This Web site is a component of the SAMHSA Health Information Network
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Mental Health ProgramsAbout CMHSNational Advisory Council Subcommittee on Consumer/Survivor IssuesRockville, Maryland Welcome and Introductions Subcommittee members identified their particular mental health interests. Ms. Yokote discussed certified peer specialists (CPS) and Hawaii’s liaison with the special education community. Ms. Maceira-Lessley’s passions are systems change to permit Latinos and Hispanics to receive the mental health services they want, including nontraditional services, and for society’s view of persons like her to change. Mr. Brock promotes lasting reform of the mental health system led from within by people who have experienced mental illnesses and treatment. Mr. Fricks anticipates the time when every state accepts and recognizes CPSs as members of the mental health professional team and when Medicaid’s rules ease to permit a focus on recovery. Mr. Fitts’s passions are involving consumers in policymaking and a focus on natural systems of support. Ms. Lawrence expressed her interest in recovery issues, particularly following electroconvulsive therapy (ECT), and in advocacy by ECT patients and survivors. Dr. Caras expressed her passion for transparent process and involvement in international mental health and cross-disability activities. CMHS Director's Report Ms. Power described her background, her goals for CMHS and the federal mental health system, and her leadership style. Ms. Power has worked to serve and empower people living with serious mental illnesses, developmental disabilities, and substance abuse and addiction, as well as victims of sexual assault and rape. She supports recovery-focused, peer-supported, and community-based services. Her priorities have mirrored SAMHSA’s priorities, including reducing stigma and discrimination; promoting recovery, healing, and resiliency; integrating treatment for co-occurring disorders; and addressing the long-term effects of trauma and violence. Ms. Power plans to lead the transformation of the mental health system at the federal level, as called for in the President’s New Freedom Commission on Mental Health final report, “Achieving the Promise: Transforming Mental Health Care in America.” She anticipates working with diverse stakeholders to define how transformation translates into institutional change, inventory SAMHSA/ CMHS activities and determining how they fit with the Commission’s goals and priorities, and devise an action plan. Ms. Power emphasized the never-ending process of transformation that will begin with internal CMHS discussions and preliminary discussions with other federal agencies. The outcome will be a “to-do list” that sets the agenda for CMHS and mental health in America over the next five years, using shared performance measures to be developed. 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.” Ms. Power identified examples of ongoing CMHS activities that map directly to the Commission’s recommendations. To address the goal of stigma reduction, 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 at stigma reduction through the Eliminating Barriers Initiative. Nearly every activity of the consumer affairs office works to ensure that mental health care is consumer and family driven. At the recent Philadelphia regional meeting, consumers expressed concerns and identified their top needs: consumer-operated services, holistic supports, housing, and aging. CMHS has supported 130 consumers at mental health meetings nationwide since June and has produced a draft information card for consumers on privacy rights and mental health records. CMHS leads in the SAMHSA priority areas of seclusion and restraint, co-occurring disorders, and mental health system transformation. Discussion. Dr. Caras observed that transforming consumers’ lives might be an interesting way to transform the system. Ms. Power stated that viewing recovery, as the way persons want to see themselves, is not universal, but that the construct of choice and independence was helpful to produce state-level systems change in the 1990s. Mr. Brock asserted that building consumer involvement speaks to long-term transformation and suggested that more consumers might become involved with federal agencies whose programs affect their lives. Mr. Fricks and Ms. Power echoed support for more federal and national partners attending to the voices of consumer/survivors. Mr. Fitts expressed concern that CMHS’s activities regarding block/Performance Partnership Grants (PPG) have insufficient public visibility. Ms. Power stated that PPGs will involve more flexibility and accountability. She noted that CMHS will stay focused on the dual issues of stigma and discrimination, and that former CMHS Acting Director Gail Hutchings continues to serve as special assistant to SAMHSA’s administrator. Ms. Maceira-Lessley urged CMHS to engage in broader linguistically and culturally competent outreach and to learn from small groups of cultural leaders on needs and best approaches. Mr. Fricks identified the need for CMS to ease Medicaid regulations to permit reimbursement for meaningful interventions that focus on recovery and help to reduce symptoms. Ms. Power stated that CMHS has initiated contact with CMS and described Rhode Island’s successful shift from day treatment to recovery-based services. She noted that the process must include state authorities and acknowledged that CMHS and other agencies must recruit collaboration with consumer/ survivors more actively. Mr. Brock suggested that CMHS take on a greater role in CMS’s systems change conference focused on home and community-based services. Judi Chamberlin, National Empowerment Center, suggested adding the mental health consumer voice to policy discussions on disability. Because accessing treatment may result in mandated treatment it is also critical to retain discrimination in discussions of stigma. Mr. Fricks noted that Georgia’s mental health consumer affairs office addresses stigma particularly among racial and ethnic minorities with mental illnesses. Old Business
