The New Freedom Commission on Mental Health was established by

U.S. President The president of the United States (POTUS) is the head of state and head of government of the United States of America. The president directs the executive branch of the federal government and is the commander-in-chief of the United States ...

George W. Bush George Walker Bush (born July 6, 1946) is an American politician who served as the 43rd president of the United States from 2001 to 2009. A member of the Republican Party, Bush family, and son of the 41st president George H. W. Bush, he ...

through on April 29, 2002 to conduct a comprehensive study of the U.S.

mental health Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental hea ...

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 A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...

and children with a

serious emotional disturbance Emotional and behavioral disorders (EBD; also known as behavioral and emotional disorders) refer to a disability classification used in educational settings that allows educational institutions to provide special education and related services to ...

. The commission, using the

Texas Medication Algorithm Project The Texas Medication Algorithm Project (TMAP) is a decision-tree medical algorithm, the design of which was based on the expert opinions of mental health specialists. It has provided and rolled out a set of psychiatric management guidelines for doct ...

(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 drug A psychoactive drug, psychopharmaceutical, psychoactive agent or psychotropic drug is a chemical substance, that changes functions of the nervous system, and results in alterations in perception, mood, consciousness, cognition or behavior. ...

s that entered the market in recent years. A broad-based coalition of

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. A coalition of opponents questioned the motives of the commission, based on the results from a similar 1995 Texas mandate while Bush was Governor. During the

mandate, psychotropic medication was wrongfully prescribed to the general public. Specifically, TMAP and drug manufacturers marketed 'atypical antipsychotic drugs', such as Seroquel, Zyprexa, and others, for a wide variety of non-psychotic behavior issues. These drugs were later found to cause increased rates of sudden death in patients. In addition to atypical antipsychotic drugs, earlier versions of psychotropic medications, including Prozac, were found to sharply increase rates of suicide, especially during the first month of drug use. Also during TMAP, psychotropic medication was wrongfully prescribed to people not suffering from mental illness, including troublesome children and difficult elderly people in nursing homes. In 2009, Eli Lilly was found guilty of wrongfully marketing Zyprexa for non-psychotic people. Opponents also assert the New Freedom initiative campaign is a thinly veiled proxy for the

pharmaceutical industry The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...

to foster

psychotropic A psychoactive drug, psychopharmaceutical, psychoactive agent or psychotropic drug is a chemical substance, that changes functions of the nervous system, and results in alterations in perception, mood, consciousness, cognition or behavior. Th ...

medication on mentally healthy individuals in its pursuit of profits. Opponents also contend that the initiative's wider objectives are to foster chemical behavior control of American citizens, contrary to

civil liberties Civil liberties are guarantees and freedoms that governments commit not to abridge, either by constitution, legislation, or judicial interpretation, without due process. Though the scope of the term differs between countries, civil liberties may ...

and to basic

human rights Human rights are Morality, moral principles or Social norm, normsJames Nickel, with assistance from Thomas Pogge, M.B.E. Smith, and Leif Wenar, 13 December 2013, Stanford Encyclopedia of PhilosophyHuman Rights Retrieved 14 August 2014 for ce ...

Reports

Interim report

The commission issued an interim report on November 1, 2002. Findings in the report included estimated prevalence of severe mental illness among adults and severe emotional disturbance in children, the existence of effective treatments, and barriers to care.

Final report

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 commission emphasised recovery from mental illness, calls for consumer and family-centered care, and recommendations 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." In contradiction, the

Congressional Research Service The Congressional Research Service (CRS) is a public policy research institute of the United States Congress. Operating within the Library of Congress, it works primarily and directly for members of Congress and their committees and staff on a c ...

, stated the commission did not specifically recommend a nationwide screening program for mental illness, while it did discuss the need to identify mental illness in certain settings (juvenile detention facilities, foster care). The commission also recommended deeper study of the safety and effectiveness of medication use, especially among children.

