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CMHS National Advisory Council
Meeting Minutes
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
National Advisory Council Meeting Minutes
January 25-26, 2001
Rockville, Maryland
Minutes
Please note that any mention of the Knowledge Exchange Network, or KEN, refers to what is now SAMHSA's National Mental Health Information Center.
January 25, 2001
Closed Session
The National Advisory Council of the Center for Mental Health Services (CMHS) met in closed session at 9:30 a.m. on January 25, 2001, at the Parklawn Building in Rockville, Maryland, to review grant applications. CMHS Director Bernard S. Arons, M.D., presided.
Open Session
Dr. Arons convened the open session at 10:15 a.m. Council members present included Francis G. Lu, M.D., Ruby J. Martinez, R.N., Ph.D., Donna Mayeux, Russell D. Pierce, J.D., Andres Julio Pumariega, M.D., Ian A. Shaffer, M.D., Josie Torralba Romero, M.S.W., David Shore, M.D., (liaison), Karina K. Uldall, M.D., William W. Van Stone, M.D., (ex officio), and Cynthia Wainscott.
Members unanimously approved the minutes of the September 2000 CMHS Advisory Council meeting, as amended. Dr. Arons welcomed SAMHSA's new class of interns and thanked Anna Marsh, Ph.D., for her contributions to CMHS during her tenure as Acting Deputy Director.
CMHS Director's Report
Dr. Arons described CMHS' recent work on racial and ethnic disparity reduction, communication efforts, and the children's mental health area. Highlights included the publication of Youth Violence: A Report of the Surgeon General, significant Congressional support for ongoing and new mental health programs in the SAMHSA reauthorization legislation, and increased appropriations levels. Dr. Arons referred to the published Director's Report for details on additional activities. Congress reauthorized SAMHSA in the Children's Health Act of 2000 (H.R. 4365). Dr. Arons distinguished between the appropriations and the authorization process, and noted that some authorized activities are not yet funded. The reauthorization bill expands and refines CMHS' general discretionary grant authority to include targeted capacity response, training grants, and systems change grants, including grants to support family and consumer networks in States. The bill also establishes a new general authority to carry out grant programs that focus on priority needs of regional and national significance. These Programs of Regional and National Significance (PRNS) may concentrate on developing knowledge or providing service dollars. The PRNS authority includes what was formerly known as the Knowledge Development and Application or KDA program. The PATH Program and the Protection and Advocacy for Individuals with Mental Illness (PAIMI) Program have been reauthorized, and the legislation renames the block grant as the Performance Partnership Program. One provision in the bill affects Advisory Councils, changing the requirement for meetings from three to two per year, although CMHS still plans to have three meetings.
As has been previously mentioned, a number of CMHS activities have been funded well above what was originally requested. The School Violence Prevention Initiative, within PRNS, was expanded by $10 million, Children's Services by $9 million, and PATH by $6 million. The Minority Fellowship Program was expanded, and a new requirement was implemented for training personnel in the use of restraints and seclusion. A new Targeted Capacity Response Program within PRNS was funded, and Protection and Advocacy was raised to $30 million to include a specific Native American PAIMI program, and to allow for the expansion of services to individuals in communities in addition to institutions. Congressionally specified topical areas for increased funding included youth violence prevention, suicide prevention hotlines, post-traumatic stress in children, data infrastructure grants, and a series of one-year earmarked programs.
Discussion. Dr. Arons noted that the scientific understanding of what works to prevent suicide is ongoing and not definitive. Much of suicide prevention is ensuring early identification and access to treatment for mental illnesses. The Surgeon General will issue a National Suicide Prevention Strategy report soon. Ms. Wainscott urged avoiding using limited resources just for treatment with the exclusion of prevention. Ms. Romero noted the necessity to involve other systems, in addition to mental health, e.g., juvenile justice and education, in identification and prevention activities. She pointed to the need for cultural competency in implementation of prevention activities and noted that families and extended families should be involved. Dr. Pumariega urged funding on the use of seclusion and restraints to non-JCAHO-accredited facilities. Dr. Arons stated that thinking has just begun on training activities in children's settings, but work has been ongoing to develop requirements.
