July 22, 2003 

Dear Mr. President: 

On April 29, 2002, you announced the creation of the New Freedom Commission on 

Mental Health, and declared, “Our country must make a commitment. Americans with 

mental illness deserve our understanding and they deserve excellent care.” You charged 

the Commission to study the mental health service delivery system, and to make 

recommendations that would enable adults with serious mental illnesses and children 

with serious emotional disturbance to live, work, learn, and participate fully in their 

communities. We have completed the task. Today, we submit our final report, Achieving 

the Promise: Transforming Mental Health Care in America. 

After a year of study, and after reviewing research and testimony, the Commission finds 

that recovery from mental illness is now a real possibility. The promise of the New 

Freedom Initiative—a life in the community for everyone—can be realized. Yet, for too 

many Americans with mental illnesses, the mental health services and supports they need 

remain fragmented, disconnected and often inadequate, frustrating the opportunity for 

recovery. Today’s mental health care system is a patchwork relic—the result of 

disjointed reforms and policies. Instead of ready access to quality care, the system 

presents barriers that all too often add to the burden of mental illnesses for individuals, 

their families, and our communities. 

The time has long passed for yet another piecemeal approach to mental health reform. 

Instead, the Commission recommends a fundamental transformation of the Nation’s 

approach to mental health care. This transformation must ensure that mental health 

services and supports actively facilitate recovery, and build resilience to face life’s 

challenges. Too often, today’s system simply manages symptoms and accepts long-term 

disability. Building on the principles of the New Freedom Initiative, the 

recommendations we propose can improve the lives of millions of our fellow citizens 

now living with mental illnesses. The benefits will be felt across America in families, 

communities, schools, and workplaces. 
2 

The members of the Commission are gratified by your invitation to serve, are inspired by 

the innovative programs across America that we learned about, and are impressed by the 

readiness for change that we find in the mental health community. We look forward to 

the work ahead to make recovery from mental illness the expected outcome from a 

transformed system of care. 

Sincerely, 

Michael F. Hogan, Ph.D. 

Chairman, President’s New Freedom Commission on Mental Health 

The Commission members: 

Jane Adams, Ph.D. 

Rodolfo Arrendondo, Jr., Ed.D. 

Patricia Carlile 

Charles G. Curie, M.A., A.C.S.W. 

Daniel B. Fisher, M.D., Ph.D. 

Anil G. Godbole, M.D. 

Henry T. Harbin, M.D. 

Larke N. Huang, Ph.D. 

Thomas R. Insel, M.D. 

Norwood W. Knight-Richardson, M.D., M.B.A. 

The Honorable Ginger Lerner-Wren 

Stephen W. Mayberg, Ph.D. 

Frances M. Murphy, M.D., M.P.H. 

Robert H. Pasternak, Ph.D. 

Robert N. Postlethwait, M.B.A. 

Waltraud E. Prechter, B.A.Ed. 

Dennis G. Smith 

Chris Spear, B.A., M.P.A. 

Nancy C. Speck, Ph.D. 

The Honorable Randolph J. Townsend, M.Ed. 

Deanna F. Yates, Ph.D. 
i

The President’s New Freedom Commission on Mental Health

Roster of Commissioners

Michael F. Hogan, Ph.D. 

Chair 

Director, Ohio Department of Mental Health 

30 East Broad Street, 8th Floor 

Columbus, Ohio 43215-3430 

Jane Adams, Ph.D. 

Executive Director 

Keys for Networking, Inc. 

1301 South Topeka Boulevard 

Topeka, Kansas 66612 

 

Rodolfo Arredondo, Jr., Ed.D. 

Professor of Neuropsychiatry 

Department of Neuropsychiatry 

Southwest Institute for Addictive Diseases 

Texas Tech University Health Sciences Center 

3601 Fourth Street 

Lubbock, Texas 79430 

 

Patricia Carlile 

Deputy Assistant Secretary, Special Needs 

Programs 

U.S. Department of Housing and Urban 

Development 

Robert C. Weaver Federal Building 

451 Seventh Street, S.W. 

Washington, DC 20410 

Charles G. Curie, M.A., A.C.S.W. 

Administrator 

Substance Abuse and Mental Health 

Services Administration 

5600 Fishers Lane, Room 12-105 

Rockville, Maryland 20857 

Daniel B. Fisher, M.D., Ph.D. 

Co-Director 

National Empowerment Center 

599 Canal Street 

Lawrence, Massachusetts 01840 

Anil G. Godbole, M.D. 

Chairman 

Advocate Illinois Masonic Medical Center 

Advocate Health Care 

836 West Wellington, Suite 7318 

Chicago, Illinois 60657 

 

Henry T. Harbin, M.D. 

Chairman of the Board 

Magellan Health Services 

6950 Columbia Gateway Drive 

Columbia, Maryland 21046 

 

Larke N. Huang, Ph.D. 

Director of Research 

Center for Child Health and Mental Health 

Policy 

Georgetown University 

3307 M Street, N.W., Suite 401 

Washington, DC 20007 

Thomas R. Insel, M.D. 

Director 

National Institutes of Mental Health 

National Institutes of Health 

6001 Executive Boulevard, Room 8235 

Bethesda, Maryland 20892-9669 
ii

Norwood W. Knight-Richardson, M.D., M.B.A. 

CEO, Richardson Group 

Associate Professor 

Oregon Health and Sciences University 

11565 N.W. McDaniel Rd. 

Portland Oregon 97229 

The Honorable Ginger Lerner-Wren 

Seventeenth Judicial Circuit 

Broward County, Florida 

Broward County Courthouse 

201 Southeast 6th Street 

Fort Lauderdale, Florida 33301 

Stephen W. Mayberg, Ph.D. 

Director 

California Department of Mental Health 

1600 Ninth Street, Room 151 

Sacramento, California 95814 

 

Frances M. Murphy, M.D., M.P.H. 

Deputy Under Secretary for Health Policy 

Coordination 

Department of Veterans Affairs 

810 Vermont Avenue, N.W., Suite 10H 

Washington, DC 20420 

 

Robert H. Pasternack, Ph.D. 

Assistant Secretary for Special Education 

and Rehabilitative Services 

U.S. Department of Education 

330 C Street, S.W. 

Washington, DC 20202 

Robert N. Postlethwait, M.B.A. 

Consultant 

7274 Hunt Club Lane 

Zionsville, Indiana 46077 

Waltraud E. Prechter, B.A. Ed. 

Chairman 

Heinz C. Prechter Fund for Manic Depression 

One Heritage Place, Suite 400 

Southgate, Michigan 48195 

Dennis G. Smith 

Director 

Center for Medicaid and State Operations 

Center for Medicare and Medicaid Services 

200 Independence Avenue, S.W. 

Room 301H 

Washington, D.C. 20201 

 

Chris Spear, B.A., M.P.A. 

Assistant Secretary of Labor for Policy 

U.S. Department of Labor 

200 Constitution Avenue, N.W. 

Washington, DC 20210 

Nancy C. Speck, Ph.D. 

Telehealth Consultant 

University of Texas Medical Branch, 

Galveston 

3316 Huntington Circle 

Nacogdoches, Texas 75965 

 

The Honorable Randolph J. Townsend, M.Ed. 

Nevada Senate 

695 Sierra Rose Drive 

Reno, Nevada 89511 

Deanna F. Yates, Ph.D. 