SAMHSA Priorities Matrix Report: Criminal Justice In 1998 CMHS initiated a Knowledge Development Application program to study the effectiveness of pre- and post-booking diversion programs. The final report will describe the significant system-wide impact of those projects, including, for example, Connecticut’s data leading to establishment of statewide diversion programs, Maryland’s program to educate incarcerated women on child abuse, and Memphis’s crisis intervention team (CIT) approach that now serves as a model for 50 other programs nationwide. In 2002 Congress funded SAMHSA/CMHS’s targeted capacity expansion for jail-diversion programs and DOJ’s mental health courts program, and the two agencies began to work together, with technical assistance from the GAINS Center’s new Technical Assistance and Policy Awareness (TAPA) Center for jail diversion programs. Mr. Brown noted that the GAINS Center is planning a national conference for 2004 and distributed materials designed to disseminate learnings, for example, about improving data systems, creating integrated service systems, dealing with Medicaid benefits for jail detainees, and blending funding to pay for diversion programs. He stated that the goal is to change people’s attitudes and to provide technical assistance to help communities implement these programs nationwide. David Morrissette, D.S.W., L.C.S.W., Social Science Analyst, CMHS, observed that the best strategy to help persons with mental illnesses avoid incarceration is to address their real needs up front. Jail diversion diverts individuals with severe mental illnesses (SMI) in contact with the justice system and generally provides linkages to community-based treatment and support services. The process involves many agencies that historically have not worked well together. The types of diversion are pre-booking, post-booking, and specialty courts (such as mental health courts). Dr. Morrissette referred to the website http://gainscenter.samhsa.gov for additional information. For people who are incarcerated, SAMHSA can provide training and technical assistance, but cannot offer direct services. In 2002 SAMHSA held a technical assistance program for the mental health and substance abuse directors of state criminal justice programs in conjunction with the National Institute on Drug Abuse and the GAINS Center. Re-entry into the community is a new area of collaboration among mental health agencies and prison/jail authorities, which have differing language and goals. SAMHSA is developing partnerships with DOJ and other agencies to learn and teach how to participate better in the criminal justice system, and to influence policy on how to assist prisoners to re-enter the community. The GAINS Center has published materials on re-entry. The Community Action Grant program helps to create support among key stakeholders to import and implement effective criminal justice practices into many of their communities, including CITs, development of forensic standards, and police training. Discussion. Mr. Brown explained that CITs focus on police diffusing consumers’ problems and trying to resolve issues nonviolently and with treatment before escalation into arrest or appearance in court occurs. Mr. Brock raised the issue of jails as the new mental institutions. Dr. Morrissette asserted that prison authorities are not interested in becoming that institution, but rather want to deal with what comes their way. Mr. Brown noted that CMHS historically has supported alternative programs and services, stating that consumer-operated diversion programs might be possible. SAMHSA Priorities Matrix Report: Mental Health Courts NAMI will work with the Council of State Governments and the GAINS Center to gather data for mental health courts. Characteristics of the courts are recognition of the need for alternatives to incarceration, a goal to get people into services and keep them out of jail, and specially trained legal personnel who work together with a common understanding of the issues and people. Some courts have relaxed procedures and informal hearings, and they may involve family members, friends, and advocates with the individuals’ consent. Judges may act more like social workers. Controversy exists over the necessity for a guilty plea, which results in the double stigma of a psychiatric label and a criminal record. Participation is nominally voluntary, but potentially coercive, and some persons plead guilty to a crime they did not commit to gain access to services. Mental health courts differ from drug courts, which are inflexible regarding abstinence. Mental health courts keep people with mental illnesses out of jail; judges serve as advocates for community services; courts are more effective than drug courts for people with co-occurring disorders; judges often implement person-centered interventions, pay more attention to cultural competence issues than typical courts, and facilitate smoother interactions among systems. Research in Florida shows that people perceive mental health courts as far less coercive than traditional courts, and outcomes are promising in terms of reduced recidivism, participation in services, perceptions of