, especially during the first months of drug use.[dead link]
On July 22, 2003, the President's commission returned a report containing nineteen formal recommendations, organized under six proposed national goals for mental health. The report of the commission was viewed favorably by most major consumer, provider and other mental health interest groups. Much of the support for the program has centered on the commission's emphasis on recovery from mental illness, its call for consumer and family-centered care, and its recommendation that states develop a more comprehensive approach to mental health.
The commission reported that "despite their prevalence, mental disorders often go undiagnosed," so it recommended comprehensive mental health screening for "consumers of all ages," including preschool children, because "each year, young children are expelled from preschools and childcare facilities for severely disruptive behaviors and emotional disorders."
According to the Congressional Research Service, the commission did not specifically recommend a nationwide screening program for mental illness, although it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care) where research has shown that very high proportions of youth have these disorders. The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.
The commission recommended to the president a set of goals intended to move the American mental health system towards a recovery oriented system, with the overall goal of helping all individuals with mental illness and disability recover, with early detection and access to the necessary support and treatment. The report's recommendations include increased public education regarding mental health, greater involvement of patients and families in care decisions, creating individualized care plans, increasing support for employment and affordable housing, early screening and treatment, and greater use of evidence-based practices. The commission also recommended that services for people with mental illness and disabilities were "fragmented" and needed to be better coordinated at the state level.
Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for pharmaceutical companies, and have concerns about the potential for unnecessarily causing neurological damage and contributing to increased substance abuse and drug dependence. Critics are also concerned by what they see as the pharmaceutical industry's use of front organizations  and the compromise of scientific integrity under color of authority, look askance at the irony of the commission's 'freedom' descriptor, contending the commission is yet another example of the excesses of drug industry marketing,[dead link] and that the effects of its recommendations will simply foster drug use rather than the prevention of mental illness and use of alternative treatment modalities.
A coalition of over 100 advocacy organizations, united under the banner of Mindfreedom.org in representing the psychiatric survivors movement, has been galvanized by their strong opposition to the New Freedom Commission. Using celebrity to advance their opposition, the MindFreedom coalition has again enlisted the support of longtime member and Gesundheit Institute founder Patch Adams, a medical doctor made famous by the movie that bears his name. Since 1992, Adams has supported MindFreedom campaigns, and in August, 2004, he kicked off the campaign against the New Freedom Commission by volunteering to screen President Bush himself. "He needs a lot of help. I'll see him for free," said Adams.
TMAP origin criticism
Critics also contend that the strategy behind the commission was developed by the pharmaceutical industry, advancing the theory that the primary purpose of the commission was to recommend implementation of TMAP based algorithms on a nationwide basis. TMAP, which advises the use of newer, more expensive medications, has itself has been the subject of controversy in Texas, Pennsylvania and other states where efforts have been made to implement its use.
TMAP, which was created in 1995 while President Bush was governor of Texas, began as an alliance of individuals from the University of Texas, the pharmaceutical industry, and the mental health and corrections systems of Texas. Through the guise of TMAP, critics contend, the drug industry has methodically influenced the decision making of elected and appointed public officials to gain access to citizens in prisons and State psychiatric hospitals. The person primarily responsible for bringing these issues to the public's attention is Allen Jones, a former investigator in the Commonwealth of Pennsylvania Office of Inspector General (OIG), Bureau of Special Investigations.
Jones wrote a lengthy report in which he stated that, behind the recommendations of the New Freedom Commission, was the "political/pharmaceutical alliance." It was this alliance, according to Jones, which developed the Texas project, specifically to promote the use of newer, more expensive antipsychotics and antidepressants. He further claimed this alliance was "poised to consolidate the TMAP effort into a comprehensive national policy to treat mental illness with expensive, patented medications of questionable benefit and deadly side effects, and to force private insurers to pick up more of the tab."
A bill, 'The Parental Consent Act of 2005', or HR 181, has been introduced in the US House of Representatives by Ron Paul, a Republican from Texas. The proposal forbids federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents.
- Lenzer, Jeanne (June 2004), "Bush plans to screen whole US population for mental illness", BMJ (June 19, 2004) 328: 1458, doi:10.1136/bmj.328.7454.1458 PsychRights.org (pdf)
- Lenzer, Jeanne (August 2004), "Secret US report surfaces on antidepressants in children", BMJ (August 7, 2004) 329: 307, doi:10.1136/bmj.329.7461.307 PsychRights.org (pdf)
- PsychRights.org (pdf) - Untitled TMAP Critique, Allen Jones (January 20, 2004)