Eliminating Racial and Ethnic Disparities in Mental Health
Overview: Teresa Chapa, Ph.D., M.P.A., Senior Social Science Analyst, Special Programs Development Branch, CMHS, discussed CMHS' work to eliminate disparities in mental health, especially important in light of dramatic ongoing and impending changes in the ethnic composition of America's population and a system ill-equipped to give adequate services. CMHS' multidimensional approach to improved treatment access and reduced barriers to services includes promotion and sponsorship of national meetings (including a National Summit on Asian American and Pacific Islander Mental Health, National Congress for Hispanic Mental Health, National Latino Behavioral Health Association, and the upcoming Conference on African American Mental Health), tribal consultation, and facilitation of and participation in development of new knowledge. CMHS spearheaded the upcoming Surgeon General's supplemental report on racial and ethnic disparities in mental health. In addition, CMHS supports minority training and education. CMHS has established a cross-division working group on cultural competence and the issue of mental health disparities for racial and ethnic minorities. CMHS participates in SAMHSA's Community Disparities Program, which will award grants to five national or regional nonprofit, minority-led organizations with access within communities. CMHS will also produce cultural competence products for communities and will manage a number of (Congressionally) earmarked programs. A Targeted Capacity Expansion Initiative will help communities meet emerging mental health needs by building infrastructure to ensure sustainability.
CMHS National Advisory Council Panel
Dr. Pumariega described unrecognized disparities, cultural differences in stressors, barriers to services and treatment, deficiencies in infrastructure, and the challenges of managed behavioral health care and a climate supporting privatization. He commended CMHS for its long-term leadership in promoting activities to reduce racial and ethnic disparities in mental health.
Among disparities often unrecognized across racial and ethnic groups are physical development—including genetics, nutritional patterns, and health risks and risky behaviors—and psychological development, including gender relational roles, differences in cognitive skills valued by different groups, behavioral norms, and adaptive and coping mechanisms. Stressors include immigration, previous traumas, domestic violence, discrimination and marginalization, acculturation, and socioeconomic stress. Barriers to services and treatment include geographical, linguistic, and financial factors, and lack of cultural competence. New challenges include managed behavioral health care and a climate supporting privatization. The infrastructure is deficient for minorities in all medical specialties, including psychiatry and allied professions. In terms of research, 74 percent of all recipients of national health grants are Caucasian. Children suffer from a double disparity: racial and ethnic differences, plus a lack of access to children's mental health services.
Ms. Romero described the process of cultural competence and urged that CMHS institutionalize the related skills and knowledge. She also urged forging partnerships with primary care providers. CMHS' cultural competence committee and pool of experts must self-extend to the point where its knowledge will be institutionalized. The process of cultural competence involves: (1) operationalizing knowledge internally by staying connected with changing communities and being educated by differences, similarities, and needs; 2) reviewing and updating job descriptions to include detailed skills and knowledge necessary to be brought into the organization to do the job; (3) training and ongoing staff development, particularly by mainstreaming knowledge and not placing ethnic groups or regions in "silos"; (4) targeting specializations and some special communities. The goal is for cultural competence knowledge not to be vested in one person, but in many. Performance evaluations of managers ensures that their divisions are responsive to and address the needs of diversity in this nation.
Ms. Romero urged CMHS' continued collaboration with substance abuse agencies and medical providers in communities. She noted that a disproportionate number of minorities and economically disadvantaged caucasian white populations may tend to access primary care more willingly than they access mental health services.
Dr. Lu discussed cultural competence initiatives and the need for a CMHS strategic plan for cultural competence to complement the National Institute of Mental Health‘s (NIMH) plan. He noted 15 projects on cultural competence in which CMHS has been involved, including the U.S. Department of Health and Human Services' (HHS) Office of Minority Health's National Standards for Culturally and Linguistically Appropriate Services (CLAS), the Surgeon General's Report on Ethnic Minorities and Mental Health, and the Minority Health and Health Disparities Research and Education Act that established a center in the National Institutes of Health (NIH).
Dr. Lu urged that the NIMH Strategic Plan for Reducing Health Disparities (see
http://www.nimh.nih.gov/strategic/healthdisparities.pdf) serve as a model for CMHS, but with a focus on CMHS directions and complementary efforts. The four major areas include: (1) increasing the knowledge base by which disparities are documented and understood; (2) improving outcomes of interventions and services through research; (3) institutional infrastructure and research training, and career development; and (4) enhancing public information, outreach, and dissemination.
Discussion. Dr. Arons noted that CMHS'ongoing cultural competence activities can inform a strategic plan. Dr. Uldall highlighted the need to integrate substance abuse and mental health into primary care. Mr. Pierce discussed the distinction between diversity and cultural competence, the need to deliver services to minorities in a way that inspires trust, over- or under-diagnosis in communities of color, and cultural differences in help-seeking behaviors. Ms. Romero described access, equal opportunity to employment, and nondiscrimination as elements of cultural competence. Dr. Van Stone commented on the inappropriateness of the widespread Eurocentric model to serve the mental health needs of all individuals, regardless of their background; the role of stigma; and the need to consider nontraditional medicine's contribution. Ms. Wainscott urged inclusion of advocates for gay, lesbian, bisexual, and transgender concerns in planning cultural competence efforts.
