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CMHS National Advisory Council
Meeting Minutes
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
National Advisory Council
September 4-5, 2003
Rockville, Maryland
Minutes
Open Session
The National Advisory Council of the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS) met in open session at 9:05 a.m. at the DoubleTree Hotel in Rockville, Maryland. New CMHS Director A. Kathryn Power, M.Ed., presided. Council members present included Abdul Basit, Ph.D., William R. Beardslee, M.D., Larry Fricks, Timothy A. Kelly, Ph.D., Josie Torralba Romero, M.S.W., Sally L. Satel, M.D., Cheryll Bowers-Stephens, M.D., M.B.A., Michael Vergare, M.D., and Stephanie White-Perry, M.D. Also present were CMHS Acting Deputy Director Ted Searle, M.B.A., and Council Executive Secretary Dale Kaufman.
Ms. Power welcomed attendees to her first Council meeting as CMHS director, noting that the "tectonic plates of history" have aligned to create an opportunity for CMHS and the mental health field to chart a new course.
Approval of Minutes. Council members unanimously approved the minutes of the CMHS Advisory Council meeting of June 25-26, 2003.
Council Introductions. Council members welcomed Ms. Power to CMHS, described their own backgrounds and major interests, and acknowledged the contributions of CMHS staff. As psychiatry chair at Children's Hospital in Boston, Dr. Beardslee works to keep families together and also does prevention. His broader interest is learning how to incorporate evidence-based treatment and prevention practices in the work of clinicians and school counselors. Dr. Perry, Tennessee's Assistant Commissioner of Health, described her interest in co-occurring disorders, children's mental health issues, and multicultural issues in mental health services. Dr. Basit, director of multicultural health services and professor of social psychiatry at the University of Chicago, is involved in the mental health issues of Chicago's Asian community and also is interested in the spiritual dimensions of trauma healing. Dr. Kelly has served as an academic, clinician, and Virginia Commissioner of Mental Health. He anticipates examining the charter that defines the Council and urged focus on clinical outcome measures.
Dr. Bowers-Stephens, Louisiana's Medical Director for Infant, Child, and Adolescent Services, has clinical and program development experience. Her special interests include youth with co-occurring developmental disabilities and mental illnesses, early intervention and prevention, and the translation of national policy into local practice. Dr. Satel, a psychiatrist affiliated with the American Enterprise Institute and who practices part-time at a methadone clinic, and Dr. Vergare, chair of psychiatry at Thomas Jefferson Medical College and University, echoed the need to explore the Council's function and definition. Dr. Vergare has focused on shaping the future practice of medicine based on current knowledge on mental health. His research focuses on bipolar disorders and identification in youth, and on cancer and addiction, and he supports an integrated, lifelong approach to services. Mr. Fricks serves as Director of Georgia's Office of Consumer Relations and chair of the CMHS National Advisory Council's Subcommittee on Consumer/Survivor Issues. He noted the Subcommittee's focus on rehabilitation, recovery, and the strengths of consumers. Ms. Romero, a part-time professor at San Jose State University and president of the National Latino Behavioral Health Association, strives to ensure that consumer and family voices are included and developed in partnerships. Other passions include cultural and language competence, evaluation of practices that work in communities, and including the voices of diverse cultural groups on the Council.
Recognition of Retiring Council Members. Ms. Power expressed appreciation for their work on the Council to Ms. Romero, Dr. Basit, and Dr. Perry, and presented them with outstanding service awards.
CMHS Director's Report and Remarks. Ms. Power referred attendees to the written CMHS Director's Report for details of activities conducted since the previous Council meeting. She recognized the contributions of former CMHS Acting Director Gail Hutchings and former Director Bernie Arons in creating a professional, responsive, and competent agency.
Ms. Power stated that she has worked to serve and empower people living with serious mental illnesses, developmental disabilities, and substance abuse and addiction, and victims of sexual assault and rape. She served as Director of Rhode Island's Department of Mental Health and Retardation and Hospitals. Her priorities have mirrored SAMHSA's priorities, including reducing stigma and discrimination; promoting recovery, healing, and resiliency through systems of care; integrating treatment for co-occurring disorders; addressing long-term effects of trauma and violence; and looking at links between primary care and behavioral health.
