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Governors' Involvement Could Be Key To Reform Of Fragmented
Mental Health System, Says Presidential Commission Chairman

Coordination of Multiple Revenue Streams Is Beyond Scope of State Mental
Health Departments, Says Interview in
Health Affairs


BETHESDA, Md.— Incremental changes will not solve the problems of a fragmented mental health system, according to an interview with Michael F. Hogan, chairman of the President's New Freedom Commission on Mental Health published as a Health Affairs Web exclusive.

"Narrow reform measures aren't up to the task of achieving such substantial change. A much more fundamental transformation in mental health care is required," said Hogan, echoing the findings of the Commission's final report, published in July. In the interview, he outlines several ideas about how such a transformation might be made. Effective mental health care involves support services such as such as housing, education and vocational rehabilitation as well as clinical treatment, he explained.
State mental health agencies lack the authority to coordinate all these services, Hogan said, so solutions to the problem of fragmentation are likely to require coordination plans that have the full backing and involvement from state governors' offices. As an incentive to encourage gubenatorial involvement, he suggested, states might be offered greater flexibility in their use of federal funds in their Medicaid, housing, education and income support programs.

In its year-long deliberations, the Commission documented the problem of fragmentation at multiple levels. The federal government supplies the lion's share of funding for mental health services through separate programs in several different governmental departments. The states, which traditionally have had primary responsibility for organizing mental health services, distribute federal funds through many different departments. At the level of patient care, coordination of treatment and support services is perennially frustrated by these layers of complexity.

The New Freedom Commission brought together representatives from many of the different state and federal agencies involved in the panoply of services, as well as treatment professionals and consumer representatives. In the interview, Hogan describes how the working relationships in the group developed and some of the strategies they considered for tackling mental health issues that arise in the criminal justice system, education, welfare, housing, the homeless population, the challenge of suicide prevention, and the coordination of research and clinical practice.

One of the biggest breakthroughs the Commission made, he said, was inspired by a meeting with former First Lady Rosalynn Carter, who chaired the last presidential commission on mental health during her husband's Administration. The one thing that has changed most dramatically in the past 25 years, Mrs. Carter said, is "the understanding that it is possible for any person to recover. Today, we have this understanding. We did not then."
Mike Hogan has been director of the Ohio Department of Mental Health since 1991. The interview was conducted by Health Affairs deputy editor Robert Cunningham.

Health Affairs, published by Project HOPE, is a bimonthly multidisciplinary journal devoted to publishing the leading edge in health policy thought and research.

©2003 Project HOPE–The People-to-People Health Foundation, Inc.