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Mental Health Programs
About CMHS
CMHS National Advisory Council
Subcommittee on Consumer/Survivor Issues
CMHS Orientation
Dr. Caras introduced Bernard S. Arons, M.D., Director, CMHS, who, in turn, introduced Dr. Lu, a member of the CMHS National Advisory Council and visitor to the subcommittee meeting.
Dr. Arons said that the formation of the consumer/survivor subcommittee is the culmination of a number of years of effort to promote greater involvement by consumers/survivors in the work of CMHS. That effort began with the hiring of Mr. del Vecchio as the first consumer/survivor advocate and his work in developing the idea of an advisory group that would represent consumers/survivors.
CMHS has also promoted greater consumer/survivor involvement by working with consumer/survivor advocacy groups, strengthening the role of consumers/survivors on state advisory councils, supporting dialogues between mental health professionals and consumers/survivors, hosting regional meetings to receive consumer/survivor recommendations and funding consumer-operated grant programs.
Dr. Arons promotes an approach that acknowledges that everyone is a consumer/survivor or potential consumer/survivor and also offers consumers/survivors a distinctive voice concerning CMHS activities. That voice is necessary to ensure that CMHS issues are portrayed accurately within the Department of Health and Human Services (DHHS) and outside DHHS to larger audiences. He encouraged subcommittee members to learn as much as possible about how CMHS operates.
He placed CMHS activities into three categories, each of which is governed by its own set of rules and requirements: (a) direct support for services, such as block grants to states; (b) improved access to quality services, and (c) information exchange, such as the CMHS Programs.
In response to a question about the role of the consumer/survivor subcommittee, Dr. Arons said that its members should be the "eyes and ears" for CMHS and should identify emerging issues, report on what states and communities are doing and help brainstorm solutions to problems. He also said that a Federal report on the consumer/survivor movement would be a "doable" activity.
Federal Government
Mr. del Vecchio introduced the orientation and spoke about the place of CMHS within the Federal structure. The Federal Government has three branches: executive, legislative and judicial. Within the executive branch are departments such as the Departments of Labor and Education.
The Substance Abuse and Mental Health Services Administration (SAMHSA), the umbrella agency that houses CMHS, is located within the Department of Health and Human Services (DHHS). SAMHSA is headed by Dr. Nelba Chavez, and DHHS is headed by Dr. Donna Shalala.
CMHS is one of three centers within SAMHSA. The other two are the Center for Substance Abuse Prevention (CSAP) and the Center for Substance Abuse Treatment (CSAT). SAMHSA also houses offices such as the Office of Applied Studies (OAS).
CMHS has three major divisions: the Division of Knowledge Development and Systems Change; the Division of State and Community Systems Development, and the Division of Program Development, Special Populations and Projects. CMHS also has the Office of Policy, Planning and Administration; the Office of External Liaison, the Office of Managed Care, and the Associate Director for Medical Affairs.
Division of Knowledge Development and Systems Change
Mr. del Vecchio introduced Mr. Michael English, Director of the Division of Knowledge Development and Systems Change.
That division contains three branches: community support programs branch, homeless programs branch, and child, adolescent and family service branch. The first branch inherited the legacy of the community support program (CSP) effort underway in the early 1980s. The third branch inherited the legacy of the child and adolescent services systems program (CASSP) activity and supports efforts to help children with serious emotional illness. Those two earlier programs affect many of the division's current activities.
Activities funded through the community support programs branch include:
- Community action grants, which assist sponsors of exemplary practices to build consensus so those practices can be adopted in communities;
- State consumer and consumer-supporter network grants, which allow consumers/survivors to organize and increase their power;
- Consumer and consumer-supporter technical assistance centers;
- Multi-site studies to learn what constitutes an effective service delivery and intervention for people with specific problems and combinations of problems. The topics are: consumer-operated services, employment intervention demonstration program, women and domestic violence, criminal justice diversion and aging and primary care program;
- Conference grants;
- Research and training centers; and
- Evaluation technical assistance center.
The Homeless Programs Branch was created as a result of activities associated with the Federal report "Outcasts on Main Street," which focuses on the connections between homelessness and people with mental illness.
Activities funded through this branch include:
- ACCESS Program, which is a multi-site study to determine how services for persons with mental illness who are homeless can be effectively organized and integrated. The study is complete and data are being analyzed;
- Studies on supported housing, homeless families and homelessness prevention;
- Co-occurring effort, which is a study to determine the value of therapeutic communities for people with mental illness and substance abuse problems.
Efforts are also being made to influence states to improve treatment for persons with co-occurring problems;
- PATH program, which is a state formula grant program designed to assist persons with the transition from homelessness; and
- Technical assistance center for homelessness.