Dr. Pumariega urged CMHS to institutionalize its focus on cultural competence and racial and ethnic disparities as a grant/policy/technical assistance thrust. CMHS should now move toward strategic planning. Dr. Martinez recommended that SAMHSA and CMHS tie funding to cultural competence.
Public Comment. Gilberto Romero, CONTAC Consumer Network, West Virginia, and CONTAC de la Westa, discussed a focus on anecdotal evidence, "telling the story," in addition to the scientific evidence base; the need for a national media institute for consumers; the value of radio to counter stigma; and the need to be aware of cultural displacement in society. Brian Coopper, Senior Director, Consumer Advocacy, National Mental Health Association (NMHA), urged that there be a focus on the following areas: consumer/survivor self-determination and the importance of advance directives, recovery as a main theme, pairing discrimination with stigma, promotion of positive images in the media, and continued help for pro-consumer efforts. Consumer advocate Ron Thompson urged the repeal of parity because it promotes involuntary care. The sense of the Council was that preserving voluntary aspects related to parity is essential.
Subcommittee on Consumer/Survivor Issues: Update. Russell Pierce, J.D., CMHS National Advisory Council Member, briefed the Council on the work of the Consumer/Survivor Subcommittee, which included housekeeping operations of the new subcommittee and discussions of critical consumer issues. Dr. Arons had presented a report on activities in which consumers have a role to play. The Subcommittee urged the use of the phrase "discrimination and stigma" to reflect the order of importance. The Subcommittee discussed social marketing, parity, the Olmstead decision, quality of life vis-à-vis quality of care, employment, anti-discrimination, the Knowledge Exchange Network, and assertive community treatment.
The Council accepted unanimously the Subcommittee's recommendation for CMHS to establish a "centralized library of resources on the concept of recovery" and an amended recommendation to support collection of data on prevalence rates of civil inpatient and outpatient commitment by ethnicity and gender.
Discussion. Ms. Mayeux discussed the productivity of employment summits and the need for more of them. She pointed out that although there is usually one track for consumers and another for individuals from the business community, most business attendees are actually mental health professionals, for example, vocational rehabilitation counselors, and not individuals from the business community who are in a position to offer employment. Ms. Wainscott suggested asking for suggestions for names of business leaders around the country who can contribute to CMHS' consumer efforts.
Role of Communications in Promoting Mental Health for Children. Paolo del Vecchio, Acting Director, Office of External Liaison, CMHS, facilitated a panel on the role of communications in promoting mental health for children and school/youth violence prevention. He also described "Blamed and Ashamed," a CMHS/Federation of Families report on the experiences of youth with co-occurring mental illness and substance abuse. The report was based on the recommendations of a series of focus groups composed of youth and of family members. Topics discussed were: common sources of information on substance abuse and mental health services; recommended ways of distributing information to the community, schools, etc., including peers through public information, door-to-door campaigns, and personal testimonies at school rallies, parent-to-parent programs, and classroom resource guides. He sought feedback for next steps in message dissemination to providers, consumers, and the general public.
Caring for Every Child's Mental Health Campaign: Past, Present, and Future.
Hardy Stone, Communications Director, Child, Adolescent, and Family Branch, CMHS, described the use of public education and social marketing campaigns to promote meeting the mental health needs of children through systems of care. He described the evolution of the Caring for Every Child's Mental Health Campaign, which began in 1994 with a top-down public education approach. The grassroots social marketing phase began in 1999 to deliver materials to local leaders for dissemination in the local community. Social marketing involves communication products, usually a spokesperson, and technical assistance to develop strategies to influence a target audience to take an action. The release of the Surgeon General's report was the "hook" used to show local media that systems of care and grantee communities had a successful method of delivering mental health services.
Maria Rodriguez, Campaign Project Director, Vanguard Communications, discussed details of the campaign, which markets a social issue—systems of care to treat children and their families—for the public benefit. The Campaign's goals are to increase public awareness, reduce stigma, increase the likelihood that children with mental health needs and their families are served, and demonstrate that needs can be met through systems of care. Basic strategies include developing public education products, developing a national communications coalition, and building communications (social marketing) capacity at the community level (among the 45 grant sites). English- and Spanish-language publications have been developed, as has a coloring book; online marketing is ongoing through links with websites of organizations that reach parents, school counselors, and teachers. Members are currently being recruited for a broad-based National Communications Coalition, whose activities will include developing new products/materials, holding special events and forums, disseminating messages and products, and opening new avenues. Technical assistance is provided to the 45 grant communities (building capacity for others to amplify this message at the community level) that are implementing systems of care in order to achieve sustainability beyond the funding cycle. Technical assistance is offered in strategic communications planning, spokesperson training, media relations, events planning, product/materials development, and cost-effective audience research, via Listserv, bi-monthly conference calls, regional communications academies, tip sheets, peer-to-peer mentoring, and onsite visits.