Ms. Power plans to guide the transformation of the mental health system at the federal level, as called for in the President's New Freedom Commission on Mental Health's final report. She anticipates consulting with diverse stakeholders to define how transformation translates into institutional change, inventorying CMHS activities and determining how they fit with the Commission's goals and priorities, and devising an action agenda. The result will be a "to-do list" that sets the agenda for CMHS and mental health in America over the next 5 years, using performance measures that track to the Commission's recommendations.
Leadership is a set of actions, Ms. Power asserted, to move systems to better serve people. She bases her leadership approach on the tasks enumerated by John Gardner in On Leadership, and sees herself as a "servant leader" whose constituents' needs supercede politics and partisanship. She stated that input from Council members will be central to formulating the action agenda.
She identified examples of CMHS activities that map to the Commission's recommendations, based on the principles of consumer- and family-centered services and a focus on resilience and recovery. To address the goal of stigma reduction, for instance, CMHS's new Resource Center to Address Discrimination and Stigma (ADS Center) sponsors training on a variety of subjects in a variety of formats. CMHS also supports and demonstrates effective public education approaches aimed to reduce stigma through the Elimination of Barriers Initiative.
On the newly revised SAMHSA priorities matrix, CMHS leads in the areas of seclusion and restraint, co-occurring disorders, and mental health system transformation. Several activities of the Special Programs Development Branch involve accelerating research and advancing evidence-based practices. CMHS is working with the Center for Substance Abuse Prevention on the National Registry of Effective Programs (NREP) to create a mental health portal on the website. CMHS will launch regional prevention and promotion activities, including a showcase of evidence-based practices in each New England state. The Child, Adolescent, and Family Branch has announced 10 new cooperative agreements for the Systems of Care program. Support for states and communities includes an early childhood state policy academy, development of an early childhood toolkit, research and planning for a Systems of Care college, social marketing efforts, and a communications academy.
CMHS participates in many partnerships and cross-agency collaborations, a strategy that addresses the barrier of fragmented bureaucracies. A new initiative involving the Departments of Health and Human Services (HHS), Veterans Affairs (DVA), and Housing and Urban Development will allow simultaneous submissions of grant applications for housing, mental health services, and other supports. Collaborations among stakeholders in mental health and criminal justice are both ongoing and planned. The newly renamed Emergency Mental Health and Traumatic Stress Services Branch continues its long-standing partnership with the Federal Emergency Management Agency (FEMA), DVA, Department of Justice, the National Association of State Mental Health Program Directors, and other agencies. Ms. Power stated that many ongoing CMHS activities dovetail with the Commission's recommendations. She highlighted issues related to the report, including a Minority Fellowship Program national conference to develop the workforce, a new publication on rural mental health outreach, parity law on mental health and substance abuse in Vermont, and establishment of an alliance for suicide prevention.
The Office of Management and Budget (OMB) has reviewed the mental health block grant program. Ms. Power believes the final report will show that CMHS has done very well. In the ongoing fiscal 2004 budget process, the House and Senate both have provided mark-ups with budget increases that demonstrate support for federal mental health programs.
Consumer/Survivor Issues: Update. Larry Fricks, Chair, CMHS National Advisory Council's Subcommittee on Consumer/Survivor Issues, invited Council members to join the Subcommittee to fill its two vacancies. To address the Commission's six recommendations, Subcommittee members heard presentations on mental health courts and the Elimination of Barriers Initiative. The Subcommittee views the Commission report as an opportunity for stakeholders to address the fragmented mental health services system with a shift to focus on recovery and building on strengths.
Mr. Fricks stated that Georgia's certified peer specialists (CPS) have billed Medicaid for $10 million in peer-support services. CPSs help others to break down problems so they are not overwhelming and to stop negative self-talk. Most state systems do not promote recovery, but Georgia's 150 CPSs write individual service plans that focus on strengths and that seek to accomplish what consumers want to achieve. Nine states have trained CPSs.