Psychologist 

14815 San Pedro Avenue 

San Antonio, Texas 78232 

Executive Staff 

Claire Heffernan, J.D. 

Executive Director 

New Freedom Commission on Mental Health 

5600 Fishers Lane, Room 13C-26 

Rockville, Maryland 20857 

H. Stanley Eichenauer, M.S.W., A.C.S.W. 

Deputy Executive Director 

New Freedom Commission on Mental Health 

5600 Fishers Lane, Room 13C-26 

Rockville, Maryland 20857 
1

Executive Summary

VISION STATEMENT

We envision a future when everyone with a mental 

illness will recover, a future when mental illnesses 

can be prevented or cured, a future when mental 

illnesses are detected early, and a future when 

everyone with a mental illness at any stage of life 

has access to effective treatment and supports — 

essentials for living, working, learning, and 

participating fully in the community. 

n February 2001, President George W. Bush announced his New Freedom Initiative 

to promote increased access to educational and employment opportunities for 

people with disabilities. The Initiative also promotes increased access to assistive 

and universally designed technologies and full access to community life. Not since 

the Americans with Disabilities Act (ADA) — the landmark legislation providing 

protections against discrimination — and the Supreme Court’s Olmstead v. L.C. 

decision, which affirmed the right to live in community settings, has there been cause for 

such promise and opportunity for full community participation for all people with 

disabilities, including those with psychiatric disabilities. 

On April 29, 2002, the President identified three obstacles preventing Americans with 

mental illnesses from getting the excellent care they deserve: 

y Stigma that surrounds mental illnesses, 

y Unfair treatment limitations and financial requirements placed on mental health 

benefits in private health insurance, and 

y The fragmented mental health service delivery system. 

The President’s New Freedom Commission on Mental Health (called the Commission in 

this report) is a key component of the New Freedom Initiative. The President launched 

I
2

the Commission to address the problems in the current mental health service delivery 

system that allow Americans to fall through the system’s cracks. 

In his charge to the Commission, the President directed its members to study the 

problems and gaps in the mental health system and make concrete recommendations for 

immediate improvements that the Federal government, State governments, local agencies, 

as well as public and private health care providers, can implement. Executive Order 

13263 detailed the instructions to the Commission. (See the Appendix.) 

The Commission’s findings confirm that there are unmet needs and that many barriers 

impede care for people with mental illnesses. Mental illnesses are shockingly common; 

they affect almost every American family. It can happen to a child,a

 a brother, a 

grandparent, or a co-worker. It can happen to someone from any background — African 

American, Alaska Native, Asian American, Hispanic American, Native American, 

Pacific Islander, or White American. It can occur at any stage of life, from childhood to 

old age. No community is unaffected by mental illnesses; no school or workplace is 

untouched. 

In any given year, about 5% to 7% of adults have a serious mental illness, according to 

several nationally representative studies.1-3 A similar percentage of children — about 5% 

to 9% — have a serious emotional disturbance. These figures mean that millions of adults 

and children are disabled by mental illnesses every year.1; 4

President Bush said, 

“... Americans must understand and send this message: mental disability is not a 

scandal — it is an illness. And like physical illness, it is treatable, especially when 

the treatment comes early.” 

Over the years, science has broadened our knowledge about mental health and illnesses, 

showing the potential to improve the way in which mental health care is provided. The 

U.S. Department of Health and Human Services (HHS) released Mental Health: A Report 

of the Surgeon General,

5

 which reviewed scientific advances in our understanding of 

mental health and mental illnesses. However, despite substantial investments that have 

 

a In this Final Report, whenever child or children is used, it is understood that parents or guardians should be 

included in the process of making choices and decisions for minor children. This allows the family to 

provide support and guidance when developing relationships with mental health professionals, community 

resource representatives, teachers, and anyone else the individual or family invites. This same support and 

guidance can also include family members for individuals older than 18 years of age.
3

enormously increased the scientific knowledge base and have led to developing many 

effective treatments, many Americans are not benefiting from these investments.6; 7 

Far too often, treatments and services that are based on rigorous clinical research languish 

for years rather than being used effectively at the earliest opportunity. For instance, 

according to the Institute of Medicine (IOM) report, Crossing the Quality Chasm: A New 

Health System for the 21st Century, the lag between discovering effective forms of 

treatment and incorporating them into routine patient care is unnecessarily long, lasting 

about 15 to 20 years.8

 

In its report, the Institute of Medicine described a strategy to improve the quality of 

health care during the coming decade, including priority areas for refinement.9

 These 

documents, along with other recent publications and research findings, provide insight 

into the importance of mental heath, particularly as it relates to overall health. 

In this Final Report ... 

Adults with a serious mental illness are persons age 18 and over, who 

currently or at any time during the past year, have had a diagnosable 

mental, behavioral, or emotional disorder of sufficient duration to meet 

diagnostic criteria specified within DSM-III-R (Diagnostic and Statistical 

Manual for Mental Disorders)

10, that has resulted in functional 

impairmentb which substantially interferes with or limits one or more 

major life activities. 

A serious emotional disturbance is defined as a mental, behavioral, or 

emotional disorder of sufficient duration to meet diagnostic criteria 

specified in the DSM-III-R that results in functional impairment that 

substantially interferes with or limits one or more major life activities in 

an individual up to 18 years of age. Examples of functional impairment 

that adversely affect educational performance include an inability to 

learn that cannot be explained by intellectual, sensory, or health 

factors; an inability to build or maintain satisfactory interpersonal 

relationships with peers and teachers; inappropriate types of behavior or 

feelings under normal circumstances; a general pervasive mood of 

unhappiness or depression; or a tendency to develop physical symptoms 

or fears associated with personal or school problems.11

 

b Functional impairment is defined as difficulties that substantially interfere with or limit role functioning in 

one or more major life activities, including basic daily living skills (e.g., eating, bathing, dressing); 

instrumental living skills (e.g., maintaining a household, managing money, getting around the community, 

taking prescribed medication); and functioning in social, family, and vocational/educational contexts 

(Section 1912 (c) of the Public Health Services Act, as amended by Public Law 102-321).
4

Mental Illnesses Presents Serious Health Challenges 

Mental illnesses rank first among illnesses that cause disability in the United States, 

Canada, and Western Europe.12 This serious public health challenge is under-recognized 

as a public health burden. In addition, one of the most distressing and preventable 

consequences of undiagnosed, untreated, or under-treated mental illnesses is suicide. The 

World Health Organization (WHO) recently reported that suicide worldwide causes more 

deaths every year than homicide or war .13

In addition to the tragedy of lost lives, mental illnesses come with a devastatingly high 

financial cost. In the U.S., the annual economic, indirect cost of mental illnesses is 

estimated to be $79 billion. Most of that amount — approximately $63 billion — reflects 

the loss of productivity as a result of illnesses. But indirect costs also include almost $12 

billion in mortality costs (lost productivity resulting from premature death) and almost $4 

billion in productivity losses for incarcerated individuals and for the time of those who 

provide family care.14

In 1997, the latest year comparable data are available, the United States spent more than 

$1 trillion on health care, including almost $71 billion on treating mental illnesses. 

Mental health expenditures are predominantly publicly funded at 57%, compared to 46% 

of overall health care expenditures. Between 1987 and 1997, mental health spending did 

not keep pace with general health care because of declines in private health spending 

under managed care and cutbacks in hospital expenditures.15

 In 1997, the United States spent more than 

$1 trillion on health care, including almost 

$71 billion on treating mental illnesses. 