"Safe Schools/Healthy Students" Communication Campaign. Louise M. Peloquin, Ph.D., Communications Director, Special Programs Development Branch, CMHS, described the Safe Schools/Healthy Students (SS/HS) Communication Campaign and the importance of relationship building, partnering, and collaborating/bartering with media. The goals of this campaign are to use social marketing and communication strategies to develop school/youth violence prevention themes with "branding" symbolism, developing partnerships with other agencies, designing web sites, and focusing on Safe Schools/Healthy Students grantee support and sustainability efforts. In the communications arena, Dr. Peloquin asserted that a good social marketing communications strategy is key to raising public awareness of social issues. She noted that it is a "two-way street": the media needs good stories and message points; our issues need good exposure; and a broad, multi-dimensional, social marketing partnership can provide more comprehensive ways to not only raise awareness but implement a "call to action" that hopefully will result in caring, responsible behavior change. Multi-agency partnership is the hallmark of the SS/HS communications initiative and campaign. The Departments of Health and Human Services, Education and Justice have teamed together to provide funding to 77 grant sites throughout the country to implement youth/school violence prevention evidence-based practices. Ongoing support is provided to help these sites disseminate these key violence prevention messages.
Why Media Partnerships Are Important for Campaigns
Howard Zeiden, General Sales Manager, WJLA-TV Channel 7 (ABC), discussed the desirability of a TV partnership: TV is seen as a major dominent influence in America because both audio and visual learning styles are accommodated. TV programs are typically designed to reach a unique audience and messages on TV often have more clout than any other medium. TV is a very persuasive medium (because of blending of sight, sound, motion, and emotion) and more people are reached by major TV media, although a media mix (TV, radio, print) is recommended for social marketing campaigns. He also noted that more time is spent daily with TV and that, because of local anchors, TV is often seen as one of the more trusted news sources.
Cliff McKeeney, Sales/Marketing Manager, WJLA-TV Channel 7 (ABC), explained why the District of Columbia is a powerful location for piloting a "social marketing campaign." Top government officials live in the neighborhood. Corporations, nonprofits, federal and local government agencies partner actively on community service campaigns, thus creating a venue for piloting a social issue, via a campaign, to reach a multitude of audiences. Once the program is delivered at the local level, then it will be brought out to other ABC and other network affiliates around the country.
Community and Communication Partnerships in Action..... 15-Plus: Make Time to Listen, Take Time to Talk. Dr. Peloquin explained that not only does the Safe Schools/Healthy Students Communication Campaign provide communications assistance to over 77 grant sites throughout the country, it also developed a locally produced program entitled "15-Plus: Make Time to Listen, Take Time to Talk." This social marketing pilot campaign has: created four public service announcements for school/youth violence prevention, arranged for a 9-month (school year) TV schedule, produced a prime-time special on parent-child communication, and hosted an interactive phone bank (at the time of the prime time special) so that the viewing audience could call in and speak with mental health providers on key issues about parent/child communications. The phone workers, who took over 300 phone calls, provided expert guidance and made referrals to additional information centers and resources, including website exposure and links. The entire program also is being presented during seminars at schools and a complete package of "communication" strategies and resources are provided free of charge to anyone calling the 800 number at CMHS' CMHS Programs. Dr. Peloquin emphasized the advantages of working together in partnerships as the key to a successful social marketing campaign.
Discussion. Council members discussed expanding campaigns beyond original grant sites, additional linkages, and Council involvement in the campaigns. Ms. Mayeux recommended that communications campaigns not rely on untrained advocacy volunteers to do media relations (but Ms. Wainscott recounted successful efforts), that the campaign target all other ABC affiliates, and that contact be made with the Newspaper Editors Association (regional and national) and newspaper publishers. Industry organizations and the American Chambers of Commerce are prime prospects as partners. Dr. Shaffer suggested contacting the Pacific and Washington Business Groups on Health. Businesses should be shown that when children are in trouble, employees are not at work, and if they are at work, productivity is low. Employers want to improve the quality of life for employees so they would be interested in these campaign products and messages. Employers can insert printed information in pay envelopes and employee assistance services can sponsor brown-bag lunches on relevant subject matter. Ms. Wainscott suggested that NIMH's outreach constituency is highly skilled at grassroots education, as is the National Mental Health Association's (NMHA) Campaign for America's Mental Health. She noted that local faith communities are good partners, as are concrete partnerships with groups of mental health educators, such as the Washington Business Group on Health. Dr. Peloquin noted that work is ongoing with this group. Ms. Romero stated the need for sufficient language-skilled personnel and tailoring campaigns to local needs. She urged filming of local pilots and informing mental health providers about the subject matter. Mr. Pierce noted the necessity to have in place the services to respond to an increase in demand. Dr. Peloquin responded that the Safe Schools/Healthy Students Campaign encourages discussion between parents and children, and does not promote services per se. She acknowledged the risk in creating demand that is not met by service availability, but stated that this is one way to create an infrastructure sufficient to meet such a need. Dr. Shaffer noted that services at a community mental health center are not a system of care. Systems of care integrate a variety of needs, including education about the concept of working within a system of care, and then creating these systems of care. Ms. Romero suggested developing coalitions with regional, ethnic-specific Chambers of Commerce, and with the National Council of La Raza. Dr. Martinez suggested partnering with school systems' mental health personnel, primary care health providers, and the juvenile justice system. Dr. Peloquin noted that the Safe Schools/Healthy Students grantees already engage in significant partnerships in their communities and that they will help to expand the 15 Plus message throughout the country. Dr. Pumariega suggested outreach to ethnically and racially diverse media, including two Hispanic TV channels and the African American print media. He also suggested more targeted types of social marketing, including opinion leaders such as city council members and business leaders; Ms. Mayeux suggested enlisting the opinion leaders' spouses. Dr. Pumariega suggested social marketing focused on dialogue around race and ethnic differences, modeling appreciation of cultural differences and the ability to resolve issues between races.