The Council accepted the following Subcommittee recommendations for consideration:
- The CMHS National Advisory Council Subcommittee on Consumer/Survivor Issues recommends that the CMHS National Advisory Council advise CMHS, in conjunction with Goal 6 and Recommendations 6.1 and 6.2 of the final report of the President's New Freedom Commission on Mental Health, to undertake pilot work to begin testing and developing a consumer-operated, culturally competent, interactive Web site that organizes information for consumers that supports self-care and self-determination; provides and updates a database of self-help groups, warmlines, and other consumer resources; shares stories of recovery; provides discussion list management software; employs chat rooms; manages interactive input from consumers; and serves as an IT (information technology) training tool by the end of 2004 and to be fully operating by the end of 2005.
- Work and service are American values and critical to recovery. The CMHS National Advisory Council Subcommittee on Consumer/Survivor Issues recommends that the CMHS National Advisory Council advise CMHS to increase support for jobs, including the employment of consumers as funded service providers, as described in Goal 2 and Recommendation 2.2 of the final report of the President's New Freedom Commission on Mental Health.
- Over 50 percent of all community mental health services are currently funded by Medicaid. The CMHS National Advisory Council Subcommittee on Consumer/Survivor Issues encourages increased focus on recovery and rehabilitation that will ensure community integration. The CMHS National Advisory Council Subcommittee on Consumer/Survivor Issues recommends that the CMHS National Advisory Council advise CMHS to collaborate with CMS (the Centers for Medicare and Medicaid Services) to form an advisory body of beneficiaries with cross-disability representation in proportion to the disabilities served by CMS, in conjunction with Goal 2 and Recommendation 2.3 of the final report of the President's New Freedom Commission on Mental Health.
Administrator's Report. James Stone, M.S.W., Deputy Administrator, SAMHSA, stated that under Administrator Charles Curie's leadership, SAMHSA and CMHS's credibility, image, and influence have improved. Recent focuses at SAMHSA include release of the New Freedom Commission report and anticipation of an unexpectedly larger fiscal 2004 budget. Ongoing issues include seclusion and restraint; building resiliency and facilitating recovery; fine tuning the matrix; expanding substance abuse treatment capacity, which will impact on the treatment of co-occurring disorders; and accelerating the pace of science to service, including a focus on technology. Mr. Stone stated that he functions as SAMHSA's chief operating officer.
Discussion. Dr. Kelly expressed the Council's willingness to engage in brainstorming on initiatives and policy direction. Ms. Power noted the potential for synergies among SAMHSA's councils, and Dr. Stone emphasized the importance of CMHS Council input. Dr. Vergare urged implementing change in a timely manner. Ms. Power stated that CMHS and the Centers for Medicare and Medicaid (CMS) have begun to address the specifics of change. Dr. Kelly suggested interaction among the SAMHSA councils. Ms. Romero urged removing barriers to diversity at all levels within SAMHSA in the broader effort to address increasing diversity and capacity in the nation's professional mental health workforce. Dr. Beardslee urged SAMHSA to consider universal insurance coverage, which is necessary to eliminate fragmentation and integrate mental health and physical health care, as a core issue.
Standard Discretionary Grant Mechanisms. Frank Sullivan, Ph.D., Director of Organizational Effectiveness, SAMHSA, discussed SAMHSA's strategy to reengineer the discretionary grant process in order to improve clarity, facilitate focus on results, increase service to the field, and achieve increased efficiencies. The grant mechanisms are services, infrastructure, best practice planning and implementation, and service to science. Approximately 75-85 percent of SAMHSA's discretionary portfolio grants fit into these categories. The mechanisms offer a flexible menu of activities for grantees. SAMHSA is working on measurement and reporting requirements regarding GPRA goals and other evaluations of programs, and will publish notices of funding availability.
Services grants address gaps in substance abuse and mental health services, and/or increase applicants' ability to meet unmet needs of specific populations or geographical areas with serious emerging needs. Services include outreach, pre-service strategies, direct treatment/prevention, and wraparound services. Judgments on the evidence base are the domain of experts in the peer-review process. Infrastructure grants are designed to increase capacity in, for example, provider network and workforce development, data infrastructure, and coordination of funding. The best practices mechanism is designed to help grantees identify practices that can meet local needs effectively, develop plans to put them in place, and pilot test them. The service-to-science grant mechanism addresses critical service gaps that have not yet been formally evaluated by funding data collection to ready a program for consideration of a scientific evaluative trial.