The Current Mental Health System Is Complex 

In its Interim Report to the President, the Commission declared, “... the mental health 

delivery system is fragmented and in disarray ... lead[ing] to unnecessary and costly 

disability, homelessness, school failure and incarceration.” The report described the 

extent of unmet needs and barriers to care, including: 

y Fragmentation and gaps in care for children, 

y Fragmentation and gaps in care for adults with serious mental illnesses, 
5

y High unemployment and disability for people with serious mental illnesses, 

y Lack of care for older adults with mental illnesses, and 

y Lack of national priority for mental health and suicide prevention. 

The Interim Report concluded that the system is not oriented to the single most important 

goal of the people it serves — the hope of recovery. State-of-the-art treatments, based on 

decades of research, are not being transferred from research to community settings. In 

many communities, access to quality care is poor, resulting in wasted resources and lost 

opportunities for recovery. More individuals could recover from even the most serious 

mental illnesses if they had access in their communities to treatment and supports that are 

tailored to their needs. 

The Commission recognizes that thousands of dedicated, caring, skilled providers staff 

and manage the service delivery system. The Commission does not attribute the 

shortcomings and failings of the contemporary system to a lack of professionalism or 

compassion of mental health care workers. Rather, problems derive principally from the 

manner in which the Nation’s community-based mental health system has evolved over 

the past four to five decades. In short, the Nation must replace unnecessary institutional 

care with efficient, effective community services that people can count on. It needs to 

integrate programs that are fragmented across levels of government and among many 

agencies. 

Building on the research literature and comments from more than 2,300 consumers,c

family members, providers, administrators, researchers, government officials, and others 

who provided valuable insight into the way mental health care is delivered, after its 

yearlong study, the Commission concludes that traditional reform measures are not 

enough to meet the expectations of consumers and families. 

To improve access to quality care and services, the Commission recommends 

fundamentally transforming how mental health care is delivered in America. The goals of 

this fundamental change are clear and align with the direction that the President 

established. 

 

c In this Final Report, consumer identifies people who use or have used mental health services (also known 

as mental health consumers, survivors, patients, or clients).
6

 To improve access to quality care and 

services, the Commission recommends 

fundamentally transforming how mental 

health care is delivered in America.

The Goal of a Transformed System: Recovery 

To achieve the promise of community living for everyone, new service delivery patterns 

and incentives must ensure that every American has easy and continuous access to the 

most current treatments and best support services. Advances in research, technology, and 

our understanding of how to treat mental illnesses provide powerful means to transform 

the system. In a transformed system, consumers and family members will have access to 

timely and accurate information that promotes learning, self-monitoring, and 

accountability. Health care providers will rely on up-to-date knowledge to provide 

optimum care for the best outcomes. 

When a serious mental illness or a serious emotional disturbance is first diagnosed, the 

health care provider — in full partnership with consumers and families — will develop 

an individualized plan of care for managing the illness. This partnership of personalized 

care means basically choosing who, what, and how appropriate health care will be provided: 

y Choosing which mental health care professionals are on the team, 

y Sharing in decision making, and 

y Having the option to agree or disagree with the treatment plan. 

The highest quality of care and information will be available to consumers and families, 

regardless of their race, gender, ethnicity, language, age, or place of residence. Because 

recovery will be the common, recognized outcome of mental health services, the stigma 

surrounding mental illnesses will be reduced, reinforcing the hope of recovery for every 

individual with a mental illness. 
7

In this Final Report ... 

Stigma refers to a cluster of negative attitudes and beliefs that motivate the 

general public to fear, reject, avoid, and discriminate against people with 

mental illnesses. Stigma is widespread in the United States and other 

Western nations.1

 Stigma leads others to avoid living, socializing, or working 

with, renting to, or employing people with mental disorders — especially 

severe disorders, such as schizophrenia. It leads to low self-esteem, 

isolation, and hopelessness. It deters the public from seeking and wanting to 

pay for care.5

 Responding to stigma, people with mental health problems 

internalize public attitudes and become so embarrassed or ashamed that 

they often conceal symptoms and fail to seek treatment. 

As more individuals seek help and share their stories with friends and relatives, 

compassion will be the response, not ridicule. 

Successfully transforming the mental health service delivery system rests on two 

principles: 

y First, services and treatments must be consumer and family centered, geared to give 

consumers real and meaningful choices about treatment options and providers — not 

oriented to the requirements of bureaucracies. 

y Second, care must focus on increasing consumers’ ability to successfully cope with life’s 

challenges, on facilitating recovery, and on building resilience, not just on managing 

symptoms. 

Built around consumers’ needs, the system must be seamless and convenient. 

In this Final Report ... 

Recovery refers to the process in which people are able to live, work, learn, 

and participate fully in their communities. For some individuals, recovery is 

the ability to live a fulfilling and productive life despite a disability. For 

others, recovery implies the reduction or complete remission of symptoms. 

Science has shown that having hope plays an integral role in an individual’s 

recovery. 

Resilience means the personal and community qualities that enable us to 

rebound from adversity, trauma, tragedy, threats, or other stresses — and to 

go on with life with a sense of mastery, competence, and hope. We now 

understand from research that resilience is fostered by a positive childhood 

and includes positive individual traits, such as optimism, good problemsolving skills, and treatments. Closely-knit communities and neighborhoods 

are also resilient, providing supports for their members. 
8

Transforming the system so that it will be both consumer and family centered and 

recovery-oriented in its care and services presents invigorating challenges. Incentives 

must change to encourage continuous improvement in agencies that provide care. New, 

relevant research findings must be systematically conveyed to front-line providers so that 

they can be applied to practice quickly. Innovative strategies must inform researchers of 

the unanswered questions of consumers, families, and providers. Research and treatment 

must recognize both the commonalities and the differences among Americans and must 

offer approaches that are sensitive to our diversity. Treatment and services that are based 

on proven effectiveness and consumer preference — not just on tradition or outmoded 

regulations — must be the basis for reimbursements. 

The Nation must invest in the infrastructure to support emerging technologies and 

integrate them into the system of care. This new technology will enable consumers to 

collaborate with service providers, assume an active role in managing their illnesses, and 

move more quickly toward recovery. 

The Commission identified the following six goals as the foundation for transforming 

mental health care in America. The goals are intertwined. No single step can achieve the 

fundamental restructuring that is needed to transform the mental health care delivery 

system. 

GOALS

In a Transformed Mental Health System ...

GOAL 1 Americans Understand that Mental Health Is Essential to Overall Health.

GOAL 2 Mental Health Care Is Consumer and Family Driven. 

GOAL 3 Disparities in Mental Health Services Are Eliminated. 

GOAL 4 Early Mental Health Screening, Assessment, and Referral to Services Are 

Common Practice. 

GOAL 5 Excellent Mental Health Care Is Delivered and Research Is Accelerated. 

GOAL 6 Technology Is Used to Access Mental Health Care and Information. 
9

Achieving these goals will transform mental health care in America. 