participants, and development of service plans. Tammy Seltzer, Esq., Staff Attorney, Bazelon Center for Mental Health Law, questioned what will be the role of mental health courts in a situation in which people with SMI are arrested twice as often and stay longer in the criminal justice system than people without a mental disorder for the same behavior. The Bazelon Center believes that preventing contact with law enforcement for people at risk of such contact is where communities should focus attention. A Bazelon survey found that mental health courts can be punitive, instead of addressing noncompliance or relapse as a treatment issue and using incentives to remain with a program. Collateral consequences include the trauma of arrest, booking, detention, and conviction; stigma; the effect on eligibility for housing, employment, public benefits, and family relations; and intrusion into one’s life that can be longer and harsher in the criminal system. In mental health courts, supervision can be longer for compliance in a complicated order, and some have no set guidelines for treatment. Positive strategies include providing good mental health services and supports, diverting as early as possible to avoid collateral consequences, and creating an integrated mental health service system. Research is necessary to show whether coercive monitoring systems are more costly than good services and supports, but it is expensive and inefficient for judges to act as case managers. Also judges make decisions without an attorney to advocate for defendants. Ms. Seltzer urged the mental health system to join with the criminal justice and corrections systems. Although mental health courts are a hopeful trend, Ms. Seltzer asserted that Bazelon has concerns about mental health courts’ operation and role. The courts are not appropriate for nonviolent misdemeanors because the individuals should not be in court in the first place. Ms. Seltzer stated that if mental health courts are used, they should be used for felony offenders, which is the current trend. Discussion. Mr. Fitts pointed out that family members and caseworkers have exerted pressure for mental health courts to achieve early diversion. Ms. Seltzer concurred, stating that pressure comes from people concerned with loved ones in jail and not knowing what else to do. Mr. Honberg urged consumers to advocate to use courts to help people who otherwise would be arrested. Ms. Seltzer suggested that consumer/survivors should ask whether or not there should be mental health courts, raised the issue of incorporating advance directives into the legal process, and stated that mental health and drug courts should remain separate, because mental illness is not an illegal activity. President’s New Freedom Commission’s Final Report: Goal 2. Mental Health
Care is Consumer and Family Driven In the developmental disability approach, self-determination involves the freedom and authority to make decisions, support as needed and preferred, responsibility to use public funding appropriately, and participation in the planning process. Under the Independence Plus Initiative, established in 2002 as the federal response to states’ evaluations of self-determination, states operationalize consumer direction under Medicaid funding, with technical assistance provided by the federal government. Ms. Crisp noted that Cash & Counseling offers a model to operationalize Medicaid to make self-determination work, for example, to hire a person to help with self-care or crisis management. The Independence Plus approach can inform the mental health arena in funding for such complex services as job training and preparation for employment, training supervisors to work with persons with developmental disabilities, crisis intervention, supportive drop-in services, peer support, and possibly self-advocacy and self-medication management therapy. The developmental disability community has trained providers effectively on how to deal with a person with a developmental disability. Ms. Crisp recommended advocating that state decision makers analyze the population of Medicaid-eligible individuals with primary or secondary mental health diagnoses and try to tailor services that could support them better. A state might focus on a disabled and elderly waiver and do a query on diagnosis codes, and then craft a demonstration that would show that, with appropriate intervention, training, and other supports, these options can save Medicaid money in lieu of hospitalization. She encouraged exploration of CMS Systems Change grants and a new round of Robert Wood Johnson Cash & Counseling grants, including in the request for funding services directly relevant to mental health consumers, for example, a component that would advocate for protection against forced treatment. Larry Fricks, Director, Office of Consumer Relations, DMHDDAD, Georgia Department of Human Resources, described Georgia’s Certified Peer Specialist program. Georgia’s governor worked proactively to change the Medicaid mental health system using the rehabilitation option to bill Medicaid dollars for peer support. The state’s consumer movement leadership advocated for a new billable service, peer support, that builds upon mutual support and trains CPSs in a set of skills that help people live independently, foster self-directed recovery, and take ownership of their lives. Under the rehab option, funding for peer support was accepted. Training and certification are required, and CPSs must have accountability. CPSs train, for example, on how to replace negative self-talk, how to set goals, and how to solve problems and work through fear. They write individual