Recommendations

Noting the country's services for people with mental illness and disabilities were "fragmented," the commission's final report offered 19 recommendations within six larger goals to improve service coordination, move toward a

recovery model The recovery model, recovery approach or psychological recovery is an approach to mental disorder or substance dependence that emphasizes and supports a person's potential for recovery. Recovery is generally seen in this model as a personal journey ...

, and help all individuals with mental illness and disability recover: # Americans Understand that Mental Health Is Essential to Overall Health. #* Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention. #* Address mental health with the same urgency as physical health. # Mental Health Care Is

Consumer A consumer is a person or a group who intends to order, or uses purchased goods, products, or services primarily for personal, social, family, household and similar needs, who is not directly related to entrepreneurial or business activities. ...

and Family Driven. #* Develop an individualized plan of care for every adult with a serious mental illness and child with a

. #* Involve consumers and families fully in orienting the mental health system toward recovery. #* Align relevant Federal programs to improve access and accountability for mental health services. #* Create a Comprehensive State Mental Health Plan. #* Protect and enhance the rights of people with mental illnesses. # Disparities in Mental Health Services Are Eliminated. #* Improve access to quality care that is culturally competent. #* Improve access to quality care in rural and geographically remote areas. # Early Mental Health

Screening Screening may refer to: * Screening cultures, a type a medical test that is done to find an infection * Screening (economics), a strategy of combating adverse selection (includes sorting resumes to select employees) * Screening (environmental), a ...

, Assessment, and Referral to Services Are Common Practice. #* Promote the mental health of young children. #* Improve and expand school mental health programs. #* Screen for co-occurring mental and substance use disorders and link with integrated treatment strategies. #* Screen for mental disorders in

primary health care Primary health care, or PHC, refers to "essential health care" that is based on scientifically sound and socially acceptable methods and technology. This makes universal health care accessible to all individuals and families in a community. PHC in ...

, across the life span, and connect to treatment and supports. # Excellent Mental Health Care Is Delivered and Research Is Accelerated. #* Accelerate research to promote recovery and resilience, and ultimately to cure and prevent mental illnesses. #* Advance

evidence-based practice Evidence-based practice (EBP) is the idea that occupational practices ought to be based on scientific evidence. While seemingly obviously desirable, the proposal has been controversial, with some arguing that results may not specialize to indiv ...

s using

dissemination To disseminate (from lat. ''disseminare'' "scattering seeds"), in the field of communication, is to broadcast a message to the public without direct feedback from the audience. Meaning Dissemination takes on the theory of the traditional view ...

and demonstration projects and create a

public–private partnership A public–private partnership (PPP, 3P, or P3) is a long-term arrangement between a government and private sector institutions.Hodge, G. A and Greve, C. (2007), Public–Private Partnerships: An International Performance Review, Public Adminis ...

to guide their implementation. #* Improve and expand the workforce providing evidence-based mental health services and supports. #* Develop the knowledge base in four understudied areas: mental

health disparities Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequiti ...

, long-term effects of medications,

trauma Trauma most often refers to: * Major trauma, in physical medicine, severe physical injury caused by an external source * Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event *Traumatic i ...

, and

acute care Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery.Alberta Health ServicesAcute care.Acce ...

. # Technology Is Used to Access Mental Health Care and Information. #* Use health technology and

telehealth Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, mon ...

to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations. #* Develop and implement integrated electronic health record and personal health information systems.

Opposition

Opponents of the plan see little in the way of potential benefits from the plan, except increased profits for

pharmaceutical companies The pharmaceutical industry discovers, develops, produces, and markets drugs or pharmaceutical drugs for use as medications to be administered to patients (or self-administered), with the aim to cure them, vaccinate them, or alleviate symptoms. ...

, 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 In United States law, the term color of law denotes the "mere semblance of legal right," the "pretense or appearance of" right; hence, an action done under color of law adjusts (colors) the law to the circumstance, yet said apparently legal acti ...