The following section of this report gives an overview of each goal of the transformed 

system, as well as the Commission’s recommendations for moving the Nation toward 

achieving it. In the remainder of this report, the Commission discusses each goal in 

depth, showcasing model programs to illustrate the goal in practice and providing 

specific recommendations needed to transform the mental health system in America. 
10

GOAL 1 Americans Understand that Mental Health Is

Essential to Overall Health.

n a transformed mental health system, Americans will seek mental health care when 

they need it — with the same confidence that they seek treatment for other health 

problems. As a Nation, we will take action to ensure our health and well being 

through learning, self-monitoring, and accountability. We will continue to learn 

how to achieve and sustain our mental health. 

The stigma that surrounds mental illnesses and seeking care for mental illnesses will be 

reduced or eliminated as a barrier. National education initiatives will shatter the 

misconceptions about mental illnesses, thus helping more Americans understand the facts 

and making them more willing to seek help for mental health problems. Education 

campaigns will also target specific audiences, including: 

y Rural Americans who may have had little exposure to the mental health service 

system, 

y Racial and ethnic minority groups who may hesitate to seek treatment in the current 

system, and 

y People whose primary language is not English. 

When people have a personal understanding of the facts, they will be less likely to 

stigmatize mental illnesses and more likely to seek help for mental health problems. The 

actions of reducing stigma, increasing awareness, and encouraging treatment will create a 

positive cycle that leads to a healthier population. As a Nation, we will also understand 

that good mental health can have a positive impact on the course of other illnesses, such 

as cancer, heart disease, and diabetes. 

Improving services for individuals with mental illnesses will require paying close 

attention to how mental health care and general medical care systems work together. 

While mental health and physical health are clearly connected, the transformed system 

will provide collaborative care to bridge the gap that now exists. 

Effective mental health treatments will be more readily available for most common 

mental disorders and will be better used in primary care settings. Primary care providers 

will have the necessary time, training, and resources to appropriately treat mental health 

I
11

problems. Informed consumers of mental health service will learn to recognize and 

identify their symptoms and will seek care without the fear of being disrespected or 

stigmatized. Older adults, children and adolescents, individuals from ethnic minority 

groups, and uninsured or low-income patients who are treated in public health care 

settings will receive care for mental disorders. 

 Understanding that mental health is 

essential to overall health is fundamental 

for establishing a health system that treats 

mental illnesses with the same urgency as 

it treats physical illnesses. 

The transformed mental health system will rely on multiple sources of financing with the 

flexibility to pay for effective mental health treatments and services. This is a basic 

principle for a recovery-oriented system of care. 

To aid in transforming the mental health system, the Commission makes two 

recommendations: 

1.1 Advance and implement a national campaign to reduce the stigma of seeking care and 

a national strategy for suicide prevention. 

1.2 Address mental health with the same urgency as physical health. 
12

GOAL 2 Mental Health Care Is Consumer and Family

Driven.

n a transformed mental health system, a diagnosis of a serious mental illness or a 

serious emotional disturbance will set in motion a well-planned, coordinated array of 

services and treatments defined in a single plan of care. This detailed roadmap — a 

personalized, highly individualized health management program — will help lead 

the way to appropriate treatment and supports that are oriented toward recovery and 

resilience. Consumers, along with service providers, will actively participate in designing 

and developing the systems of care in which they are involved. 

An individualized plan of care will give consumers, families of children with serious 

emotional disturbances, clinicians, and other providers a valid opportunity to construct 

and maintain meaningful, productive, and healing relationships. Opportunities for updates 

— based on changing needs across the stages of life and the requirement to review 

treatment plans regularly — will be an integral part of the approach. The plan of care will 

be at the core of the consumer-centered, recovery-oriented mental health system. The 

plan will include treatment, supports, and other assistance to enable consumers to better 

integrate into their communities; it will allow consumers to realize improved mental 

health and quality of life. 

In partnership with their health care providers, consumers and families will play a larger 

role in managing the funding for their services, treatments, and supports. Placing 

financial support increasingly under the management of consumers and families will 

enhance their choices. By allowing funding to follow consumers, incentives will shift 

toward a system of learning, self-monitoring, and accountability. This program design 

will give people a vested economic interest in using resources wisely to obtain and 

sustain recovery. 

The transformed system will ensure that needed resources are available to consumers and 

families. The burden of coordinating care will rest on the system, not on the families or 

consumers who are already struggling because of a serious illness. Consumers’ needs and 

preferences will drive the types and mix of services provided, considering the gender, 

age, language, development, and culture of consumers. 

I
13

 The plan of care will be at the core of the 

consumer-centered, recovery-oriented 

mental health system. 

To ensure that needed resources are available to consumers and families in the 

transformed system, States will develop a comprehensive mental health plan to outline 

responsibility for coordinating and integrating programs. The State plan will include 

consumers and families and will create a new partnership among the Federal, State, and 

local governments. The plan will address the full range of treatment and support service 

programs that mental health consumers and families need. 

In exchange for this accountability, States will have the flexibility to combine Federal, 

State, and local resources in creative, innovative, and more efficient ways, overcoming 

the bureaucratic boundaries between health care, employment supports, housing, and the 

criminal justice systems. 

Increased flexibility and stronger accountability will expand the choices and the array of 

services and supports available to attain the desired outcomes. Creative programs will be 

developed to respond to the needs and preferences of consumers and families, as reflected 

in their individualized plans of care. 

Giving consumers the ability to participate fully in their communities will require a few 

essentials: 

y Access to health care, 

y Gainful employment opportunities, 

y Adequate and affordable housing, and 

y The assurance of not being unjustly incarcerated. 

Strong leadership will need to: 

y Align existing programs to deliver services effectively, 

y Remove disincentives to employment (such as loss of financial benefits or having to 

choose between employment and health care), and 

y Provide for a safe place to live. 
14

In this transformed system, consumers’ rights will be protected and enhanced. 

Implementing the 1999 Olmstead v. L.C decision in all States will allow services to be 

delivered in the most integrated setting possible — services in communities rather than in 

institutions. And services will be readily available so that consumers no longer face 

unemployment, homelessness, or incarceration because of untreated mental illnesses. 

No longer will parents forgo the mental health services that their children desperately 

need. No longer will loving, responsible American parents face the dilemma of trading 

custody for care. Families will remain intact. Issues of custody will be separated from 

issues of care. 

In this transformed system, stigma and discrimination against people with mental 

illnesses will not have an impact on securing health care, productive employment, or safe 

housing. Our society will not tolerate employment discrimination against people with 

serious mental illnesses — in either the public or private sector. 

Consumers’ rights will be protected concerning the use of seclusion and restraint. 

Seclusion and restraint will be used only as safety interventions of last resort, not as 

treatment interventions. Only licensed practitioners who are specially trained and 

qualified to assess and monitor consumers’ safety and the significant medical and 

behavioral risks inherent in using seclusion and restraint will be able to order these 

interventions. 

The hope and the opportunity to regain control of their lives —often vital to recovery — 

will become real for consumers and families. Consumers will play a significant role in 

shifting the current system to a recovery-oriented one by participating in planning, 

evaluation, research, training, and service delivery. 

To aid in transforming the mental health system, the Commission makes five 

recommendations: 

2.1 Develop an individualized plan of care for every adult with a serious mental illness and 

child with a serious emotional disturbance. 

2.2 Involve consumers and families fully in orienting the mental health system toward 

recovery. 

2.3 Align relevant Federal programs to improve access and accountability for mental 

health services. 

