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On February 1, President Bush announced the release of a series of policy initiatives designed to assist people with disabilities, including children and adults with severe mental illnesses, in achieving greater independence and community integration. The President's "New Freedom Initiative" was originally proposed during last year's election campaign. In his announcement, the President committed to sign a series of Executive Orders directing agencies across the federal government to take actions to move toward the goals in the overall package. These Presidential orders will apply only to the executive branch and thus do not require congressional action.

The "New Freedom Initiative" contains over a dozen separate goals all designed to improve educational, employment, housing and community support opportunities for people with disabilities. Among the highlights is a pledge that the new Administration will fully enforce the Americans With Disabilities Act (ADA). The proposal also reiterates the President's plan to seek full funding of the federal commitment special education under the Individuals With Disabilities Education Act (IDEA) and seek increased investment in assistive technology. The full text of the "New Freedom Initiative" can be viewed at www.whitehouse.gov/news/freedominitiative/index.html.

Of particular concern to NAMI are the establishment of a new national commission on mental illness treatment services, a pledge to fully implement the Ticket to Work and Work Incentives Improvement Act (TWWIIA) and a plan to assist states in complying with the Supreme Court's Olmstead decision.


National Commission on Mental Illness Treatment Services

The Executive Order the President has committed to sign will establish a National Commission on Mental Health Services. The Commission will "study and make recommendations for improving America's mental health service delivery system, including making recommendations on the availability and delivery of new treatments and technologies for individuals with severe mental illness."

NAMI strongly endorses this action by President Bush. Although other parts of the proposal refer primarily to coordination among Federal agencies, there is a profound need for this broader examination of the mental health services system.

At the time this article went to press, the details of the commission's membership and charge had not yet been specified. NAMI has recommended that the commission be modeled on last year's bipartisan proposal put forward by Senators Pete Domenici (R-NM) and Edward M. Kennedy (D-MA). NAMI was involved in the formulation of this proposal that would have authorized a commission to examine diagnosis, treatment, rehabilitation and hospitalization of individuals with mental illness and make recommendations on model state legislation based on their findings. The scope of the commission envisioned also included:

a review of the 1999 Surgeon General's Report on Mental Health,
examination of the interaction between mental illness and criminal justice,
a review of the effectiveness and results of state laws governing outpatient and inpatient involuntary treatment, and
a study of the use of psychiatric advance directives.
On these two latter issues, the commission was to be charged with making recommendations for model state legislation.
The commission proposed by Senators Domenici and Kennedy also required representation from specific federal agencies (NIMH, CMHS), state and local officials (state mental health commissioner, judge, prosecutor, etc.), and stakeholders (consumers, family members, professionals, etc.). Thus, President Bush has a unique opportunity to follow through on the bipartisan groundwork established in Congress last year.


TWWIIA Implementation

In 1999, Congress enacted important legislation designed to address the complex and unfair disincentives against employment in Social Security's income support and health programs (SSI, SSDI, Medicaid and Medicare). Because the Ticket to Work and Work Incentives Improvement Act (TWWIIA) stretches across several of the federal government's most complicated programs and most cumbersome agencies, implementation has been far from simple. For example, the provisions governing extended Medicaid coverage for SSI beneficiaries seeking to enter the workforce depend on state adoption of new buy-in programs. Further, an examination of the proposed rules for Social Security's "ticket" program finds that there are numerous barriers preventing individuals with mental illness from using the program. All of these difficult implementation issues have been left for the new Bush Administration to grapple with.

In his announcement, President Bush committed to sign an Executive Order that directs all the federal agencies involved (including Social Security and HCFA) to swiftly implement TWWIIA. NAMI strongly supports this action and urges that the new Administration pay specific attention to the flaws in Social Security's proposed "ticket" regulations to ensure that adults with severe mental illness are fully able to use the new program. NAMI also urges the Bush Administration to push for participation by the states in TWWIIA's Medicaid buy-in programs.


State Implementation of the Olmstead Decision

In June 1999, the U.S. Supreme Court handed down a landmark ruling (Olmstead v. L.C.) stating that the ADA obligates states to provide community placement for individuals with severe disabilities wherever possible. States are now in the process developing plans to bring their public mental illness and mental retardation systems into compliance with the decision.

As part of his "New Freedom Initiative," the President announced his Administration's support for community integration and the removal of barriers to community placement. To promote state compliance with Olmstead, the President has committed to sign an Executive Order that directs federal agencies (including NIMH and SAMHSA) to coordinate research and pilot programs to make public mental health agencies more accountable through outcome measures. NAMI strongly supports this initiative, particularly its focus on accountability for public mental health agencies. In NAMI's view, this goal is best achieved through replication of evidence-based, recovery-oriented service delivery models such as the Program of Assertive Community Treatment (PACT).


Homeownership Initiative

President Bush's "New Freedom Initiative" contains a proposal to allow Public Housing Authorities (PHAs) to offer people with disabilities receiving Section 8 tenant-based rental assistance a homeownership option. This option would allow disabled recipients of Section 8 to use up to a year's worth of their voucher in a lump sum payment to finance the down-payment or closing cost on a home. A nearly identical proposal was enacted by Congress as part of a housing authorization bill that was signed into law in December 2000.

While NAMI supports efforts to increase homeownership among people with disabilities, questions remain as to whether this is a viable option for non-elderly adults with severe disabilities. On average, monthly SSI benefits are less than 20% of area median income—far below any reasonable standard for homeownership in nearly every housing market. Several homeownership pilot programs for people with disabilities developed in recent years have proven ineffective in reaching households below 30% of median income, let alone down to the incomes of SSI beneficiaries.

Instead of focusing limited federal housing resources on homeownership, NAMI has been urging HUD to place greater emphasis on rental housing and support services as the answer for assisting non-elderly adults with severe disabilities to achieve greater independence and community integration. Specifically, NAMI has been supporting more funding for the HUD Section 811 program, additional Section 8 vouchers for people with disabilities, a new rental housing production at HUD that focuses on supportive housing, and preservation of existing stock of affordable rental housing.