Free to Choose: Transforming Behavioral Health Care to Self-Direction. Report of the 2004 Consumer Direction Initiative Summit

摘要

Self-directed health care is emerging as a critical element in the transformation of Americas health care system. Two of the factors that are driving this trend are the recent increases in the cost of health insurance and health services and the inconsistent quality of health care. Both private and public health care delivery systems are responding by developing new consumer-directed products. The Presidents New Freedom Commission on Mental Health has called for the development of consumer-driven models of care and system changes to support community-based services in behavioral health care. All components of the health care system urgently need to become more consumer-centered; behavioral health services are no exception. Consumer involvement in behavioral health care systems and programs is a primary value of the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS). For many years SAMHSA has supported consumer advocacy, consumer-operated services, and peer recovery programs. In April 2003, SAMHSA held a self-determination planning meeting that recommended that the agency design a consumer-directed health care initiative for persons with mental illnesses and/or substance use disorders. Accordingly, SAMHSA hosted a Consumer Direction Initiative Summit on March 22-23, 2004, in Washington, DC. The Consumer Direction Initiative Summit convened recipients of mental health and addiction services and family members, policymakers, providers, and State and Federal representatives. In total, 79 people attended, participated in an in-depth discussion of the issues, and worked to develop recommendations for SAMHSAs next steps towards fostering a more consumer-directed approach in behavioral health care services for people with substance use disorders and mental illnesses and children with serious emotional disturbances. Through a combination of papers, presentations, and discussions, workgroups at the Summit identified specific needs of consumers and potential barriers to self-directed behavioral health care. They developed their visions for a self-directed care service system and formulated recommendations for SAMHSA that seek to transform the delivery of behavioral health services. At the end of the meeting, the recommendations were presented to the directors of the Center for Substance Abuse Treatment (CSAT), the Center for Mental Health Services (CMHS), and the Center for Substance Abuse Prevention (CSAP) within SAMHSA. The directors then presented their perspectives on the work that had been accomplished. The term consumer direction was used in planning the SAMHSA Summit because it has been widely accepted in the general health care field to refer to health care organization and delivery that encourages consumerism among people receiving services. However, in the mental health and substance abuse fields, this term sometimes has a negative connotation. For this reason, the term self-direction is used in this report. When the term consumer is used, it is intended to refer to recipients of mental health and substance abuse services.