2.4 Create a Comprehensive State Mental Health Plan. 

2.5 Protect and enhance the rights of people with mental illnesses. 
15

GOAL 3 Disparities in Mental Health Services Are

Eliminated.

n a transformed mental health system, all Americans will share equally in the best 

available services and outcomes, regardless of race, gender, ethnicity, or geographic 

location. Mental health care will be highly personal, respecting and responding to 

individual differences and backgrounds. The workforce will include members of 

ethnic, cultural, and linguistic minorities who are trained and employed as mental 

health service providers. People who live in rural and remote geographic areas will have 

access to mental health professionals and other needed resources. Advances in treatments 

will be available in rural and less populated areas. Research and training will 

continuously aid clinicians in understanding how to appropriately tailor interventions to 

the needs of consumers, recognizing factors such as age, gender, race, culture, ethnicity, 

and locale. 

Services will be tailored for culturally diverse populations and will provide access, 

enhanced quality, and positive outcomes of care. American Indians, Alaska Natives, 

African Americans, Asian Americans, Pacific Islanders, and Hispanic Americans will not 

continue to bear a disproportionately high burden of disability from mental health 

disorders.1

 These populations will have accessible, available mental health services. They 

will receive the same high quality of care that all Americans receive. To develop 

culturally competent treatments, services, care, and support, mental health research will 

include these underserved populations. In addition, providers will include individuals 

who share and respect the beliefs, norms, values, and patterns of communication of 

culturally diverse populations. 

In rural and remote geographic areas, service providers will be more readily available to 

help create a consumer-centered system. Using such tools as videoconferencing and 

telehealth, advances in treatments will be brought to rural and less populated areas of the 

country. These technologies will be used to provide care at the same time they break 

down the sense of isolation often experienced by consumers. 

Mental health education and training will be provided to general health care providers, 

emergency room staff, and first responders, such as law enforcement personnel and 

emergency medical technicians, to overcome the uneven geographic distribution of 

psychiatrists, psychologists, and psychiatric social workers. 

I
16

In a transformed mental health system, all 

Americans will share equally in the best 

available services and outcomes, 

regardless of race, gender, ethnicity, or 

geographic location. 

To aid in transforming the mental health system, the Commission makes two 

recommendations: 

3.1 Improve access to quality care that is culturally competent. 

3.2 Improve access to quality care in rural and geographically remote areas. 
17

GOAL 4 Early Mental Health Screening, Assessment,

and Referral to Services Are Common Practice.

n a transformed mental health system, the early detection of mental health problems 

in children and adults — through routine and comprehensive testing and screening 

— will be an expected and typical occurrence. At the first sign of difficulties, 

preventive interventions will be started to keep problems from escalating. For 

example, a child whose serious emotional disturbance is identified early will receive 

care, preventing the potential onset of a co-occurring substance use disorder and breaking 

a cycle that otherwise can lead to school failure and other problems. 

Quality screening and early intervention will occur in both readily accessible, low-stigma 

settings, such as primary health care facilities and schools, and in settings in which a high 

level of risk exists for mental health problems, such as criminal justice, juvenile justice, 

and child welfare systems. Both children and adults will be screened for mental illnesses 

during their routine physical exams. 

For consumers of all ages, early detection, assessment, and links with treatment and 

supports will help prevent mental health problems from worsening. Service providers 

across settings will also routinely screen for co-occurring mental illnesses and substance 

use disorders. Early intervention and appropriate treatment will also improve outcomes 

and reduce pain and suffering for children and adults who have or who are at risk for cooccurring mental and addictive disorders. 

Early detection of mental disorders will result in substantially shorter and less disabling 

courses of impairment. 

 For consumers of all ages, early detection, 

assessment, and links with treatment and 

supports will help prevent mental health 

problems from worsening. 

To aid in transforming the mental health system, the Commission makes four 

recommendations: 

I
18

4.1 Promote the mental health of young children. 

4.2 Improve and expand school mental health programs. 

4.3 Screen for co-occurring mental and substance use disorders and link with integrated 

treatment strategies. 

4.4 Screen for mental disorders in primary health care, across the lifespan, and connect 

to treatment and supports. 
19

GOAL 5 Excellent Mental Health Care Is Delivered and

Research Is Accelerated.

n a transformed mental health system, consistent use of evidence-based, state-of-the 

art medications and psychotherapies will be standard practice throughout the mental 

health system. Science will inform the provision of services, and the experience of 

service providers will guide future research. Every time any American — whether a 

child or an adult, a member of a majority or a minority, from an urban or rural area 

— comes into contact with the mental health system, he or she will receive 

excellent care that is consistent with our scientific understanding of what works. That 

care will be delivered according to the consumer’s individualized plan. 

Research has yielded important advances in our knowledge of the brain and behavior, and 

helped develop effective treatments and service delivery strategies for many mental 

disorders. In a transformed system, research will be used to develop new evidence-based 

practices to prevent and treat mental illnesses. These discoveries will be immediately put 

into practice. Americans with mental illnesses will fully benefit from the enormous 

increases in the scientific knowledge base and the development of many effective 

treatments. 

Also benefiting from these developments, the workforce will be trained to use the most 

advanced tools for diagnosis and treatments. Translating research into practice will 

include adequate training for front-line providers and professionals, resulting in a 

workforce that is equipped to use the latest breakthroughs in modern medicine. Research 

discoveries will become routinely available at the community level. To realize the 

possibilities of advances in treatment, and ultimately in prevention or a cure, the Nation 

will continue to invest in research at all levels. 

Knowledge about evidence-based practices (the range of treatments and services of welldocumented effectiveness), as well as emerging best practices (treatments and services 

with a promising but less thoroughly documented evidentiary base), will be widely 

circulated and used in a variety of mental health specialties and in general health, schoolbased, and other settings. Countless people with mental illnesses will benefit from 

improved consumer outcomes including reduced symptoms, fewer and less severe side 

effects, and improved functioning. The field of mental health will be encouraged to 

expand its efforts to develop and test new treatments and practices, to promote awareness 

of and improve training in evidence-based practices, and to better finance those practices. 

I
20

 Research discoveries will become routinely 

available at the community level. 

The Nation will have a more effective system to identify, disseminate, and apply proven 

treatments to mental health care delivery. Research and education will play critical roles 

in the transformed mental health system. Advanced treatments will be available and 

adapted to individual preferences and needs, including language and other ethnic and 

cultural considerations. Investments in technology will also enable both consumers and 

providers to find the most up-to-date resources and knowledge to provide optimum care 

for the best outcomes. Studies will incorporate the unique needs of cultural, ethnic, and 

linguistic minorities and will help ensure full access to effective treatment for all 

Americans. 

To aid in transforming the mental health system, the Commission makes four 

recommendations: 

5.1 Accelerate research to promote recovery and resilience, and ultimately to cure and 

prevent mental illnesses. 

5.2 Advance evidence-based practices using dissemination and demonstration projects and 

create a public-private partnership to guide their implementation. 

5.3 Improve and expand the workforce providing evidence-based mental health services 

and supports. 

5.4 Develop the knowledge base in four understudied areas: mental health disparities, 

long-term effects of medications, trauma, and acute care. 
21

GOAL 6 Technology Is Used to Access Mental Health

Care and Information.

n a transformed mental health system, advanced communication and information 

technology will empower consumers and families and will be a tool for providers to 

deliver the best care. Consumers and families will be able to regularly communicate 

with the agencies and personnel that deliver treatment and support services and that 

are accountable for achieving the goals outlined in the individual plan of care. 