Dr. Peloquin noted that training grantees who can subsequently train their community leaders is an element of both campaigns. Dr. Arons suggested that untapped needs might be a CMHS focus for the future. Dr. Lu discussed the differential impact of media campaigns on various populations and classes and suggested specific media approaches vis-à-vis content and language in the next stages of the campaign. Dr. Peloquin noted that the Office of National Drug Control Policy (ONDCP) is conducting a national campaign, and also that CMHS has mounted a pilot campaign on the local level that could be packaged for replication/adaptation in other locations. CMHS campaign funds are focused on sites and on strategies for continuing their work. Ms. Rodriguez observed that benefits accrue from links with such groups as the Advertising Council, but Mr. Zeiden noted that the local angle and relationship is essential, because almost every station does "pay-back" to the community. The community relations director and the PSA director are the two key individuals to talk to in developing initiatives of this type. Ms Wainscott suggested a future focus on social marketing around recognizing the signs of distress in children and getting them to appropriate care.
Dr. Marsh recessed the meeting at 4:45 p.m. The meeting reconvened the following day at
8:45 a.m.
JANUARY 26, 2001
"Report of the Surgeon General's Conference on Children's Mental Health: A National Action Agenda." Judith W. Katz-Leavy, M.Ed., Public Health Analyst, Office of Policy, Planning, and Administration, and Rolando Santiago, Ph.D., Public Health Analyst, Child, Adolescent, and Family Branch, CMHS, discussed the history of the report and its underlying principles and goals, and findings; the role CMHS played; and the projected impact of the Surgeon General's involvement in children's mental health.
Dr. Santiago explained that the issue of overmedication of preschoolers launched a series of events in 2000 and a public-private effort to improve diagnosis and treatment of children with emotional and behavioral conditions. The Surgeon General's Conference on Children's Mental Health was held with in September 2000, and NIMH and the Food and Drug Administration (FDA) convened (with CMHS support) a multi-stakeholder meeting that resulted in publication of the report, available at mentalhealth.samhsa.gov/cmhs/SurgeonGeneral/default.asp.
Ms. Katz-Leavy summarized the underlying principles, goals, and action steps developed at the conference and presented in the report. The goals, each supported by specific action steps, were to promote public awareness of children's mental health and reduce stigma associated with mental illness; disseminate and implement scientifically proven prevention and treatment services in children's mental health; improve the assessment and recognition of mental health needs in children; eliminate racial, ethnic, and socioeconomic disparities in access to mental health care; improve the infrastructure for children's mental health services, including support for scientifically proven interventions across professions; increase access to and coordination of quality mental health care systems; train frontline providers to recognize and manage mental health issues, and educate mental health providers in scientifically proven prevention and treatment services; and monitor access to and coordination of quality mental health care services. Dr. Santiago explained that the voice of youth and family participants is integrated into the report's policy recommendations.
Ms. Katz-Leavy described the report's impact. Increased visibility of children's mental health concerns is already underway, in part because of massive press coverage of the conference. The report will be useful to advocates in many realms.
Discussion. Council members discussed disparities in treatment among minority children, the importance and challenges of early identification and treatment for children, the durability of the problem of supporting children's mental health, the role and self-interest of business in children's mental health, and inadequate teacher skills in behavioral techniques. Mr. Pierce identified the problem of disparities in identification of minorities with emotional problems. Dr. Shaffer noted the uneven access to, and application of, comprehensive assessment of young people, but also acknowledged the role of off-label use of certain medications.
