title: Self-directed care for adults with serious mental illness: the barriers to progress.
abstract: The President's New Freedom Commission on Mental Health identified self-directed care as one service innovation that could create a more consumer- and family oriented mental health system. Four years later, there are still fewer than 400 consumers in five states accessing self-directed care in the public mental health system. This Open Forum identifies three main barriers to explain this lack of progress: the absence of a strong evidence base to support the effectiveness of self-directed care for serious mental illness, uncertainty over the appropriate scope of self-directed care, and the absence of a sustainable source of funding. The introduction of the 1915(i) provision of the Social Security Act in 2007 appears to partly address the funding barrier to self-directed care. There is also a strong case for a large-scale evaluation of self-directed care for persons with serious mental illness to address the two remaining barriers to progress.
authors.affiliation: Office of the Assistant Secretary, Department of Health and Human Services, Washington, DC 20201, USA. vidhya.alakeson@hhs.gov
authors.forename: Vidhya
authors.initials: V
authors.lastname: Alakeson
mesh_terms: D000328:Adult; D003256:Community Participation / Q000191:economics*; D005260:Female; D006291:Health Policy; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000639:trends; D012648:Self Care; D012943:Social Security / Q000331:legislation & jurisprudence; D014481:United States