Information about illnesses, effective treatments, and the services in their community will 

be readily available to consumers and families. 

Access to information will foster continuous, caring relationships between consumers and 

providers by providing a medical history, allowing for self-management of care, and 

electronically linking multiple service systems. Providers will access expert systems that 

bring to bear the most recent breakthroughs and studies of optimal outcomes to facilitate 

the best care options. Having agreed to use the same health messaging standards, 

pharmaceutical codes, imaging standards, and laboratory test names, the Nation’s health 

system will be much closer to speaking a common language and providing superior 

patient care. Informed consumers and providers will result in better outcomes and will 

more efficiently use resources. 

Electronic health records can improve quality by promoting adoption and adherence to 

evidence-based practices through inclusion of clinical reminders, clinical practice 

guidelines, tools for clinical decision support, computer order entry, and patient safety 

alert systems. For example, prescription medications being taken or specific drug 

allergies would be known, which could prevent serious injury or death resulting from 

drug interactions, excessive dosages or allergic reactions. 

Access to care will be improved in many underserved rural and urban communities by 

using health technology, telemedicine care, and consultations. Health technology and 

telehealth will offer a powerful means to improve access to mental health care in 

underserved, rural, and remote areas. The privacy of personal health information — 

especially in the case of mental illnesses — will be strongly protected and controlled by 

consumers and families. With appropriate privacy protection, electronic records will 

enable essential medical and mental health information to be shared across the public and 

private sectors. 

I
22

Reimbursements will become flexible enough to allow implementing evidence-based 

practices and coordinating both traditional clinical care and e-health visits. In both the 

public and private sectors, policies will change to support these innovative approaches. 

 The privacy of personal health information — 

especially in the case of mental illnesses — 

will be strongly protected and controlled by 

consumers and families. 

An integrated information technology and communications infrastructure will be critical 

to achieving the five preceding goals and transforming mental health care in America. To 

address this technological need in the mental health care system, this goal envisions two 

critical technological components: 

y A robust telehealth system to improve access to care, and 

y An integrated health records system and a personal health information system for 

providers and patients. 

To aid in transforming the mental health system, the Commission makes two 

recommendations: 

6.1 Use health technology and telehealth to improve access and coordination of mental 

health care, especially for Americans in remote areas or in underserved populations. 

6.2 Develop and implement integrated electronic health record and personal health 

information systems. 
23

reventing mental illnesses remains a promise of the future. Granted, the best 

option is to avoid or delay the onset of any illness, but the Executive Order 

directed the Commission to conduct a comprehensive study of the delivery of 

mental health services. The Commission recognizes that it is better to prevent 

an illness than to treat it, but unmet needs and barriers to services must first be 

identified to reach the millions of Americans with existing mental illnesses who are 

deterred from seeking help. The barriers may exist for a variety of reasons: 

y Stigma, 

y Fragmented services, 

y Cost, 

y Workforce shortages, 

y Unavailable services, and 

y Not knowing where or how to get care. 

These barriers are all discussed in this report. 

The Commission — aware of all the limitations on resources — examined realigning 

Federal financing with a keen awareness of the constraints. As such, the policies and 

improvements recommended in this Final Report reflect policy and program changes that 

make the most of existing resources by increasing cost effectiveness and reducing 

unnecessary and burdensome regulatory barriers, coupled with a strong measure of 

accountability. A transformed mental health system will more wisely invest resources to 

provide optimal care while making the best use of limited resources. 

The process of transforming mental health care in America drives the system toward a 

delivery structure that will give consumers broader discretion in how care decisions are 

made. This shift will give consumers more confidence to require that care be sensitive to 

their needs, that the best available treatments and supports be available, and that 

demonstrably effective technologies be widely replicated in different settings. This 

confidence will then enhance cooperative relationships with mental health care 

professionals who share the hope of recovery. 

P
24

GOALS AND RECOMMENDATIONS

In a Transformed Mental Health System ...

GOAL 1 Americans Understand that Mental Health Is Essential to Overall Health. 

RECOMMENDATIONS 1.1 Advance and implement a national campaign to 

reduce the stigma of seeking care and a national 

strategy for suicide prevention. 

1.2 Address mental health with the same urgency as 

physical health.

GOAL 2 Mental Health Care Is Consumer and Family Driven.

RECOMMENDATIONS 2.1 Develop an individualized plan of care for every 

adult with a serious mental illness and child with a 

serious emotional disturbance. 

2.2 Involve consumers and families fully in orienting the 

mental health system toward recovery. 

2.3 Align relevant Federal programs to improve access 

and accountability for mental health services. 

2.4 Create a Comprehensive State Mental Health Plan. 

2.5 Protect and enhance the rights of people with mental 

illnesses.

GOAL 3 Disparities in Mental Health Services Are Eliminated.

RECOMMENDATIONS 3.1 Improve access to quality care that is culturally 

competent. 

3.2 Improve access to quality care in rural and 

geographically remote areas.
25

GOAL 4 Early Mental Health Screening, Assessment, and Referral to Services Are 

Common Practice.

RECOMMENDATIONS 4.1 Promote the mental health of young children. 

4.2 Improve and expand school mental health programs. 

4.3 Screen for co-occurring mental and substance use 

disorders and link with integrated treatment 

strategies. 

4.4 Screen for mental disorders in primary health care, 

across the life span, and connect to treatment and 

supports.

GOAL 5 Excellent Mental Health Care Is Delivered and Research Is Accelerated.

RECOMMENDATIONS 5.1 Accelerate research to promote recovery and 

resilience, and ultimately to cure and prevent mental 

illnesses. 

5.2 Advance evidence-based practices using 

dissemination and demonstration projects and create 

a public-private partnership to guide their 

implementation.

5.3 Improve and expand the workforce providing 

evidence-based mental health services and supports. 

5.4 Develop the knowledge base in four understudied 

areas: mental health disparities, long-term effects of 

medications, trauma, and acute care. 

GOAL 6 Technology Is Used to Access Mental Health Care and Information.

RECOMMENDATIONS

6.1 Use health technology and telehealth to improve 

access and coordination of mental health care, 

especially for Americans in remote areas or in 

underserved populations. 

6.2 Develop and implement integrated electronic health 

record and personal health information systems.
26

References

1. United States Public Health Service Office of the Surgeon General (2001). 

Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A 

Report of the Surgeon General. Rockville, MD: Department of Health and 

Human Services, U.S. Public Health Service. 

2. Department of Health and Human Services: Substance Abuse and Mental Health 

Services Administration (2002). National Household Survey on Drug Abuse: 

Volume I. Summary of National Findings; Prevalence and Treatment of Mental 

Health Problems. 

3. Kessler, R. C., Berglund, P. A., Bruce, M. L., Koch, J. R., Laska, E. M., Leaf, P. 

J. et al. (2001). The prevalence and correlates of untreated serious mental illness. 

Health Services Research, 36, 987-1007. 

4. Farmer, E. M. Z., Mustillo, S., Burns, B. J., & Costello, E. J. (2003). The 

epidemiology of mental health programs and service use in youth: Results from 

the Great Smoky Mountains Study. In M.H. Epstein, K. Kutash, & A. 

Duchnowsk (Eds.), Outcomes for Children and Youth with Behavioral and 

Emotional Disorders and Their Families: Programs and Evaluation Best 

Practices 2nd ed., [in press] 

5. United States Public Health Service Office of the Surgeon General (1999). 

Mental Health: A Report of the Surgeon General. Rockville, MD: Department of 

Health and Human Services, U. S. Public Health Service. 

