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National Council on Disability Says Let People with Psychiatric Disabilities Become Part of the American Dream

Monday, March 17, 2008

March 17, 2008

WASHINGTON—The National Council on Disability (NCD) today released a paper entitled Inclusive Livable Communities for People with Psychiatric Disabilities (/LivableCommunities.html), calling on Congress and the Administration to fully include and integrate people with psychiatric disabilities into America’s livable communities. Let people with psychiatric disabilities become part of the American dream.

According to NCD Chairperson John R. Vaughn, “For the promise of full integration into the community to become a reality, people with disabilities need safe and affordable housing; access to transportation; access to the political process; and the right to enjoy whatever services, programs, and activities are offered to all members of the community by both public and private entities. Although previous NCD reports addressed people across the full array of disabilities, a main focus of accessibility was on environmental elements that primarily apply more to the ‘obvious’ disabilities than to ‘hidden’ disabilities like many psychiatric disabilities and mental illnesses. Information about the six identified elements of livable communities, other elements, barriers, and promising practices for people with psychiatric disabilities needs to be broadened to achieve all-inclusive communities.”

This paper focuses specifically on expanding the livable communities framework and elements to people with psychiatric disabilities and supports full inclusion that leaves out no one. Grounded in the six identified elements, a livable community

  1. Provides affordable, appropriate, accessible housing
  2. Ensures accessible, affordable, reliable, safe transportation
  3. Adjusts the physical environment for inclusiveness and accessibility
  4. Provides work, volunteer, and education opportunities
  5. Ensures access to key health and support services
  6. Encourages participation in civic, cultural, social, and recreational activities

When the focus shifts specifically to people with psychiatric disabilities, it becomes plain that without expansion this framework is insufficient to ensure the full integration of all people who have disabilities. The main barrier that people with psychiatric disabilities face is that a community that eliminates all the physical environment barriers still may not be fully accessible to people with psychiatric disabilities because of ingrained attitudes toward mental illness. Before people with psychiatric disabilities can even begin to take full advantage of the elements of the livable communities framework, they must be able to surmount an attitudinalbarrier.

The attitudinal barrier is exemplified by outdated policies, programs, and beliefs about people with psychiatric disabilities as needing to receive all services within segregated settings in which mental health providers deliver housing, work, education, health care, and support services entirely within the mental health system. Abolishing this attitudinal barrier is necessary to ensure that people with psychiatric disabilities have access to the wider community and all that it may offer.

In this paper, by examining a variety of programs that show promise or have proved successful in achieving community integration for people with psychiatric disabilities, NCD recognizes the need for major changes in public policies to support further efforts for full integration and participation. Five core recommendations summarizing some needed federal-level changes follow.

Core Recommendation One: Congress should ensure that Department of Health and Human Services (HHS) appropriations continue to support anti-stigma campaigns and expand efforts to provide a funding base for self-help programs operated and run by mental health consumers and survivors, analogous to the funding provided under the Rehabilitation Act for operation of independent living centers. Consideration should be given to implementation through HHS/Substance Abuse and Mental Health Services Administration (SAMHSA) reauthorization or other federal mechanisms. Consumers/survivors should be included in the evaluation of ongoing anti-stigma campaigns and the design, development, and expansion of self-help program funding.

Core Recommendation Two: Implement changes in federal and state funding and policy to encourage housing models that are integrated, in accordance with individual choice, and delinked from mandatory health services, while providing ongoing flexible supports. Several federal agencies should examine policies and practices through a partnership effort. The work can begin with congressional action to ensure removal of contradictory or incompatible federal paperwork burdens and policy barriers. Congress should provide the funding needed for initial joint planning and reporting by the Department of Housing and Urban Development (HUD), HHS, and the Social Security Administration (SSA).

Core Recommendation Three: Congress and HUD, HHS, and SSA should work 
to change federal and state funding and policy to eliminate the “benefits trap,” which discourages people with psychiatric and other disabilities from working, and to 
ensure that work opportunities are available for the full range of jobs, with ongoing flexible supports.

Core Recommendation Four: HHS should be authorized to change Medicaid policy and regulations as implemented by the Centers for Medicare and Medicaid Services (CMS).  The agency should examine and consider the merits of existing models; for example, the Michigan state model reframes the definition of “medical necessity” to include “community integration,” and shifts funding to services based on “person-centered planning.” Such changes would allow a broader variety of recovery-oriented services to be eligible for Medicaid funding than is available currently.

Core Recommendation Five: Congress should ask the Government Accountability Office to assess and identify indicators of practices that seem to be working in HHS efforts to address cultural and linguistic issues through initiatives like the National Center on Cultural Competence (NCCC). In addition, Congress should allocate funds to expand the NCCC cultural and linguistic competence training model to ensure that as national demographics change, services to people from diverse racial and ethnic groups are provided in ways that meet their self-defined needs.

“By ensuring the expansion of the livable communities framework and recommendations to fully include and integrate people with psychiatric disabilities, American society can provide all citizens the opportunity to become part of the American dream,” Vaughn concluded.

NCD is an independent federal agency and is composed of 15 members appointed by the President, by and with the advice and consent of the Senate. NCD provides advice to the President, Congress, and executive branch agencies to promote policies, programs, practices, and procedures that—
(A) guarantee equal opportunity for all individuals with disabilities, regardless of the nature or severity of the disability; and
(B) empower individuals with disabilities to achieve economic self-sufficiency, independent living, and inclusion and integration into all aspects of society.

An official website of the National Council on Disability