service plans based on building recovery skills that can move people out of day treatment. Mr. Fricks noted the website www.gacps.org. The 150 CPSs in Georgia have billed $10 million in three years for peer support. Following training and an examination, peers can earn revenue. A code of ethics, online technology, and state-supported continuing education bolster the new profession, and a new training program teaches front-line staff how to work with CPSs as agents of recovery. Under the rehab option, a new Medicaid provider has emerged that provides and bills for peer support. In Georgia nine peer support centers operate independently. They access multiple funding streams, including Medicaid and vocational rehabilitation. Jon Brock, Member, Subcommittee on Consumer/Survivor Issues, pointed out that President Reagan, during whose administration the Americans with Disability Act was passed, emphasized personal independence of Americans to develop their own lives—a thread that runs through the Commission’s report. Diminished funding for disability issues and cost cutting at all levels are the reality. The role of consumer/survivors is to make as much good come out of the Commission’s report as possible. Mr. Brock asserted that the only practical way to do this is to find ways to fund provision of services by consumer-providers, people who have experienced mental illnesses and treatment, and who are highly motivated change agents. The CPS experience embodies what must happen for funding: accountability, accreditation of organizations, and certified individuals. Carole Schauer, M.S., R.N., Consumer Affairs Specialist, CMHS, discussed how mental health consumer/survivors can benefit from the types of programs offered by CMS. CMS and SAMHSA recently convened a planning meeting to determine the feasibility of a self-determination initiative for people with mental health and/or substance abuse disorders and to formulate recommendations to SAMHSA leadership on how to advance a self-determination initiative. Experts on developmental disability, physical disability, and aging described their approaches, and consumers with mental health and substance abuse disorders described their perspectives on self-determination. Participants identified barriers to self-determination: a mental health service delivery system that has limited support for implementation of consumer-directed or self-determination services, that focuses on acute treatment and not on early intervention and ongoing recovery, that focuses on the coercive nature of treatment in which service providers lack a full understanding of the people they intend to serve, in which there is no acknowledgement in the formal system of natural supports in the community, where stigma and negative stereotypes endure, and in which consumers rarely participate in decision making on improvements to the delivery system. Participants’ major recommendation to SAMHSA was to exercise leadership in developing a self-determination initiative in partnership with other federal agencies, states, and local agencies. In a paradigm shift, on the systems level, policies must support recovery-based peer and community-based approaches with genuine involvement of consumers and families. On the collaborative level, the approach must encompass pooled funding sources, including Medicaid, block grant, and other funds to support purchasing arrangements that would fund a range of consumer-directed services. On the individual level, the approach must include policies that support consumers and families in making choices about the services they receive. Participants discussed the important themes of language and cultural differences among various constituencies, the necessity to consider the needs of young families with children, and the recognition that skills building and training will be necessary to foster consumer and provider readiness for a self-determination approach. The overall recommendation was for SAMHSA to develop a consumer-directed initiative together with federal partners, including CMS. The next step will be a meeting to develop the initiative to be recommended to SAMHSA. Language in the Commission’s report supports this initiative. SAMHSA/CMHS has contracted with Mary Ellen Copeland, developer of the Wellness Recovery Action Program, to prepare a train-the-trainer manual for public mental health systems and states, in collaboration with the National Association of State Mental Health Program Directors (NASMHPD) and others. The work will include developing a process by which states can implement self care training. Discussion. Ms. Schauer stated that recovery training will be broadened to include peer support—building skills for consumers to make choices and control their services. Mr. Brock, who sits on a CMS advisory board, suggested the systems change conference as a venue to promote self-determination among mental health consumer/survivors, and suggested that Mr. Fricks be invited to serve as a keynote speaker. Ms. Yokote urged a focus on data sharing among service systems. Public Comment Randy Bosin, Advocate, urged integration among disability assistance systems at all levels. He stated that persons with psychiatric disabilities receive significantly less Medicaid funding than people with developmental disabilities. Yvonne Smith, Recovery 2000, Board of NAMI DC, and Member, National Mental Health Association, cited the importance of peer support and the need for more consumer-directed services. She suggested language in grant and contract solicitations that requires applicants to demonstrate their consumer orientation, and tying funding to evidence-based practices, such as skill-based services. She cited the need for training in mental health courts and public defenders’ offices. Mr. Fricks noted the growing body of evaluation activity and results for peer support programs The meeting recessed at 5:05 p.m. and reconvened the following morning at 9:00 a.m. Discussion. Mr. Fricks discussed the entry of Habitat for Humanity into the mental health consumer arena with partners NAMI and NMHA. The local organization enlisted volunteers to build a house for a man with schizophrenia. National Advisory Council Agenda and Recommendations