6. Lehman, A. F. & Steinwachs, D. M. (1998). Patterns of usual care for 

schizophrenia: Initial results from the Schizophrenia Patient Outcomes Research 

Team (PORT) Client Survey. Schizophrenia Bulletin, 24, 11-20. 

7. Wang, P. S., Demler, O., & Kessler, R. C. (2002). Adequacy of treatment for 

serious mental illness in the United States. American Journal of Public Health, 

92, 92-98. 

8. Balas, E. A. & Boren, S. A. (2000). Managing clinical knowledge for health care 

improvement. In Yearbook of Medical Informatics (pp. 65-70). Bethesda, MD: 

National Library of Medicine. 
27

9. Institute of Medicine Committee on Quality of Health Care in America (2001). 

Crossing the Quality Chasm: A New Health System for the 21st Century. 

Washington, DC: National Academies Press. 

10. American Psychiatric Association (1987). Diagnostic and Statistical Manual of 

Mental Disorders. (3rd Revision Edition.) Washington, DC: American 

Psychiatric Association. 

11. Individuals with Disabilities Education Act (IDEA), Pub. L. No. 105-17. (1997). 

12. World Health Organization. (2001). The World Health Report 2001 - Mental 

Health: New Understanding, New Hope. Geneva: World Health Organization. 

13. World Health Organization. (2002). World Report on Violence and Health. 

Geneva: World Health Organization. 

14. Rice, D. P. & Miller, L. S. (1996). The economic burden of schizophrenia: 

Conceptual and methodological issues and cost estimates. In M. Moscarelli, A. 

Rupp, & N. Sartorius (Eds.), Schizophrenia (pp. 321-334). Chichester, UK: 

Wiley. 

15. Coffey, R. M., Mark, T., King, E., Harwood, H., McKusick, D., Genuardi, J. et 

al. (2000). National Estimates of Expenditures for Mental Health and Substance 

Abuse Treatment, 1997 (Rep. No. SAMHSA Publication SMA-00-3499). 

Rockville, MD: Substance Abuse and Mental Health Services Administration. 
22337 

Federal Register PRESIDENTIAL DOCUMENTS

Vol. 67, No. 86 

Friday, May 3, 2002 

Title 3 -- Executive Order 13263 of April 29, 2002 

The President President's New Freedom Commission on Mental Health 

By the authority vested in me as President by the Constitution 

and the laws of the United States of America, and to improve 

America's mental health service delivery system for individuals 

with serious mental illness and children with serious emotional 

disturbances, it is hereby ordered as follows: 

Section 1. Establishment. There is hereby established the 

President's New Freedom Commission on Mental Health 

(Commission). 

Sec. 2. Membership. (a) The Commission's membership shall be 

composed of: 

(i) Not more than fifteen members appointed by the President, 

including providers, payers, administrators, and consumers of 

mental health services and family members of consumers; and 

(ii) Not more than seven ex officio members, four of whom shall 

be designated by the Secretary of Health and Human Services, 

and the remaining three of whom shall be designated--one each--

by the Secretaries of the Departments of Labor, Education, and 

Veterans Affairs. 

(b) The President shall designate a Chair from among the fifteen 

members of the Commission appointed by the President. 

Sec. 3. Mission. The mission of the Commission shall be to 

conduct a comprehensive study of the United States mental 

health service delivery system, including public and private 
sector providers, and to advise the President on methods of 

improving the system. The Commission's goal shall be to 

recommend improvements to enable adults with serious mental 

illness and children with serious emotional disturbances to live, 

work, learn, and participate fully in their communities. In 

carrying out its mission, the Commission shall, at a minimum: 

(a) Review the current quality and effectiveness of public and 

private providers and Federal, State, and local government 

involvement in the delivery of services to individuals with 

serious mental illnesses and children with serious emotional 

disturbances, and identify unmet needs and barriers to services. 

(b) Identify innovative mental health treatments, services, and 

technologies that are demonstrably effective and can be widely 

replicated in different settings. 

(c) Formulate policy options that could be implemented by 

public and private providers, and Federal, State, and local 

governments to integrate the use of effective treatments and 

services, improve coordination among service providers, and 

improve community integration for adults with serious mental 

illnesses and children with serious emotional disturbances. 

Sec. 4. Principles. In conducting its mission, the Commission 

shall adhere to the following principles: 

(a) The Commission shall focus on the desired outcomes of 

mental health care, which are to attain each individual's 

maximum level of employment, self-care, interpersonal 

relationships, and community participation; 

(b) The Commission shall focus on community-level models of 

care that efficiently coordinate the multiple health and human 

service providers and public and private payers involved in 

mental health treatment and delivery of services; 
(c) The Commission shall focus on those policies that maximize 

the utility of existing resources by increasing cost effectiveness 

and reducing unnecessary and burdensome regulatory barriers; 

(d) The Commission shall consider how mental health research 

findings can be used most effectively to influence the delivery of 

services; and 

(e) The Commission shall follow the principles of Federalism, 

and ensure that its recommendations promote innovation, 

flexibility, and accountability at all levels of government and 

respect the constitutional role of the States and Indian tribes. 

Sec. 5. Administration. (a) The Department of Health and 

Human Services, to the extent permitted by law, shall provide 

funding and administrative support for the Commission. 

(b) To the extent funds are available and as authorized by law 

for persons serving intermittently in Government service (5 

U.S.C. 5701-5707), members of the Commission appointed from 

among private citizens of the United States may be allowed 

travel expenses while engaged in the work of the Commission, 

including per diem in lieu of subsistence. All members of the 

Commission who are officers or employees of the United States 

shall serve without compensation in addition to that received for 

their services as officers or employees of the United States. 

(c) The Commission shall have a staff headed by an Executive 

Director, who shall be selected by the President. To the extent 

permitted by law, office space, analytical support, and additional 

staff support for the Commission shall be provided by executive 

branch departments and agencies. 

(d) Insofar as the Federal Advisory Committee Act, as amended, 

may apply to the Commission, any functions of the President 

under that Act, except for those in section 6 of that Act, shall be 

performed by the Department of Health and Human Services, in 
accordance with the guidelines that have been issued by the 

Administrator of General Services. 

Sec. 6. Reports. The Commission shall submit reports to the 

President as follows: 

(a) Interim Report. Within 6 months from the date of this order, 

an interim report shall describe the extent of unmet needs and 

barriers to care within the mental health system and provide 

examples of community-based care models with success in 

coordination of services and providing desired outcomes. 

(b) Final Report. The final report will set forth the Commission's 

recommendations, in accordance with its mission as stated in 

section 3 of this order. The submission date shall be determined 

by the Chair in consultation with the President. 

Sec. 7. Termination. The Commission shall terminate 1 year 

from the date of this order, unless extended by the President 

prior to that date. 

George W. Bush 

The White House, 

April 29, 2002. 
Acknowledgments

The Commission deeply appreciates the more than 2,300 persons who shared comments, 

personal stories, and recommendations through its web site, at public hearings, and in 

letters and e-mails. Their insightful and heartfelt comments have strengthened and helped 

shape the work of the President’s New Freedom Commission on Mental Health. 

