Commentary: advocacy perspective.

A supporting research for a new generation of medications to treat major mental illness, recognizing that the old medications had significant problems with side effects and, in some cases, efficacy. About 10 years ago, new medica-tions—atypical antipsychotics and new antidepressants— began to appear. There was great celebration within NAMI because, for the first time, scientific advances joined with other evidence-based treatments and services to create a system where we could begin to achieve recovery from mental illness. These new medications are central to recovery from mental illness. Quality case management, treatment teams, and other types of services are also key to recovery, but these medications with fewer side effects and/or more efficacy have substantially improved the quality of life for those with serious mental illness. Because the treatments are more effective, the stigma of mental illness has been reduced significantly, and the reduction of stigma has released a huge pent-up demand for treatment and recovery. While research supports evidence-based treatment, unfortunately , on any given day, about 1 person of every 2 who need mental health treatment does not receive it. 1 Our mental health system needs dramatic reform if it is to become capable of financing and delivering effective treatments. It has taken years to reach general agreement that these treatments are the best of the best, but we are incapable of getting those treatments to many people who need them most. NAMI has sympathy for the policymakers in the public and private sectors who decide how to pay for these new treatments. Our 50 state organizations work directly with these policymakers. We had success in 2002– 2003 in over 24 states working for legislative and administrative carve-outs on the drugs for mental illness. States face increasingly bleak fiscal situations. Tax revenues are falling more sharply than they have at any time in the past 10 years, and Medicaid health care costs are skyrocketing. Spending on prescription drugs is the fastest growing proportion of Medicaid spending. Bleak fiscal times are forcing policymakers to move quickly to solve financial problems. The risk for creative but dangerous decision-making is high. The states have already spent their reserves and borrowed their way toward balanced budgets. To control pharmaceutical spending, many states have adopted or are considering restrictions on access to psychotropic medications in their Medicaid programs. Preferred drug lists, fail-first procedures, monthly prescription limits, and prior authorization all pose serious threats for …