Process improvement also involves earlier and simpler policy review. SAMHSA has completed outlines for notices of funding availability in 2004 for most programs, which is expected to result in earlier announcements and reviews that are spaced better. Simplified concept papers are planned, and reviews will be keyed to exceptions. Expected outcomes include planning linked to the budget, increased collaboration and coordination, predictability of activities and time frames, and fewer intra-agency hand-offs. The reengineering of reviews involves front-end triage, closer linkage between the review operation and program, increased teleconferencing and technology support, and competitive sourcing of the function. Expected outcomes include more timely review, a larger pool of experts, cost savings, more flexible scheduling, and better assessment of reviewer productivity.
The reengineering process requires relinquishing turf considerations, a shift from individualized and changing views of SAMHSA mission and policy, and ceasing to reinvent programs and the temptation to change rules. Benefits include shared vision and mission internally and externally, coordinated planning and coherent resource allocation, improved efficiency and morale, and increased stability to ensure quality of process for all grant activities. Feedback received on the plans has been positive.
Discussion. Dr. Sullivan noted that science to service and service to science constitute a continuous cycle. Ms. Romero stated that this construct meets the vision of ethnic communities that historically have not been part of the research. She expressed concern about the quality of the outsourced review process. Dr. Sullivan stated that the RFA for the review contract has been released, a SAMHSA project officer and additional staff will monitor the contract, and SAMHSA will approve the composition of review panels. Drs. Vergare and Kelly expressed interest in the demographics and qualifications of applicants and grantees, and reviewers' qualifications and review guidelines. Dr. Beardslee noted that the Council has made strong recommendations about cultural and ethnic representation and about guidelines as part of the RFA and review. Ms. Power noted that peer review training is ongoing.
Faith-Based and Community Initiative. Capt. John Tuskan, Jr., U.S. Public Health Service, CMHS Division of Prevention, Traumatic Stress, and Special Programs, discussed the Faith-Based and Community Initiative, charitable choice, the Compassion Capital Fund, and related SAMHSA activities. The Faith-Based and Community Initiative is designed to enable faith-based and community organizations to partner with the federal government in providing services. In 2001 President Bush issued an executive order to create a White House Office of Faith-Based and Community Initiatives and faith-based offices at four departments, including HHS. In 2002 the President issued orders to eliminate discriminatory practices against faith-based and community groups, create faith-based offices in additional governmental entities, and directed FEMA to permit religious nonprofit organizations to receive disaster relief funds. The principles and goals of the initiative are to reach out to faith-based and community groups to help them compete for federal funds; government should be pro-results, whether services are provided by secular or religious organizations; energize and rebuild social capital; support the unique capacity of faith-based and community organizations; and improve the federal response to need.
Charitable choice refers to legislation designed to remove barriers to receipt of certain federal funds by faith-based organizations without relinquishing their organizations' religious character. The law also prohibits states from discriminating against religious organizations when choosing providers under certain federal grant programs. Charitable choice affects substance abuse prevention and treatment activities and CMHS's PATH program. Final regulations for implementation are forthcoming. No new funds are set aside for faith-based organizations.
Executive Order 13279 applies charitable choice principles to federal discretionary funding, according to the following parameters: no government funds for inherently religious activities, clear separation between religious and nonreligious program components, strict fiscal accountability for federal funds, and no discrimination for beneficiaries or potential beneficiaries on the basis of religion or religious belief. Organizations may discriminate on the basis of faith in hiring and selecting board members; need not abandon religious independence, autonomy, expression, or character; may display icons, religious art, and scripture; may retain religious terms in name, mission, and other governing documents; and may conduct religious activities, if they are privately funded and under certain other conditions.
The Compassion Capital Fund funds a national resource center and clearinghouse to provide technical assistance and training resources to grassroots groups, and 21 intermediary organizations to provide technical assistance to grassroots organizations in local areas. A SAMHSA workgroup has identified barriers organizations face, including limited capacity to write successful grant applications. SAMHSA funds training in grantsmanship. SAMHSA also is training its staff, posting a webpage, implementing charitable choice and Executive Order 13279, expanding and training the pool of peer reviewers, conducting interfaith symposia, and training faith-based organizations on religion and spirituality in prevention, treatment, and recovery.