Dr. Santiago pointed out that CMHS, in the Safe Schools/Healthy Students arena, is focusing on prevention and on the system-of-care approach. Dr. Pumariega urged early identification and treatment, when children do not require intensive modalities, residential treatment, and medication. He noted the complex problems in doing so: insufficient diagnostic tools, inadequately trained personnel, and IDEA interpretation in some jurisdictions that results in rates of identification levels below true prevalence rates in schools. He emphasized training needs due to a staff-shortage crisis across all disciplines at all levels, including adequately trained teachers and child and adolescent psychiatrists and allied professions. Cultural competence training is critical for mental health professionals, as is training in contingency-based, systematic behavioral approaches, especially for school personnel.
Ms. Katz-Leavy observed that legislative action to move forward would be required, which in turn would rely on increased grassroots activity. Ms. Romero urged dissemination of the report to State representatives, local media, and advocates (including school-based nurses, teachers, principals, and school district policy makers). Dr. Santiago noted that the interdepartmental planning group is energized to follow up. Dr. Van Stone noted that society's historical devaluation of education and children's treatment is a barrier that may be overcome by adequate funding for the systems. Dr. Shaffer urged inclusion of the business community as a stakeholder in children's mental health. Ms. Wainscott urged a direct approach in social marketing messages, including covers of publications with titles such as "Kids Are Not Getting What They Need, and It's Costing Us Money." She concurred that action must occur at the local level for change to occur in states. Mr. Pierce and Ms. Wainscott noted several issues concerning labeling of children. Ms. Wainscott urged the importance of saying that mental illness is a reality for adults and for children, to avoid children labeled as "bad" and being placed in jail, because that person was not appropriately labeled with mental illness.
Dr. Pumariega discussed the importance of classroom staff skilled in behavioral interventions, speech therapy, and social skills training in minimizing the inappropriate use of medications. He emphasized the need for coaching parents on how to navigate the IDEA system. He also noted the need to define standards of care for personnel and other resources for children's mental health. Dr. Shaffer commented on the shortage of behavioral therapists and the lag behind the science of existing training program curricula.
SAMHSA Administrator's Update. Joseph H. Autry, III, M.D., Acting Administrator, predicted a smooth political transition between administrations. CMHS' front burner issues include the Olmstead decision, seclusion and restraint, and Medicaid-eligible young people in nursing homes. Cross-cutting issues involving CMHS include homelessness, elimination of racial and ethnic disparities, home- and community-based long-term service provision, prevention of school violence, and department-wide data collection and analysis practices.
Dr. Autry announced that Dr. Camille Barry will become the CMHS Deputy Director. He noted Dr. Barry's background, prior work in the Agency, and experience in the mental health and substance abuse area. He also commended Dr. Anna Marsh for her service as the Acting Deputy of CMHS. Dr. Autry discussed Congress' reauthorization of SAMHSA and noted that new specific authorities have been granted for programs for homelessness and fetal alcohol syndrome. Congress has collapsed discretionary budget lines to give more flexibility to target funds to have the greatest impact. With the new Targeted Capacity Responsiveness Expansion program, CMHS can address targeted population needs. He observed that the School Violence Prevention Initiative, budgeted at $90 million, could be expected to continue to grow in upcoming years, as will emphasis on youth violence prevention across DHHS. He also observed that the CMHS block grant has grown to $420 million, which demonstrates new attention to the block grant in the mental health area by the Congress. Dr. Autry noted that it seems that the Congress recognizes the importance of addressing behavioral health issues.
Stable leadership now guides all three SAMHSA centers. SAMHSA is working diligently to have management systems and programs in place that can be readily justified to policy makers. SAMHSA, in working on Performance Partnership grants with states, is negotiating with them on data collection and analysis regarding the provision of services. SAMHSA efforts continue on developing the 2001 plan, providing guidance for RFAs for 2002 and 2003, and working on the 2002 and 2003 budgets.
Discussion. Dr. Arons commented that CMHS supports the movement of mental health care into the community as required in the U.S. Supreme Court's Olmstead decision. DHHS's Office of Civil Rights, CMHS, the Centers for Medicare and Medicare Services, and others are working on a protocol for states to do self-assessment on the expectations under the Olmstead decision and what constitutes good practice. CMHS has funded a national coalition of public and private organizations interested in Olmstead and community treatment and hopes to stimulate similar coalitions in states. There will be a mini-grant program supported by the national coalition so that each state will be able to support coalition-building activities. Dr. Autry stated that the Olmstead decision can be used as a tool to work with coalitions to move people with mental illness out of institutions and into appropriate, available community services. He recognized the under-capitalization of the current community-based system, which needs improvement at the federal, state, and local levels. Dr. Arons asserted that the Americans With Disabilities Act defines the federal application for Olmstead. Dr. Autry observed that although Olmstead was a state case, it would be difficult for the federal government to offer less than Olmstead's requirements in the direct services its agencies provide.
