From Exclusion to Belonging:

Transforming Mental Health Care in America

The Vision: A Life in the Community for Everyone

The Substance Abuse and Mental Health Services Administration

The Centers and Offices
Transforming Mental Health Care in America
The New Federal Leadership
The Challenge
Highlights of the Federal Action Agenda
Components of Recovery
National Consensus Statement on Mental Health Recovery
Programs of Transformation
Making It Count






The Challenge

Promoting An Understanding That Mental Health Is Part of Overall Health

The reshaping of the Nation's approach to mental health is well underway. No longer does a diagnosis of a mental disorder mean automatic institutionalization and exclusion from the community. There are four major fronts of progress that deserve celebration—

First, is the new understanding of the power of resiliency to thwart mental illnesses. Scientific research in the mental health field has led to new knowledge that is transforming the Nation's approach to mental health. We know now that by developing assets in individuals, families, and communities, and by fostering relationships with caring adults, children can develop resiliency that acts as an antidote to the development of a mental disorder. This "strength-based" approach has gained a proven place in mental health care and has guaranteed a prevention-oriented perspective on the part of mental health researchers, providers, and policymakers.

Second, is the strong Federal commitment to facilitate recovery from mental illnesses. Today, mental illnesses can be viewed as not only treatable, but recovery is the expectation. Recovery is cited within Transforming Mental Health Care in America, Federal Action Agenda: First Steps, as the "single most important goal" for the mental health service delivery system. Even those individuals with serious mental illness such as psychosis, who require medical monitoring and ongoing medication, can partake in the promise of recovery, if only by virtue of the compassion and de-stigmatization of mental illness on the part of those who care for them. Mental health recovery not only benefits individuals with mental health disabilities, it also enriches the texture of American community life, by focusing on their ability to live, work, learn, and fully participate in our society.

A third and critical stride forward is the evolution of Federal leadership in addressing co-occurring mental illness and substance abuse. Transforming systems means breaking down the wall between the mental health care and substance abuse treatment systems. Ideally, the two systems are fully connected so that when a person with either disorder initially accesses one system, the person is properly assessed and referred to the other as necessary and appropriate. The Federal Action Agenda on Mental Health underscores the growing consensus that all mental health and substance abuse service providers must be able to screen, assess, and provide treatment for, or refer individuals with co-occurring substance use and mental disorders, without regard to disease severity, duration, or symptomatology. Treatment must be seamless, comprehensive, coordinated, and involve the client’s family when feasible.

Fourth, the final report of the President’s New Freedom Commission on Mental Health and the Federal Action Agenda have established an historic vision and goals for transforming the mental health system of care in America . These two landmark reports have generated substantial momentum for change. Transformative programs and activities are taking shape across the Nation. Transformation is happening. SAMHSA, and its many partners across government and the private sector, are making real strides toward realizing the vision and creating a recovery-focused mental health care system that can transform lives. With the Federal Action Agenda, the Federal partners commit themselves to action and accountability in pursuit of the vision.

The Federal Action Agenda on Mental Health

 Building on the work of the President’s New Freedom Commission on Mental Health, SAMHSA/CMHS has led an unprecedented partnership among Federal departments, agencies, and offices to take the initiative to formally collaborate to transform the mental health system.

Transforming Mental Health Care in America—The Federal Action Agenda: First Steps is the collaborative product of the U.S. Department of Health and Human Services agencies and offices, including SAMHSA, along with the Departments of Agriculture, Defense, Education, Housing, Justice, Labor, Transportation, and Veterans Affairs; the Equal Employment Opportunity Commission; and the Social Security Administration. Together, these agencies and departments comprise the Federal Executive Steering Committee on Mental Health Transformation. (See page 4 for a complete list of partners.)

In developing the Action Agenda, each participating Federal department and agency created an inventory of its current mental health activities. An additional list was created by each Federal partner outlining proposals for transforming programs and practices. From these inventories and lists of transforming activities, this first Federal Action Agenda on Mental Health was developed. The Federal goal in delivering the more than 70 activities contained in the Action Agenda is to act as a leader and a facilitator, promoting shared responsibility for change at the Federal, State, and local levels, as well as in the private sector.

The proud record of improvement and accomplishment comes as a result of the President's leadership and vision that was passionately embraced by the Secretary of Health and Human Services, the Administrator of SAMHSA, and its three center Directors. Together, we will continue to make progress through an unwavering commitment to develop resilient communities and embrace the promise of recovery that offers a life in the community for everyone.