Members identified the following topics of interest related to information technology: provide access to consumer/survivor approaches and programs; full range of views and responses; tips on/stories about the recovery process; searchable, rather than hierarchical, design; links to/finding guide for local information and services; and currency of information. Subcommittee members identified several additional priorities, including public funding for recovery-oriented mental health services that promote community integration and independence, similar to the level of services for which individuals with other disabilities currently are eligible; development and dissemination of information on how to establish CPS programs in states; avoidance of bureaucratic barriers in the CPS system; and working with NASMHPD on recovery-related issues. Public Comment Karena Bayruns, Technical Assistance Coordinator, National Mental Health Consumers Self-Help Clearinghouse, staff has spent time in contingency planning and thinking about how to conduct strategic planning for the long run if CMHS funding ends or is renewed on a year-to-year basis. She recommended that if consumer technical assistance funding continues, the funding cycle should be greater than one year. She expressed a preference for grant funding, rather than cooperative agreements, asserting that grant funding permits better service planning. Dan Fisher, M.D., Director, National Empowerment Center, urged the Subcommittee to address the funding crisis for technical assistance centers, which have a potentially important role in implementing the Commission’s recommendations. Although uncertainties make it difficult to plan for the future, consumers still are asking for assistance, which requires funds. Dr. Fisher also identified the issue of trust building in information dissemination to consumers, who seek a perspective separate from that of mental health professionals. He expressed concern that at least some technical assistance centers be funded. The National Empowerment Center has worked to actualize the shift to a recovery-oriented system and to develop materials to prepare consumers to be contributing members of boards and to develop linkages with other consumers and organizations. The center conducted a survey and submitted a paper to a journal on the positive influence of certain of its training materials in changing consumers’ thinking on the possibility of recovery—the first stage in systems change. Dr. Fisher noted that cross-disability work is ongoing. A “Recovery Reader” is in progress that incorporates the literature on PACE to show the existing evidence base. Discussion. On funding for technical assistance centers, Dr. Fisher noted his hope that the format will shift back to the Congressionally authorized three-to-five-year commitments. Mr. Fitts expressed concern that the centers will operate under cooperative agreements, and that reduction in their numbers would limit the unique perspective, experiences, and skills of each center. Dr. Fisher stated that he had many opportunities to educate his fellow commissioners, reflected by the degree to which recovery and the technical assistance centers appear in the report. He observed that the centers represent a link to the federal level, raised people’s awareness of the Commission, and raised the number of e-mail responses and personal testimonies. Dr. Fisher urged that the consumer issues report of the Commission, a valuable resource document, be disseminated in a timely manner. He acknowledged the contribution of the Alternatives conference to break through consumers’ isolation. He does not support the cooperative agreements, which he believes will constrain consumers’ work. Ms. Maceira-Lessley echoed the need for training for board membership, and Dr. Fisher pointed out that education can help improve the receptivity of nonconsumers. In the future Dr. Fisher hopes to collaborate with the California Network of Mental Health Clients to provide technical assistance to other states, particularly on how to build a statewide group with geographical and minority representation. He also plans to develop materials for training boards and to engage in cross-disability work, including cross-training, to investigate how independent living centers can serve as a bridge between people in the mental health system and the community. Sherry Jenkins Tucker, Consumer Organization and Networking Technical Assistance Center, expressed hope for a return to grant funding and longer-term funding for technical assistance centers. Time spent closing out grants is challenging, although CONTAC is conducting business as usual. CONTAC is enhancing its website, improving its Leadership Academy manuals, and working on WRAP training and its nonprofit governance materials. CONTAC found the most recent RFA to be less consumer-driven and more prescriptive. CONTAC supports continuing Alternatives conferences. Discussion. Dr. Caras noted that a November meeting will be held in California
on how to implement the Commission’s report and invited Subcommittee input.