Ms. Wainscott lauded the new interdepartmental linkages and CMHS' focus on prevention and early intervention. Dr. Autry stated that addressing disparities is a key component of future program implementation plans. Dr. Pumariega urged further collaboration between the SAMHSA Centers to provide integrated substance abuse and mental health treatment. Dr. Arons solicited ideas for discussion topics and speakers for the upcoming SAMHSA Joint Council meeting.
Communication Efforts in Promoting Appropriate Messages about Mental Illness. Facilitator Paolo del Vecchio introduced a panel that addressed communications activities to address stigma and discrimination, future events, and next steps in strategic planning to improve CMHS's name recognition and impact.
National Mental Health Awareness Campaign Update. Al Guida, Executive Director, National Mental Health Awareness Campaign, described the campaign to counter stigma and to increase the number of individuals who access mental health services. The campaign is a nonpartisan, public/private effort that is an outgrowth of the June 1999 White House Conference on Mental Health. Mr. Guida enumerated barriers to access, including lack of, or discriminatory, health insurance coverage and stigma. A long-term campaign objective is to deal with the discriminatory issues that flow from stigma.
The campaign currently runs PSAs on TV and programs that support the PSAs, and maintains a multidimensional website, http://www.nostigma.org, that helps individuals access mental health services in their community through a variety of existing resources and linkages. The Youth Public Service Advertising Campaign launched in June 2000 currently runs advertising on MTV and major networks. Warner Brothers Home Video will run spots as standard previews on DVDs and movies that target young people. America Online has donated banner advertising and a keyword. iVillage.com will be involved in advertising directed to adults. PSAs will be placed in Teen People, People Espanol, and Scholastic Magazine. Advertising postcards will be distributed free through MaxRacks. PSAs will also run on radio.
The response to on-air advertising has been heavy use of website and low use of the toll-free number among the target population. The Internet offers a more confidential means of communication, and more ease to download a brochure than to leave a name and address on a voice-mail system. The PSAs premiered on the MTV movie awards telecast at 11:00 p.m. Through the first four subsequent days, almost 1 million youngsters crashed the website. Mr. Guida noted that fear and shame suppress dialogue, both among young people and between young people and their parents.
An adult PSA campaign is underway. Most production and distribution services are donated to the campaign. The campaign has drawn about $4 million in in-kind products and services. Mr. del Vecchio noted that the Surgeon General's office held a meeting with major screen writers to encourage accurate depictions of people with mental illness and of the issues of stigma.
Discussion. Council members discussed the following areas with regard to the campaign: adequate services to handle increased demand it may generate; possibility of obtaining demographic information about it; exclusion of substance abuse as a campaign focus; and limited effectiveness of the campaign with minority individuals. Mr. del Vecchio stated that the KEN website offers people a number of different referrals, and encourages them to contact family and consumer groups. Follow-up contacts are also offered. Nevertheless, some people may still be turned away. He suggested that CMHS can explore feedback mechanisms for an early warning system if needs are not met. Mr. Guida stated that the most common topic of inquiry is depression; the guarantee of confidentiality impedes collecting demographic information. He acknowledged the importance of addressing substance abuse, which is being undertaken by the Office of National Drug Control Policy in a prevention campaign. Dr. Van Stone suggested that elderly people be included in the adult target audience. Mr. del Vecchio stated that CSAT and CSAP are undertaking awareness efforts on substance abuse. Mr. Pierce and Mr. Guida discussed the term "mental health" and its cultural ramifications in certain populations. Mr. Guida acknowledged the challenges presented by minority communities for PSAs; although heavy minority representation is present in the advertising, it is one-on-one for target audiences. Dr. Pumariega suggested approaching ethnic-specific outlets. Ms. Wainscott encouraged connections with Council members, who have contacts in local areas, particularly with the business community, for a personal angle. Mr. del Vecchio stated that NMHA, The National Alliance on Mental Illness (NAMI), and the Department of Veterans Affairs, among other organizations, are active in anti-stigma and anti-discrimination efforts.
Upcoming Nationwide Conferences
National Mental Health Symposium to Address Discrimination and Stigma, March 26-27, 2001, in Baltimore. Iris Hyman, Consumer Affairs Specialist, Office of External Liaison, CMHS, noted that a summary report on stigma in the Hispanic community is forthcoming. She presented background on the stigma issue and introduced "Challenging Stereotypes: A Media Guide," the educational tool/brochure, designed for consumer technical assistance centers and state and local organizations. At the symposium, national leaders will convene to examine discrimination and stigma associated with mental illness in programming presented in five tracks.