Discussion. Dr. Tuskan stated that some anecdotal evidence shows an increase in successful applicants; an evaluation is underway. Mr. Fricks stated that Habitat for Humanity's national pilot to build houses for people in mental health recovery has helped to reduce stigma. Dr. Satel asked about the status of vouchers for patients as the locus of control for treatment. Ms. Power responded that the Access to Recovery Initiative is working to operationalize that program.
Public Comment. Advocate Randy Bosin expressed concern that safeguards for charitable choice may be insufficient to protect participants. To address system fragmentation, Mr. Bosin suggested interdepartmental dialogue on a holistic, multidisciplinary approach to persons with mental health disabilities. He also urged rejecting the term "consumer/survivor" and acknowledging strengths in addition to weaknesses and problems.
Council Discussion. Dr. Satel asserted the need for ideological and intellectual diversity in looking at such problems as stigma, self-esteem, the population of individuals so sick they cannot take advantage of the social system, and varying views of the consumer/survivor movement. Dr. Fricks stated that the Subcommittee supports Mr. Bosin's position that people with psychiatric disabilities the need same level of integration and support as people with other disabilities. Ms. Power noted that CMHS is working aggressively to place permanent people in agency positions. Dr. Kelly urged that more time for Council discussion be incorporated into the agenda. He urged using clinical outcomes to guide transformation, a practice that will be helpful in evaluating evidence-based practices for minority populations. He suggested as an agenda item the common performance measures initiative. Ms. Power explained that the Council nomination process involves sending resumes of likely candidates to SAMHSA and then to HHS. CMHS looks to the Council to nominate individuals representing demographic, ethnic, and professional diversity. Ms. Romero stated that intellect comes in different colors, different stages, and from different voices. Ms. Power observed the need to value individual philosophies, life experiences, and perceptions and perspectives.
Closed Session
The Council conducted a secondary review of grant applications.
The meeting adjourned for the evening and reconvened the following day at 8:35 a.m.
Council Discussion. Dr. Beardslee noted the Council's willingness to work between meetings and acknowledged the contributions of the retiring Council members. He described National Depression Screening Day, part of a public health campaign to recognize and treat depression in caregivers. Ms. Romero suggested piloting the materials in Spanish and Asian languages.
Measuring Data and MHSIP/NREP: Update. Ronald Manderscheid, Ph.D., Chief, Survey and Analysis Branch, CMHS, and Paul Brounstein, Ph.D., CMHS. Dr. Manderscheid introduced concepts key to a viable information system: data standards, data recording, data reporting, and decision support. Decision Support 2000+ involves Data Infrastructure Grants (DIGs) for states; a MHSIP Quality Report is forthcoming. Decision Support 2000+ covers the essential domains of the public health model, and attention to access, capacity, and effectiveness are built into the system.
The consumer-friendly decision support system will be posted on the Internet. A HIPAA mapper that assesses a user's current data systems against HIPAA requirements and a consumer survey that benchmarks services are currently available on the website. A test is underway on receipt of data from states and private-sector organizations, using techniques under consumer control. Prior to HIPAA implementation, CMHS and CSAT produced a provider handbook to use the downloadable system. CMHS has been working with providers and states, but recognizes the need to reach out to consumers and families to ensure that people know their rights. The Subcommittee supports building consumer information systems to promote recovery. The new clinical outcome information system will be a plug-in module for the decision-support IT system. CMHS and CSAT are developing performance measures for the mental health and substance abuse fields that will include administrative and consumer survey data.
Dr. Manderscheid explained that NREP primarily measures clinical practice performance, but measures of clinical and organizational systems are important to set the context. Concepts that must be addressed for evidence-based practices include implementation of the clinical intervention, how well the practice followed the model as presented (fidelity), and adherence to the model over time. Global, summary, and real-time measures cross-cut the concepts. Use of real-time measures at the individual clinician/consumer interaction level produces most meaningful information. The field is currently examining whether global measures of implementation should be used until measurement of evidence-based practices is improved. Summary measures relate to implementation and fidelity; they can be absolute or relative. Real-time scoring of an actual clinical intervention against specific standards as the intervention occurs requires codification of standards; the technology exists. A small design contract has been arranged to work through these measures. CMHS also will test summary measures in DIGs.
