What is the Federal Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC)?

     In 2016, the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC) was established by the 21st Century Cures Act to improve federal coordination of efforts that address the pressing needs of adults with serious mental illness (SMI) and children and youth with serious emotional disturbance (SED). The ISMICC is composed of senior leaders from ten federal agencies including HHS, the Departments of Justice, Labor, Veteran Affairs, Defense, Housing and Urban Development, Education, Labor and the Social Security Administration along with 14 non-federal public members. In August 2017 SPARC's Director, Maryann Davis, Ph.D, was appointed as one of the 14 national experts by the Secretary of the HHS to serve a 3-year term as a non-federal member of the Committee.

On December 13, 2017 the federal ISMICC released its first report to Congress detailing major barriers to treatment for individuals with SMI or SED that offers an initial assessment of the current needs of Americans. The report presents the current status of federal activities, a summary of advances in the care and treatment, and research and strategies to improve services for individuals with serious mental illness/emotional disturbances. Finally the report recommends ways to improve government-wide coordination to address unmet needs of people with SMI or ED.

Recommendations from the Non-Federal ISMICC Members^*

The non‐federal members of the ISMICC created a set of recommendations aimed at coordinating the efforts of federal departments to develop a comprehensive continuum of care focused on improving outcomes for people of all ages with SMI or SED, and promoting evidence‐based practices and a strong community‐based system of care. These recommendations were developed based on input from the non‐federal members of the ISMICC and do not represent federal policy. These recommendations should not be interpreted as the formal position of the Administration. 

The 5 focus areas are:

1. Strengthen federal coordination to improve care.
2. Make it easier to get care that is an evidence-based best practice.
3. Close the gap between what works and what is offered.
4. Increase opportunities for individuals with SMI or SED to be diverted from the criminal and juvenile justice systems and to improve care for those involved in the criminal and juvenile justice systems.
5. Develop finance strategies to increase availability and affordability of care.

Recommendations^*

The interim ISMICC report contains many recommendations from the non-federal members for improving the national response to adults with SMI and children and youth with SED, including:

• Expanding nationwide availability of coordinated specialty care for first episode psychosis
• Developing an integrated crisis response system for diverting people with SMI or SED from the criminal justice system
• Eliminating the use of solitary confinement for people with SMI or SED
• Enforcing full implementation of parity for mental health and substance use disorder coverage in health insurance
• Expanding availability of housing for people with SMI or SED
• Eliminating discrimination in reimbursement for mental health care in Medicaid and Medicare by repealing the Institutions for Mental Diseases (IMD) exclusion in Medicaid and the 190-day lifetime limit on inpatient care in Medicare
• Providing guidance, resources and training on HIPAA and communications with families and caregivers
• Expanding the Certified Community Behavioral Healthcare Center (CCBHC) program nationwide
• Establishing uniform data collection and outcomes measurement across all relevant federal agencies and programs
• Developing and disseminating national standards for a comprehensive continuum of health care for people with SMI or SED

Transition-age Youth Specific Recommendations^*

The ISMICC report describes some of the challenges that are unique to transition-age youth (ages 14-30). In addition to the above, the ISMICC report includes recommendations from the non-federal members that pertain specifically to this age group. Some examples of these recommendations include the following:

A. Harmonize and improve policies to support federal coordination.

A.1. Identify age-based barriers to services in the federal policies of the ISMICC federal departments that impede access to needed treatments and services that support the transition to adulthood for 16‐ to 25‐year‐olds with or at risk of SED or SMI.

B. Prioritize early identification and intervention for children, youth, and young adults.

C. Make screening and early intervention among children, youth, transition‐age youth, and young adults a national expectation.

D. Make coordinated specialty care for first‐episode psychosis available nationwide.

E. Implement effective systems of care for children, youth, and transition‐age youth throughout the nation. This must include the following.

E.1. Provide strong supports for students with or at risk of SED/SMI through special education and Section 504 of the Rehabilitation Act services and supports.

E.2. Expand policies and guidelines that require transition planning for all students ages 16‐22 with SED/SMI or first‐episode psychosis, including those not covered within special education programs, to ensure that they have a student-centered plan that identifies treatment, services, and supports to achieve their best mental health and successful assumption of adult roles, including state vocational rehabilitation and other employment options.

Future Work of the ISMICC

This report is intended to set the stage for work by HHS and other federal government departments in the years ahead. In the immediate future, the ISMICC will help to prioritize recommendations and continue to meet on a routine basis to provide guidance as necessary to assist in addressing the recommendations in this report. A final ISMICC report is due to Congress in December 2022 and will both describe what has been accomplished and identify future opportunities to continue to better coordinate federal program and policy development.

Over the next 5 years, the ISMICC will work in collaboration with federal interdepartmental leadership to promote shared accountability for a system that provides the full range of treatments and supports needed by individuals and families living with SMI and/or SED. In the months ahead, the ISMICC will, with federal staff support, continue data collection efforts and begin the process of a broader evaluation of federal policies and programs, and their impact nationally. The federal ISMICC members will also examine the non‐federal recommendations and look for opportunities to improve systems and coordination.

The Committee's activities will center on the five focus areas listed above. Mental health care and treatment is not solely a federal responsibility, but rather one shared across federal, state, tribal, and local governments; private insurers; and diverse provider organizations and advocates. Therefore partnerships must be developed among all stakeholders to improve services, engagement and access; close gaps in availability of evidence based treatment; reduce the number of persons with SMI and/or SED that are involved with criminal justice systems; and support financing models that promote access to evidence‐based treatment and recovery support services.

Watch the December 14 press conference about the ISMICC Report to Congress 2017 here. Get the full report of The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers on SAMHSA's website.

^*These recommendations reflect the views of the non‐federal ISMICC members. Federal members were consulted regarding factual concerns and federal processes, but the final list of recommendations are the product of the non‐federal members. These recommendations do not represent federal policy, and the federal departments represented on the ISMICC have not reviewed the recommendations to determine what role they could play in the future activities of the departments. The recommendations should not be interpreted as recommendations from the federal government.