National Summit on Employment of People with Psychiatric Disabilities, October 2001, Washington, D.C., Area. Crystal Blyler, Ph.D., Social Science Analyst, Community Support Programs Branch, CMHS, described an upcoming meeting on a high-priority issue for mental health consumers, targeted at businesses and consumers. Dr. Blyler noted that the goal of the summit is to provide consumers with tools to advance their employment goals and to give businesses concrete information and ideas to advance their employee development objectives, to increase their hiring of people with psychiatric disabilities. The main message to the general public is that people with psychiatric disabilities can work, and that they're worth the investment in recruitment and personnel development. Among the topics under consideration for the agenda are the Americans with Disabilities Act, the Employment Intervention Demonstration Program, available support services to consumers who are working, self-employment, effects on Social Security and health care benefits, self-disclosure, career development and education, mental health parity in health insurance, and employee assistance programs. Dr. Blyler identified the challenge of attracting businesses to this meeting and requested suggestions.
Discussion. Council members suggested partners and strategies for the programs. Proposed partners included: the Washington Business Group on Health, the Pacific Business Group, the U.S. Chamber of Commerce, the Conference Board, the Business Roundtable, national and local chambers of commerce in ethnic communities, Welfare to Work experts, civil rights activists, Department of Veterans Affairs' vocational rehabilitation experts, and state vocational rehabilitation commissions. It was also suggested that the newly appointed Secretaries of HHS and Labor be involved.
Proposed strategies and topic areas included: model corporations with good benefits and supports on how they developed consumer-friendly work environments; transitioning consumers to meaningful—not just sheltered—work; addressing the stigma issue; and using mentors as an aid in the orientation of new employees. There should be workshops on interviewing skills to which participants could bring resumes. Participants should be encouraged to network and to use business cards. It was suggested that a breakfast for leaders be held before the conference began. It was also suggested that there be a focus on working in small businesses, and that there be a workshop in the business track on what to expect from mental health professionals in working with consumers in their work place, including how to support clients in work settings. The overall message should be that mental health is a workplace issue that feeds the bottom line.
How the Knowledge Exchange Network Supports CMHS Communication Activities. William Scarbrough, III, Ph.D., Vice President, Macro International, Inc., discussed ongoing development of a strategic communications plan for the CMHS Programs. Macro's research found that: KEN's audiences have complex communication dynamics; program staff felt that resources were not sufficient to accomplish their mission; the CMHS story is not being told; CMHS is one player in a complex information market; and CMHS' core roles include being a collaborative leader in the field, a partnership builder, and a knowledge steward. The strategic communications strategy focuses on increasing the overlap of the organizational promise of CMHS and consumer-oriented information needs to increase the degree of KEN's positive impact. Among actions under consideration are having a KEN communications consultant, changing KEN's name to reflect its role, developing new services to meet needs, and implementing process improvements to make KEN easier for programs to use. Dr. Scarbrough discussed several organizational strategies to further CMHS' mission, including developing excellent knowledge products and harnessing communications as the tool for profound impact. A new name for KEN might result in more CMHS brand-name recognition in communications.
Discussion. Council members discussed a new name for KEN,
enhanced CMHS brand-name recognition, and Council members' potential
role in brand-name recognition. Ms. Wainscott stated her preference
that there not be a name change for KEN, unless the experts recommend
it. She suggested that CMHS brand-name recognition can be enhanced
by Council members' official attendance at meetings and conferences.
Ms. Romero noted existing funding sources in communities; name recognition
will come from grassroots individuals. She asserted that what distinguishes
CMHS is the forming of relationships that institutionalize within
communities. Macro's Carol Freeman suggested the importance of audience-based
communications. Ms. Wainscott suggested identifying KEN's strengths
and deficits vis-à-vis the mass media, advocacy and professional
organizations, states, grantees and potential grantees. If the process
is simpler and more responsive to the grass roots community, a result
will be increased community appreciation of our contributions. Names
about new names included mentalhealth.samhsa.gov by Dr. Marsh and
mentalhealthservices.gov. by Dr. Scarbrough.
Dr. Martinez suggested that KEN facilitate dissemination of research findings to practitioners and train direct-care providers to teach consumers to use the system. Ms. Freeman suggested developing audience profiles to apply appropriate communications strategies to programs to enhance their success. Dr. Scarbrough noted the practical constraints of clearance on the KEN site. Ms. Romero cautioned that not everyone has access to the Web, and developmental phases must be considered. Small United Way providers, often overlooked as gateways into the mental health care system, could benefit from appropriate education and information on where to send clients to appropriate services; United Way directories are available in every region.
Members suggested topics for the upcoming Joint Council meeting and the CMHS meeting. National Advisory Council meeting. Dr. Arons adjourned the meeting at 12:56 p.m. Tentative dates for future CMHS National Advisory Council Meetings: May 22 & 23, 2001 (Joint Council); May 24, 2001 (CMHS National Advisory Council Meeting); September 6 & 7, 2001.
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