Ms. Lawrence stated that funding uncertainties regarding the technical assistance
centers adds to consumer/survivors’ stress. Fiscal sustainability is a complex, high-priority aspect of the program, toward which sites devote the first year to developing collaborative relationships and planning. Since 1993, 85 agreements have been funded, and graduates share knowledge of best practices. A new round of sites is to be funded as cooperative agreements. Matching nonfederal monies are required, in increasing amounts each year that reflect true collaboration and buy-in from participating agencies. The social marketing campaign aims to reduce stigma associated with mental illnesses and promote mental health; use social marketing strategies to help increase the likelihood that children and youth can receive appropriate care; and increase awareness of the need for services among stakeholders, how systems of care can help, and how to use social marketing with funding bodies to promote sustainability. Strategies include a template for strategic planning for sites; evaluation to determine how social marketing is helpful in achieving sustainability, a communications academy, and sharing best practices to raise awareness at the local level. A national Systems of Care portfolio of materials to use with organizations includes revised mental disorder fact sheets, a guide for families to take a leadership role in Systems of Care, a best practices guide, a series of Systems of Care vignettes to show its impact on various communities, and PowerPoint presentations with national data that is useful in sustainability efforts. Existing materials on mental health awareness will be updated, including materials tailored for Spanish-speaking and Native American communities. Ms. Rubenstein described a variety of mechanisms for feedback and evaluation, and solicited Subcommittee input on collaboration opportunities with the Safe Schools/Health Students Initiative and EBI. Paolo del Vecchio, M.S.W., Associate Director for Consumer Affairs, CMHS thanked Mr. Fitts, Ms. Lawrence, and Josie Romero, M.S.W., for their contributions during their tenure on the Subcommittee, and thanked Mr. Fricks for serving as Subcommittee chair. As background on the EBI, Mr. del Vecchio discussed data from the upcoming National Household Survey of Drug Use and Health and their implications for public education and addressing discrimination and stigma. The survey found that 17.5 million adults with SMI live in the U.S., 8.3 percent of the population. High percentages were females and younger adults. Of these people with SMI, 50 percent smoke and 29 percent use illicit drugs, and 4 million people have co-occurring issues. The survey found that of the 17.5 million adults with SMI, 48 percent receive some sort of treatment, 40 percent felt they needed no treatment, and 20 percent wanted treatment but could not get it. The main reasons for not accessing services were cost (50 percent), stigma (28 percent), unawareness of services (26 percent), and fear of involuntary commitment or forced medication (9 percent). A 1996 MacArthur Foundation study of how people view individuals with mental illnesses showed that 38 percent were unwilling to be friends with a person with mental health difficulties, 64 percent did not want to work closely with a person with schizophrenia, and 60 percent did not want anyone with depression marrying into their family. The Surgeon General’s report cited violence as a key factor in promoting discrimination and stigma. A 1999 National Mental Health Association study showed that almost half of Americans believe people with mental illnesses to be more violent than the general public. Between 1950 and 1996 the number of Americans who described mental illnesses in terms consistent with violent behavior nearly doubled. Mr. del Vecchio presented a video on prejudice related to mental illness and solicited feedback. The EBI—a three-year effort to support and evaluate anti-discrimination and anti-stigma efforts in California, Florida, Massachusetts, North Carolina, Ohio, Pennsylvania, Texas, and Wisconsin—addresses barriers to treatment, employment, housing, and opportunity, and aims to promote acceptance of people with mental illnesses. EBI’s has roots in the Surgeon General’s statement that stigma is a central factor around why people do not recover, Healthy People 2010’s specific objective on stigma, and an acknowledgement by President Bush of the role of stigma. CMHS has produced anti-stigma materials and sponsored a Spring to Action meeting that led to support for the ADS Center to serve as an information clearinghouse and training provider. Additional efforts include teleconferences, a speakers bureau, and a developmental website. Other work includes roundtables on issues of older adults and stigma, and a study of historical issues related to mental health, public education, and awareness. Future activity may involve a large-scale national stigma-reduction campaign, if Congress appropriates funding. To determine strategically effective means to reduce stigma and discrimination, the $1.7 million annual EBI effort was initiated, funded through the Gallup Organization and its subcontractor, Vanguard Communications. The EBI conforms to the Commission’s recommendation to create targeted public education activities that reduce stigma and to focus on marketing for school and business communities. The EBI is based on intensive market research and targets the general public, employers, and high school educators. Mr. del Vecchio noted that Pat Corrigan’s research has shown that contact with persons with mental