Dr. Manderscheid observed that data standards and clinical standards for evidence-based practices must be developed together; data standards for evidence-based practices and data standards for outcomes must be developed simultaneously; data standards should not be too complex; and both data standards and clinical standards for evidence-based practices should be designed with IT applications in mind.
Dr. Brounstein explained that NREP evaluates comprehensive information to determine whether an intervention is effective and whether a causal relationship can be inferred between the intervention and outcomes. Rating criteria include scientific rigor, consistency of results, program adaptability to different populations, and ability to disseminate the program, among others. NREP drives technical assistance and resources to communities and provides feedback and evaluation. States' experience with science-based prevention programs has been positive.
To determine the quality of the evidence-base, published materials on interventions are collected, experts review the materials, a consensus conference is held, and current materials are reviewed for usefulness. An intervention that meets the criteria of causality and consistency of results is identified as effective. If the program developer consents to provide technical assistance to support proper implementation of the intervention, that program is deemed a model program.
NREP is conducting consensus conferences for 16 programs that address co-occurring disorders. Work with CMHS and consumers on mental health treatment programs recently has begun to determine rating criteria on the science and on the usefulness of interventions to consumers. The National Cancer Institute and the Centers for Disease Control also use the NREP process.
Discussion. Dr. Kelly supported the linkage of data to care outcomes. Dr. Manderscheid noted that his presentation described the process that follows NREP determination of evidence-based practices, and that the two processes are complementary. To help the field move ahead on outcome data, CMHS can provide IT and make the process easy to accomplish. The process must fit the cultural milieu of the field, and consumers and family members must help to develop and implement evidence-based practices in mental health. PPGs require building a data infrastructure and an evidence-based practices infrastructure. Dr. Brounstein pointed out the importance of fidelity of evaluation.
Dr. Beardslee stated that implementation is as important as developing the evidence base. He expressed concern about accessibility of the system to clinics without computers, to individuals whose primary language is not English, and in areas where alternative technologies, such as voice recognition, are better than keyboards. He suggested that a pilot test work intensively with centers and clients who represent those issues to see what it would take to get up to speed. Ms. Romero stated the importance of incentives and funding for training to use the systems under development, and of incentives for providers to offer essential services for good outcomes, including wraparound services. Dr. Manderscheid agreed that it is pointless to design a system that will leave people behind, but technology is developing to make systems more accessible in the future. Dr. Beardslee articulated the need for advocates and training to ensure that consumers and families are Internet competent. Dr. Manderscheid emphasized the need for holistic interventions. Dartmouth studies show that evidence-based practices work, and DIGs data show positive changes.
Dr. Vergare urged attention to outcomes in the private sector and to the issue of training providers. Dr. Manderscheid stated that CMHS work on clinical outcomes and standard performance measures spans both sectors. CMHS has contracted with the American College of Mental Health Administration (ACMHA) to work on issues of new training and continuing education. Ms. Romero suggested investigating evidence-based practices in the use of trained versus untrained interpreters in mental health. Dr. Manderscheid suggested looking at the historic work with deaf populations and ACMHA's new publication on disparities in mental health care in that context.
Dr. Kelly stated that Virginia had adopted a successfully tested performance measure system (later terminated due to budget cuts) that included an IT component. Mr. Fricks commented on the power of the Internet to combat consumer isolation and on consumer satisfaction regarding quality-of-life issues as a powerful vehicle for change. Consumers are seeking recovery-based interventions. Richard Nakamura, Ph.D., Deputy Director, National Institute of Mental Health, stated that his agency is focusing increasingly on outcomes related to people recovering their lives and that he looks forward to collaborative interagency activities.
President's New Freedom Commission on Mental Health Report. H. Stanley Eichenauer, M.S.W., A.C.S.W., Deputy Executive Director, New Freedom Commission on Mental Health, discussed the context for the Commission, which includes passage of the 1990 Americans with Disabilities Act (ADA) and the 1999 U.S. Supreme Court Olmstead decision that affirmed the right of people to move from institutional to community life. In 2001 President Bush issued an executive order that required federal agencies to work with states toward full compliance with the Olmstead decision. He established the New Freedom Initiative and a commission whose mission was to conduct a comprehensive study of the U.S. mental health service delivery system and then to advise the President on methods to improve the system.