, look askance at the irony of the commission's '

freedom Freedom is understood as either having the ability to act or change without constraint or to possess the power and resources to fulfill one's purposes unhindered. Freedom is often associated with liberty and autonomy in the sense of "giving on ...

' descriptor, contending the commission is yet another example of the excesses of drug industry marketing, 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.

Screening recommendations

Mad in America ''Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill'' is a 2002 book by medical journalist Robert Whitaker, in which the author examines and questions the efficacy, safety, and ethics of past and presen ...

'' author Robert Whitaker criticized the commission's screening recommendations as "fishing for customers." A coalition of over 100 advocacy organizations, united under the banner of Mindfreedom.org in representing the

psychiatric survivors movement The psychiatric survivors movement (more broadly consumer/survivor/ex-patient movement) is a diverse association of individuals who either currently access mental health services (known as consumers or service users), or who are survivors of interv ...

, 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 Hunter Doherty "Patch" Adams (born May 28, 1945) is an American physician, comedian, social activist, clown, and author. He founded the Gesundheit! Institute in 1971. Each year he also organizes volunteers from around the world to travel to var ...

, 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. Others, including Congressman Ron Paul (-), were more concerned by the commission's suggestion to use schools as a site for screening. Paul's concern led to the introduction of Parental Consent Act of 2005 in the

US House of Representatives The United States House of Representatives, often referred to as the House of Representatives, the U.S. House, or simply the House, is the lower chamber of the United States Congress, with the Senate being the upper chamber. Together they ...

on January 4, 2005. The bill, which died in committee, would have forbidden federal funds from being used for any mental health screening of students without the express, written, voluntary, informed consent of parents. Paul introduced similar bills in May 2007 (), April 2009 (), and August 2011 (); those, likewise, died in committee.

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 been the subject of controversy in

Texas Texas (, ; Spanish language, Spanish: ''Texas'', ''Tejas'') is a state in the South Central United States, South Central region of the United States. At 268,596 square miles (695,662 km2), and with more than 29.1 million residents in 2 ...

Pennsylvania Pennsylvania (; ( Pennsylvania Dutch: )), officially the Commonwealth of Pennsylvania, is a state spanning the Mid-Atlantic, Northeastern, Appalachian, and Great Lakes regions of the United States. It borders Delaware to its southeast, ...

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 University of Texas at Austin (UT Austin, UT, or Texas) is a public research university in Austin, Texas. It was founded in 1883 and is the oldest institution in the University of Texas System. With 40,916 undergraduate students, 11,075 ...

, the

pharmaceutical A medication (also called medicament, medicine, pharmaceutical drug, medicinal drug or simply drug) is a drug used to diagnose, cure, treat, or prevent disease. Drug therapy (pharmacotherapy) is an important part of the medical field and re ...

industry, and the mental health and

corrections In criminal justice, particularly in North America, correction, corrections, and correctional, are umbrella terms describing a variety of functions typically carried out by government agencies, and involving the punishment, treatment, and s ...

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

prison A prison, also known as a jail, gaol (dated, standard English, Australian, and historically in Canada), penitentiary (American English and Canadian English), detention center (or detention centre outside the US), correction center, correc ...

s and State

psychiatric hospital Psychiatric hospitals, also known as mental health hospitals, behavioral health hospitals, are hospitals or wards specializing in the treatment of severe mental disorders, such as schizophrenia, bipolar disorder, eating disorders, dissociative ...

s. The person primarily responsible for bringing these issues to the public's attention is

Allen Jones Allen Jones may refer to: *Allen Jones (Continental Congress) (1739–1798), Continental Congress delegate *Allen Jones (artist) (born 1937), British pop artist *Allen Jones (record producer) (1940–1987), American record producer * A.J. Styles (A ...

, 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

antipsychotic Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of ...

s 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."