Many people assisted the President’s New Freedom Commission on Mental Health with 

its work. The Commission acknowledges the following individuals for their important 

contributions: 

Executive staff 

Claire Heffernan, J.D., Executive Director 

H. Stanley Eichenauer, M.S.W., 

A.C.S.W., Deputy Executive Director 

Patty DiToto, Administrative Assistant 

Dawn Foti Levinson, M.S.W., Policy 

Advisor 

James Finley, M.A., Policy Analyst 

Kevin Hennessey, Ph.D., Senior Policy 

Advisor 

Ann Jacob Smith, M.S., NCC, LPC, 

Policy Advisor 

Elaine Viccora, L.C.S.W., Senior Policy 

Advisor 

Substance Abuse and Mental Health Services 

Administration (SAMHSA) 

Gail Hutchings, M.P.A, Acting Director, 

Center for Mental Health Services, and 

Senior Advisor to the Administrator, 

SAMHSA 

Mark Weber, M.B.A., Associate 

Administrator for Communications, 

SAMHSA 
2

Jeffrey Buck, Ph.D., Associate Director 

for Organization and Financing, Center for 

Mental Health Services 

Kana Enomoto, M.A., Special Assistant to 

the Director, Center for Mental Health 

Services 

Sybil Goldman, M.S.W., Senior Advisor 

on Children, Office of the Administrator 

Michael Malden, Public Health Advisor, 

Center for Mental Health Services 

Ronald Manderscheid, M.D., Chief, Survey 

and Analysis Branch, Center for Mental 

Health Services 

Barbara McGrath, Administrative Officer, 

Office of Program Services, Division of 

Administrative Services 

Rich Morey, Webmaster, Division of 

Information Resources Management 

Renee Perthuis, Department of Health and 

Human Services, Washington, DC 

Susette Rego, Web Team Leader, Division 

of Information Resources Management 

Eleanor Vincent, M.P.A., Manager, 

Andrea Adams and Andre McCabe, 

Mental Health Information Center, 

SAMHSA 

Expert consultants advising the Commission’s 

subcommittees 

Steve Adelsheim, M.D., Children and 

Families, New Mexico Department of 

Health, Albuquerque, NM 

Lynn Aronson, Housing and 

Homelessness, Goleta, CA 

Stephen J. Bartels, M.D., Older Adults, 

Associate Professor of Psychiatry, 

Dartmouth Medical School, Lebanon, NH 

Eric Caine, M.D., Suicide Prevention, 

John Romano Professor and Chair, 

Department of Psychiatry, University of 

Rochester Medical Center, Rochester, NY 

Jean Campbell, Ph.D., Consumer Issues, 

Research Assistant Professor, Missouri 

Institute of Mental Health, St. Louis, MO 

Judith Cook, Ph.D., Employment and 

Income Supports, Professor and Principal 

Investigator, University of Illinois at 

Chicago, Chicago, IL 

King Davis, Ph.D., Cultural Competence

and Children and Families, Professor, 

University of Texas, Austin, TX 

Miriam R. Davis, Ph.D., Interim Report 

and Final Report, Medical Writer and 

Consultant (LLC), Silver Spring, MD 

Stephen Day, Medicaid, Executive 

Director, Technical Assistance 

Collaborative, Inc., Boston, MA 

Richard Frank, Ph.D., Medication, 

Professor, Department of Health Care 
Policy, Harvard Medical School, Boston, 

MA 

Bob Friedman, Ph.D. Children and 

Families, Professor and Chair, Department 

of Child and Family Studies, Louis de la 

Parte Florida Mental Health Institute, 

University of South Florida, Tampa, FL 

Barbara Friesen, Ph.D., Children and 

Families, Director, Research and Training 

Center on Family Support and Children’s 

Mental Health, Portland State University, 

Portland, OR 

Howard Goldman, M.D., Ph.D., EvidenceBased Practices/Medication, Professor, 

Department of Psychiatry, University of 

Maryland School of Medicine, Baltimore, 

MD 

Rachel Guerrero, L.C.S.W., Children and 

Families, Chief, Office of Multicultural 

Services, State Department Mental Health, 

Sacramento, CA 

Pamela Hyde, J.D., Medicaid, Senior 

Consultant, Technical Assistance 

Collaborative, Santa Fe, NM 

Ethleen Iron Cloud-Two Dogs, Cultural 

Competence, Program Director, Oglala 

Sioux Tribe, Porcupine, SD 

Kerry Knox, Ph.D. Suicide Prevention 

(assisting Eric Caine), Department of 

Psychiatry, University of Rochester 

Medical Center, Rochester, NY 

Col. David Litts, M.D., Suicide 

Prevention, Associate Director for Suicide 

Prevention Resource Center, Washington, 

DC 

Ruby J. Martinez, Ph.D., Cultural 

Competence, Assistant Professor, School 

of Nursing, University of Colorado Health 

Sciences, Denver, CO 

Kenneth Minkoff, M.D., Co-occurring 

Disorders, Director of Integrated 

Psychiatric and Addiction Services for 

Arbour Health System, Medical Director 

of Choate Health Management Care, and 

Assistant Clinical Professor of Psychiatry 

at Harvard, Boston, MA 

Dennis Mohatt, M.A., Rural Issues, Senior 

Program Director, Mental Health 

Program, Western Interstate Commission 

for Higher Education, Boulder, CO 

John T. Monahan, Ph.D., Rights and 

Engagement, Professor, University of 

Virginia, Institute of Law, Psychiatry, and 

Public Policy, Charlottesville, VA 

Pat Mrazek, Ph.D., M.S.W., Children and 

Families, Mental Health Policy 

Consultant, Rochester, MN 

Sheila Pires, M.P.A., Children and 

Families, Partner, Human Service 

Collaborative, Washington, DC 

Ann O’Hara, Housing and Homelessness, 

Associate Director, Technical Assistance 

Collaborative, Boston, MA 

Steven P. Shon, M.D., Cultural 

Competence, Medical Director, Texas 

Department of Mental Health and Mental 

Retardation, Austin, TX 
Henry Steadman, Ph.D., Criminal Justice,

President, Policy Research Associates, 

Inc., Delmar, NY 

Susan Stefan, J.D., Rights and 

Engagement, Attorney, Center for Public 

Representation, Newton, MA 

Beth Stroul, M.Ed., Children and 

Families, Vice President, Management 

and Training Innovations, Inc., McLean, 

VA 

Jurgen Unutzer, M.D., M.P.H., Mental 

Health Interface with General Medicine, 

Principle Investigator and Director, 

IMPACT Study Coordinating Center, 

Health Services Research Center, UCLA 

Neuropsychiatric Institute, Los Angeles, 

CA 

Doug Ziedonis, M.D., M.P.H., Cooccurring Disorders, Associate Professor, 

Department of Psychiatry, UMDNJ - 

Robert Wood Johnson Medical School, 

Piscataway, NJ 

Research and technical support

Garrett Moran, Ph.D., Associate Area 

Director, Westat, Rockville, MD 

Susan Azrin, Ph.D., Senior Study 

Director, Westat, Rockville, MD 

Miriam Davis, Ph.D., Medical Writer and 

Consultant, Silver Spring, MD 

Howard Goldman, M.D., Ph.D., Professor, 

Department of Psychiatry, University of 

Maryland School of Medicine, Baltimore, 

MD 

Carolyn Boccella Bagin, M.Ed., Center 

for Clear Communication, Inc., Rockville, 

MD