The Commission's tasks included: (1) organizing, including hiring staff, producing a background book for commissioners, creating a website and communications channels with stakeholders, and identifying external resources; (2) listening and learning from persons who shared experiences and provided substantive comments about the mental health service delivery system, and to invited testimony from national organizations of advocates, trade associations, and providers, and visits to exemplary program sites; (3) understanding and framing issues, including creating subcommittees to explore major issues, hiring experts to create issue papers and draft policy options, and publishing final subcommittee reports; and (4) reporting to the President, via an interim and final report. The Commission approved the outline of goals and recommendations, and writers consulted with commissioners to ensure fidelity of the evolving document to the Commission's perspective. Final sign-off was achieved, and the Commission delivered the report to the President on July 22, 2003, the 13th anniversary of the signing of the ADA legislation.
New Freedom Commission Report and CMHS Plans. Ms. Power leads SAMHSA's report implementation team, whose members also include James Stone, Stanley Eichenauer, Gail Hutchings, Mark Weber, and Sybil Goldman. CMHS is beginning the process by conducting an inventory of its activities and engaging with its federal and other partners and with entities that testified before the Commission. The action agenda of long- and short-term activities will serve as the basis for evaluating performance; performance measures must be developed.
To help set CMHS's action agenda for the next 5 years, Ms. Power facilitated a discussion on evidence that would signal transformation of the system of care. Council members suggested the following examples of evidence:
- CMS focus and Medicare/Medicaid rules shifted from pathology and diagnostics to prevention of mental illnesses and promotion of mental health
- Majority of individuals with serious mental illnesses able to live in a home in the community
- Meaningful paid or volunteer activity for every consumer, which presupposes proper medications and a safe place to live
- Consumers paid fairly and recognized by all states as part of the continuum of care as certified peer specialists
- Disparities among populations eliminated in access, quality, and services
- All federal programs (e.g., housing and social support) aligned around recovery goals
- Evidence-based practices and outcome measures understood and embraced as standard operating procedure by treatment providers, commercial insurers, employers, and others
- Single point of access to all services at the local level, integration from the local through the federal level, bi-directional information flow, and local synergies
- Aggregated outcome data available to the public on a regular basis
- Clear, unified definition of medical necessity in the public and private sectors
- Private/public partnerships, including community and faith-based organizations
- Integrated substance abuse and mental health assessments
- Spectrum of clinicians, administrators, legislators, and other government officials educated on the mental health process and system and barriers to care
- Engagement of national and local organizations
- Single, transparent system of care
- Integrated public health, medical, and mental health principles; integrated consideration of brain disease, neurological issues, developmental problems, and mental illnesses; integrated mental health and physical health in a holistic approach to care
- Care of individuals considered in the contexts of culture, religion, and family
- Understanding of specific illnesses, but also recognition of public health risk factors
- High quality care for young children
- Public sector exerts financial pressure on private sector to join in transformation
- Behavioral health evidence used more effectively to focus on early intervention
- Single set of standards to measure outcomes for public and private insurance
- Emphasis on family and cultural protective factors
- Community development conducted by partnerships, focused on strengths and assets
- Mental health and medical educational institutions and licensing and accreditation organizations transformed
- Systems change managed effectively
- Stigma and discrimination reduced with public understanding that many people can have restored lives and enter life's mainstream
- Policy agenda developed at all levels, including necessary changes to laws, regulations, and policies to achieve transformation
- Action agenda developed, including a business plan and marketing strategy
Consumer/Survivor Issues: Update (cont.). The Council voted unanimously to approve the Subcommittee's recommendations.
Council Discussion. Dr. Vergare suggested a focus on the usefulness of the term "consumer." Dr. Kelly suggested linkages to the common performance measures project. Ms. Romero urged attention to the needs of racial and ethnic minorities and America's aging population.
Public Comment. Time was set aside for public comment, but no speakers appeared.
Adjournment. The meeting adjourned at 12:15 p.m. The next Council meeting is to be held in February 2004.
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