BOX 5-1: Interagency (Non)Communication About
Psychiatric Disability and Employment

Effecting communication among agencies that share responsibilities and interests is a common bureaucratic dilemma. Several Federal agencies, as described in this chapter and report, have authority over research, technical assistance, program administration, and policy enforcement relevant to psychiatric disability and employment. Despite jurisdictional overlap, each agency has a unique culture and functional role. Many observers believe that this heterogeneity is healthy, permitting distinct and potentially useful approaches to flourish. However, redundant or conflicting Federal policies and activities may also flourish in the absence of meaningful communication. While individuals in different agencies informally interact, formal mechanisms of interagency communication lie moribund.

Public Law 102-321 created a new Center for Mental Health Services (CMHS) within the Substance Abuse and Mental Health Services Administration (SAMHSA) of the Public Health Service, Department of Health and Human Services, thus separating this mental health service agency from the principal mental health research agency--the National Institute of Mental Health (NIMH). That law requires cooperation and consultation between the CMHS and the NIMH in a variety of areas. Such communication clearly could help the CMHS move forward with demonstration projects, technical assistance, and services solidly based on research supported by NIMH. Also, NIMH's research expertise could assist in program evaluation at the CMHS. Conversely, the CMHS could assist NIMH in promoting research relevant to current practices, policy needs, and real world demands. While NIMH and CMHS indicate that they are working together on a report to the U.S. Congress on effective methods of providing mental health services to individuals in correctional facilities, to date, no general mechanism has been elaborated to animate the congressional mandate for information exchange between the CMHS and NIMH.

The U.S. Congress established the Interagency Committee on Disability Research to promote communication and funding coordination among the committee's 27 member agencies, which include: the National Institutes of Health (including NIMH); SAMHSA (including CMHS); the National Science Foundation; and offices in the U.S. Departments of Health and Human Services, Education, Labor, and Veterans Affairs, and the National Aeronautics and Space Administration. In existence since 1981, the committee has not met at all during the last year and has never focused directly on psychiatric disability.

In April of 1993, the CMHS replaced the NIMH as a cosigner with the Rehabilitation Services Administration (RSA) and NIDRR on a renewed Memorandum of Understanding (MOU). In effect since 1979, the MOU sets out guidelines for interagency collaboration on service delivery, staff training, and evaluation activities related to the rehabilitation and employment of people with psychiatric disabilities. Representatives from each agency serve as members of a liaison group responsible for informing each other about their agency's activities, exploring possible cooperative efforts, recommending cooperative activities to the chief executives of their agency, and developing and implementing a work plan to carry out approved cooperative activities. The MOU specifically mentions as one of its goals the "provision of technical assistance on implementing the Americans with Disabilities Act for persons with psychiatric disabilities." Also, it helps coordinate the cofunding by CMHS and NIDRR of the National Rehabilitation and Research Centers at Boston University and Thresholds Institute in Chicago, Illinois. While proponents contend that the MOU can and has been an important catalyst for interagency cooperation, several experts and advocates commented to OTA about its current ineffectiveness. And no efforts have focused on the ADA to date.

The National Task Force on Rehabilitation and Employment for People with Psychiatric Disabilities (NTREPPD) has tried to promote collaboration among RSA, NIDRR, NIMH, CMHS, and the Social Security Administration. NTREPPD is composed of representatives of professional organizations, service providers, consumers, family members, research and training organizations, advocacy groups, Federal, State, and local government agencies, and others. Its central function is to advise the RSA and NIDRR on policy and research priorities related to rehabilitation and employment issues for people with psychiatric disabilities. The group originated as the RSA Task Force on Vocational Rehabilitation for Persons with Long-Term Mental Illness. In 1991, it became an independent entity and was chartered as NTREPPD. The members of NTREPPD had been meeting quarterly in Washington, DC to shareinformation and develop recommendations about legislation and regulations, research priorities, training and service delivery issues; many observers considered the group vital. More recently, however, many members have desisted meeting attendance, complaining about NTREPPD's voluntary nature and its limited impact on policies.

SOURCE: Office of Technology Assessment, 1994.
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