Mental Health Policy: SAMHSA, NIMH, NAMI & Carter Center

Introduction: The Changing Landscape of Mental Health Policy

Mental healthcare is an area that has been neglected by policymakers and by the medical community at various points in its history. Examining how people with mental illness have been treated throughout history demonstrates that opinions have changed, and that treatment has followed shifts in how the general public viewed mental health. At times, reformers would improve conditions, but these periods always seemed to be followed by eras in which the mentally ill were treated like criminals. This cyclical pattern of reform and regression appears to be changing, and the idea that mental illness is as much a disease as other forms of chronic illness is beginning to take hold with the general public.

Some of the credit for this shift can be attributed to a greater awareness of how PTSD affects soldiers and other victims of extreme trauma. In part, it is also due to the greater awareness and education fostered by local and national organizations. Because of the efforts of organizations such as the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute of Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and more local efforts such as the Carter Center, the message of mental health awareness has started to take root. This paper examines these organizations, how they affect a particular practicum site, and how they have influenced the author personally.

The goal of SAMHSA, as stated in its Leading Change document, is to reduce "the impact of substance abuse and mental illness on American communities" (SAMHSA, 2011), though this does not fully capture the organization's true mission. That mission might be better described as providing programs and alternatives for families that will lessen the financial and care-related stress they experience due to mental illness and substance abuse. The organization has attempted to accomplish this by first outlining the issues it faces and then determining how it can "best use its limited resources" to positively impact as many lives as possible (SAMHSA, 2011). Throughout its planning documents, the purpose of putting people first is consistently emphasized.

Major Mental Health Organizations and Their Missions

The primary impact of mental illness is emotional, applying to both the person with the disease and the family who cares for them, but financial responsibility is also a significant concern. SAMHSA recognizes, especially in the context of fiscal challenges, that charitable giving has declined and that government funds are directed toward areas perceived as more urgent. Nevertheless, SAMHSA has outlined why substance abuse and mental illness represent such a large public health issue. Its action plan states that: "The annual total estimated societal cost of substance abuse in the United States is $510.8 billion; by 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide; in 2008, an estimated 9.8 million adults aged 18 and older in the United States had a serious mental illness" (SAMHSA, 2011). Additional statistics further underscore this need. The organization's overarching goal is to increase understanding of these issues throughout the United States.

The primary purpose of the National Institute of Mental Health (NIMH) is to conduct and support research that provides insight into various mental and behavioral health disorders (NIMH, 2008). The organization considers this a vital mission because mental illness affects more than 13 million people every year and, according to NIMH, accounts for 25% of the hours lost to illness in the United States and Canada (NIMH, 2008). The research carried out by NIMH is not aimed primarily at controlling mental health disorders so much as understanding and managing them.

The institute operates according to four guiding principles designed to help researchers develop appropriate studies: promote discovery in the brain and behavioral sciences; chart mental illness trajectories; develop new and better interventions; and strengthen the public health impact of research. These principles are meant to provide a continuum that can lead to better government and public support, possible cures, and improved management strategies (NIMH, 2008). The organization also recognizes that professionals use the DSM series for diagnosis, and a corollary goal is to "redefine mental disorders into dimensions or components of observable behaviors that are more closely aligned with the biology of the brain" (NIMH, 2008). This effort should allow scientists to better understand the causes of specific mental illnesses and, ideally, develop more effective treatments.

NIMH's strategic plan explains, in considerable detail, how each of the four principles will be pursued in the coming years. NIMH is continually narrowing its research focus and seeking to educate the public on its findings. This organization may ultimately prove to be the most important force in controlling mental illness in the future.

The National Alliance on Mental Illness (NAMI) offers a more accessible view of what mental illness actually is than many other organizations. Its language is geared toward people seeking help rather than researchers or policymakers. NAMI's definition of recovery is notable: the organization does not claim that a person is ever fully cured, but rather that symptoms can be mitigated to a degree that allows individuals to lead normal lives (NAMI, 2012). Perhaps the most important message on the site is that recovery is a process, not an event (NAMI, 2012), and that it is achieved through "medical and clinical values, community, and successful living" (NAMI, 2012). This framing offers a positive and realistic message for those struggling with mental illness.

The NAMI site provides a variety of ways for people — both those with mental illnesses and other concerned individuals — to get involved. Advocacy is a particularly important tool, since people with mental illness are very often silent about their struggles. The stigma attached to mental illness means that many of those affected do not wish others to know about their condition. It is therefore essential that there are people willing to advocate on behalf of those who prefer to remain silent. The site also lists events occurring around the country to honor those who have contributed to the fight against mental illness, and NAMI holds an annual convention highlighting different aspects of mental health. Caregivers, consumers, and professionals all attend these conferences (NAMI, 2012). In addition, the site offers many interactive resources — discussion groups, assistance through the STAR center, current news, and a store that supports NAMI's mission — through which people can become involved.

Jimmy Carter and his wife Rosalynn have worked tirelessly to improve the lives of people around the world. The Carter Center's Mental Health Program "works to promote awareness about mental health issues, inform public policy, achieve equity for mental health care comparable to other health care, and reduce stigma and discrimination against those with mental illnesses" (The Carter Center, 2012). The final two goals — achieving equity and reducing stigma — are arguably the most important that any advocacy group can pursue in the short term.

One way that Rosalynn Carter has advanced these goals is by providing awards in responsible mental health journalism for journalists around the world (The Carter Center, 2012). These fellowships are designed to ensure that the media covers mental health issues in a fair and informed manner, addressing both the anti-stigma and equity messages simultaneously. Several of the organizations reviewed here have noted that mental illness is often not regarded in the same way as other chronic illnesses such as diabetes, and the Carter Center — along with NAMI and NIMH — is actively working to change professional and public attitudes on this point.