Activities funded through the Child, Adolescent and Family Service branch include:
- Comprehensive mental health services for children and their families program, which offers 5-year grants with the aim of creating institutionalized change in service delivery systems;
- State family network grants;
- Circles of Care, which is a program to assist Native Americans to envision how they want to provide mental health services for children;
- Technical assistance and research and training centers; and
- Public awareness programs concerning children's mental health.
Activities of the division operate through a knowledge development and application (KDA) cycle, which has the following steps:
- With the help of consumers/survivors, mental health professionals, and other interested parties identify a problem to be addressed;
- Learn what works in addressing the problem;
- Synthesize knowledge about solutions to the problem and make it available in formats appropriate for different audiences;
- Disseminate the knowledge through such means as the CMHS Programs and assist communities to accept the knowledge. Currently, for example, CMHS is working with various Federal agencies and consumer/survivor groups to help communities adopt activities associated with a jail diversion program; and
- Take action and develop evaluation methods to determine success.
Mr. English noted that the community action grant program is a good source of funds for consumers/survivors and encouraged input from the subcommittee members about the division's activities. In response to a question, he replied that he would be happy to meet with subcommittee members and encouraged members to bring concerns to Mr. del Vecchio as well. He invited comments on the next round of funding of technical assistance centers.
Support was expressed for the involvement of consumers/survivors in the knowledge development phase of the KDA cycle. Mr. English described efforts of consumers/survivors to organize within the context of the women and domestic violence study. The contact person for the study is Susan Salasin at 301-443-3653. Support was expressed for the work of Mr. English, Mr. del Vecchio and CMHS staff.
Division of State and Community Systems Development.
Mr. del Vecchio introduced Anita Mandis, J.D., Project Officer, Division of State and Community Systems Development. Within the State Planning and Systems Development Branch are:
- State block grants, which provide flexible sources of funds to state mental health authorities to assist community-based systems of mental health care. Mental health planning and advisory councils, which include consumers/survivors, comment on State plans. Panels of peer reviewers evaluate applications using criteria stipulated in the legislation. States must implement plans within 12 months or risk loss of funds.
Five percent of the state block grant budget is spent on technical assistance and program evaluation. Technical assistance is also provided annually at a conference.
- Minority fellowship program, which provides stipends for graduate education in mental health fields.
- Aging issues. State coalitions are being developed to increase public awareness of problems facing older adults with mental illness. With funding from several federal agencies, a study is underway contrasting services in primary care settings with services in specialized care setting for older adults with co-occurring problems. Dr. Paul Wohlford offered to recommend older consumers/survivors for service on the subcommittee.
- Protection and advocacy section, which funds designated protection and advocacy agencies (P&As) to investigate allegations of abuse and neglect and rights violations in residential facilities and similar allegations affecting consumers/survivors discharged within 90 days. Each P&A has an advisory council with consumer/survivor representation. The chair of the advisory council sits on the governing body of the P&A. That body establishes priorities for the funds available.
In response to a question, Ms. Mandis noted an increase in the number of law suits filed. Often a lack of funds requires P&As to work collaboratively with other organizations, such as the ACLU, to file such suits.
It was suggested that a fellowship program for consumers/survivors be established similar to the minority fellowship program. The availability of federal funds might encourage States to use vocational rehabilitation funds to support consumers/survivors in their efforts to enter mental health professions.
Mr. del Vecchio introduced Ms. Ingrid Goldstrom, who spoke about the Survey and Analysis Branch. She noted the commitment of Dr. Ronald Manderscheid to involving consumer/ survivors in all aspects of the work of the branch and invited subcommittee members to call him at 301-443-3343. Within the branch are:
- Data collection. Relying on a sampling technique, staff collect data from State and county hospitals, community mental health centers, managed care organizations and mental health services providers. Data can be used to identify trends or to offer a snapshot of conditions at a given point in time.
- Mental Health Statistics Improvement Program (MHSIP), which is a joint federal- state effort to ensure that data are comparable across states and organizations. Decision Support 2000 focuses on ensuring data comparability with non-traditional mental health services providers, such as educational institutions and prisons.
- Quality and outcome measures. This effort includes the MHSIP Consumer Report Card.
- Mental Health US, a comprehensive compendium of mental health statistics.
- Self-Help Inventory, which was initiated as a result of a suggestion by Judi Chamberlin that the Federal Government examine non-traditional means of providing help to consumers/survivors. The survey will collect data about self-help services and programs in a random sample of 171 counties. Only consumer-operated activities will be included in the survey.
- State Data Reform and Performance Indicator Grants
- Statistics Conference
Mr. del Vecchio said that the most recent issue of Mental Health US will be sent to subcommittee members.
Division of Program Development, Special Populations and Projects
Mr. del Vecchio introduced Mr. Charles Cook, Public Health Advisor, who spoke about the work of the Emergency Services and Disaster Relief Branch.
