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Psychiatr Serv. 2008 Jul;59(7):792-4. doi: 10.1176/

Self-directed care for adults with serious mental illness: the barriers to progress.

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Office of the Assistant Secretary, Department of Health and Human Services, Washington, DC 20201, USA.


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.

[Indexed for MEDLINE]

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