illnesses (fostered, for example, in CMHS’s dialogue meetings), public education, and reward/protest strategies (awards events/media watches) work to reduce stigma and discrimination. Some research shows a negative effect from protest strategies, however. Mr. Fricks noted that the Atlanta Constitution has reported that race relations in Georgia improve most when people work together, which supports consumers hired as providers. Mr. Brock added that stigma may be reduced when consumer providers work with the traditional mental health community. Mr. Fricks referred to the success in reducing stigma of Habitat for Humanity’s house built for a man with schizophrenia. Deanna Troust, Director, Vanguard Communications, explained that Vanguard is part of a multidisciplinary EBI implementation team that includes the Mental Health Association in Southeastern Pennsylvania, Al Guida, and evaluator James Bell Associates. In Phase I EBI offers to its pilot states materials targeted to the business community and school systems; technical assistance and training in spokesperson training, partnership development, and media relations; support in strategic communications planning; help with strategic partnerships at the national level; and support from the ADS Center. These activities offer states the opportunity to develop and test cutting-edge materials that address stigma and discrimination, and states roll out the EBI in communities by creating key partnerships at the local level. EBI’s social marketing plan systematically identifies audiences and channels, and recommends activities. Audiences that rose to the top were the general public, including opinion leaders and “influentials”; the business community; and high school administrators and teachers. A mass media campaign includes TV, radio, and print public service announcements, and drop-in articles for the broader print media and local publications. To reach the business community, a toolkit will be prepared for implementation by hiring managers and supervisors; CEOs will be encouraged to vest in the program; and a training program, fact sheets, and posters will be prepared. A similar system will be proposed for schools to be implemented by “helping professionals.” Possible contact-related activities include speakers’ bureaus supported by technical assistance. Phase II focuses mainly on the evaluation, which will document the implementation and identify evidence-based strategies for national dissemination and replication. It will track and monitor short-term outcomes (dissemination of materials) and training/technical assistance, and conduct case studies of implementation activities and operations. In Phase III EBI will involve national replication of products and activities based on evaluation findings, and an awards program. Next steps are to assimilate the feedback from eight state meetings, complete state marketing plans, kick off the technical assistance program, and develop materials for an early 2004 launch. Discussion. Dr. Caras questioned whether the Systems of Care program incorporates input from youth. Ms. Rubenstein responded that youth groups advise the program; several sites are developing films about issues from their perspective; and a youth track is presented at each meeting. Dr. Caras suggested that active consumer/survivor adults can serve as mentors. Ms. Yokote pointed out that transition programming requires attention; for example, teenagers with SED may not qualify for adult assistance without hospitalization. Ms. Rubenstein responded that CMHS has funded youth transition programs. Mr. Brock noted that consumer/survivors who experienced mental health treatment as a child/youth and parents who experience mental illnesses are an untapped resource. Mr. del Vecchio stated that CMHS supports statewide family network grants, designed in part to support youth in the states. Mr. Fitts cautioned that promoting all treatment as good treatment is problematic. Mr. del Vecchio asked for Subcommittee members’ input on effective messages. Dr. Caras noted reservations about the terms “stigma,” “elimination” of mental illnesses, “barriers” (instead of the concepts of integration and management), and “suffer”; cautioned that social marketing may raise demand for nonexistent community capacity. She suggested encouraging consumers to serve on boards, committees, and councils; to engage in volunteerism; and to make a place in the world beyond mental illness. Mr. Fricks expressed concern that the video perpetuates disability and urged moving to a strengths-based message, such as “people with mental illnesses enrich our lives” or the experiences of Habitat for Humanity. He also identified the need to engage certain organizations (for example, black churches) to change their views of mental illnesses to a strengths-based construct. Ms. Yokote identified the need for strengths-based messages to be heard in the business community. Laurie Ahern, Associate Director, Mental Disability Rights International, explained her organization’s international work to investigate abhorrent treatment of individuals with mental and developmental disabilities, to try to pressure governments to improve conditions, and to mobilize grassroots, disability, women’s, and consumer/survivor groups in this work. Adjournment. The next Subcommittee meeting will take place
on November 5, 2003, at The Carter Center in Atlanta prior to the 19th Annual
Rosalynn Carter Symposium on Mental Health Policy. A conference call will be
scheduled to discuss the agenda and format. The meeting adjourned at 3:05 p.m.
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