The work of the branch focuses on the mental health needs of persons affected by presidentially declared disasters such as floods. Staff assist with capacity building at the State level, technical assistance, and grants management. Funds are available for 60-day grants that begin as soon as a disaster is declared and for 9-month grants that are available for severe disasters. Special guidance is available for addressing the problems of vulnerable populations such as the elderly and people with mental illness, although the overall effort is directed to the community as a whole.
Staff work closely with the Federal Emergency Management Administration (FEMA), state agencies, and private organizations such as the Red Cross. A program of crisis counseling is put into effect immediately after a disaster. The underlying assumption of the program is that normal people are responding normally to an abnormal event. The crisis counseling model has proven so effective that it is being used for other populations, such as victims of crime.
Ms. Lawrence complimented the work of the branch in St. Louis, Mo., after the floods of 1993. It was commended the focus on mental health, as opposed to mental illness, as an assumption for program design. Ms. Yokote said that persons trained in Hawaii to help with mental health problems after the 1990 hurricanes were still active in that role.
Mr. del Vecchio introduced Maria T. Baldi, Public Health Advisor, who spoke about the Suicide Initiative.
Ms. Baldi opened with a description of the scope of the problem. Suicide is the eighth leading cause of death in the United States. Of four demographic groups, white males are most likely to commit suicide. The highest rates of suicide are in Alaska, Hawaii, and the Midwest.
CMHS became involved in suicide prevention with its sponsorship of the National Suicide Prevention Conference in 1998. Conferees recommended development of a national strategy to lower suicide rates. The U.S. Surgeon General's "Call to Action to Prevent Suicide" was issued in 1999. Subcommittee members will receive copies of the pamphlet, which is also available at the website: www.surgeongeneral.gov/.
Activities to promote the development of the National Suicide Prevention Strategy (NSPS) include:
- Convening of the 2000 Leadership Consultant's Workshop to advise on strategies, goals, and future activities.
- Development of a draft statement of NSPS's goals and objectives. That statement is on the Internet at www.surgeongeneral.gov/. Comments are welcome on the statement until November 2, 2000.
- Convening of four regional meetings, at which members of the general public can comment on the goals and objectives.
Other activities include:
- High School Screening and Intervention Program, which developed from efforts to identify and combat depression among high school students;
- Suicide Prevention Cooperative Agreements, which are two-year grants to community organizations. Four will be awarded in 2000; and
- Support for a report from the Institute of Medicine and for a consensus conference on suicide prevention.
Mr. del Vecchio introduced Ms. Estelle Rondello, Public Affairs Specialist, who spoke on behalf of Anne Mathews-Younes, Ed.D., chief of the Special Programs Development Branch. The branch offers programs directed to youth violence, refugees, rural populations, and people of color. It is also responsible for prevention activities and HP 2010. Members will receive a copy of the annual branch summary report, as soon as it becomes available.
Ms. Rondello discussed public relations activities in support of the Safe Schools/Healthy Students program. They include:
- Communications tool kit, which contains generic media pieces, such as press releases, that can be tailored for specific projects.
- Brochures that assist grantees to develop community coalitions.
- PSAs that encourage parents to listen to their children and a 30-minute television special on the same topic.
- "Academy Awards" that honor those responsible for television shows that present positive messages about breaking the cycle of violence and accurate portrayals of people with mental illness.
Mr. del Vecchio reviewed the remaining offices that comprise CMHS.
The Office of External Liaison contains:
- Public affairs
- CMHS Programs, which is accessible on the Internet at mentalhealth.samhsa.gov and by telephone at 800-789-2647.
- Consumer affairs, which includes activities such as dialogue meetings and production of a newsletter and consumer-operated report. Staff also work on issues related to stigma, patient's bill of rights, and managed care.
The Office of Policy, Planning and Administration is responsible for such activities as:
- Work on seclusion and restraint, consumer/survivor rights, regional consumer/survivor/survivor meetings, custody issues, Olmstead implementation, welfare reform, consumer/survivor/ survivor networks, international issues and development of the U.S. Surgeon General's Report on Mental Health.
- Development of the CMHS budget.
The Office of Managed Care is responsible for:
- Studies on financing and insurance coverage.
- Analysis of parity issues.
- Study of managed care trends.
The Associate Director for Medical Affairs is responsible for activities related to HIV/AIDS programs.
At the invitation of Dr. Caras, members identified next steps for the subcommittee and CMHS staff.
- CMHS staff will arrange for conference calls to enable subcommittee members to offer advice on Grants to Support Consumer/survivor and Consumer/survivor Supporter National Technical Assistance Centers. Appropriate information will be supplied to members prior to the calls. Staff will also arrange for an agenda-setting conference call.
- Staff will supply a matrix indicating subjects areas of expertise of members. That matrix can be used to form task groups.
- Staff will notify members about the date, theme, and location of the next advisory committee meeting as soon as the information becomes available.
Dr. Caras asked that appreciation be expressed to KRA Corporation for help in the logistics of the meeting. She adjourned the meeting at 11:50 a.m.
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