Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Butler Hospital Annual Meeting
Providence, Rhode Island
January 18, 2005
PowerPoint version
Attached is the text prepared for delivery; however, some material may have
been added or omitted at the time of delivery.
[SLIDE 1. Title slide]
I am delighted to be with you today, and so happy to be back in Rhode Island.
Rhode Island is a special place for me. I spent important years of my working life here, and I learned a great deal from the people I encountered. Many of you are in this room today. It is wonderful to see you again.
Thomas Wolfe wrote, “You can’t go home again.” Wolfe was a brilliant novelist, but I disagree with him on this point. I am always happy to come home to Rhode Island…to recharge my batteries…to renew friendships…and to rekindle the sense of passion and energy I experienced while serving here. Rhode Island is home to me in a way that is much more than just geography.
Part of what draws me back is the independent spirit of the people of Rhode Island. I know Rhode Islanders inherited their pioneering spirit from our State's Founding Father, Roger Williams…the great reformer and champion of personal freedom in the American colonies. Rhode Island—Roger Williams' "lively experiment"—was America's first working model of a genuine democracy. His legacy…the idea that every citizen should be free to control his or her own destiny…is just as important today as it was when the colony was founded.
This spirit is a motivating force for all of us involved in mental health care. Our goal is to empower every citizen with or at risk for mental illnesses to live meaningful, independent lives.
This spirit of independence is what I sought to foster when I served as the Director of Rhode Island’s Department of Mental Health, Retardation and Hospitals. It is the fuel that drives the work I continue to do today to ensure a rich, rewarding life in the community for the citizens across this Nation who are living with mental illnesses.
I am honored to be here today because of the spirit of one Rhode Islander, in particular—Lila Sapinsley—who has done so much for the people of Rhode Island, particularly those living with mental illnesses. No one is more dedicated to the well being of the citizens of Rhode Island, or more dedicated to Butler Hospital, especially its growing role as a teaching and research institution. Lila is a wonderful role model for anyone involved in community service and mental health care. I am deeply honored to receive this award named in her honor. It means more to me than you can imagine, and brings to mind something that Albert Schweitzer said that expresses my view of community service:
“At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted the flame within us.”
Through her tremendous efforts on so many fronts, Lila has lighted the flame for so many of us. We owe her a debt of gratitude. And each one of us, in turn, must be ready to light the spark for someone else. We cannot accomplish our goals entirely by ourselves. We must support each other.
In that spirit, I gratefully accept the Lila M. Sapinsley award—not only as a much-appreciated validation of my life’s work, but also because of the ideals it represents…the ideals of service…of caring for society’s most vulnerable…of working together as a community.
A deep desire to serve others…a desire to serve a higher power…lies at the heart of my approach to leadership. I ascribe to Robert Greenleaf’s servant leadership model—a practical philosophy built around the concept that true leaders are those who lead by serving others. Becoming a servant-leader begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead. According to Greenleaf, the best test of leadership is this: “Do those served grow as persons? Do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?"
I accept this award as an endorsement…as confirmation that, through my personal and professional efforts, I have worked to empower our society’s most vulnerable women, men, and children to live healthier, freer, higher quality lives. Today, in my role as Director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration (SAMHSA), I bring this philosophy to bear on a task of monumental importance: the task of transforming our national mental health system into one that can deliver the promise of hope of recovery to the millions of Americans we have the responsibility to serve.
This is a critically important task…one that neither I, nor SAMHSA, nor the Federal government, nor any individual or organization can accomplish alone. I am here, today, to enlist your help…as leaders in your own right…in making this vision of a transformed system a reality.
About a year ago, SAMHSA accepted a challenge from the Department of Health and Human Services to lead the Federal government in an unprecedented collaborative effort to transform our national mental health system into one that is truly consumer driven and focused on recovery. Our roadmap for change is the final report of the President’s New Freedom Commission on Mental Health, “Achieving the Promise: Transforming Mental Healthcare in America.”
Some of you may be familiar with “Achieving the Promise.” For those of you who are not, I have copies available for you today. I urge you to read it…and study it carefully. I believe it is the single most important document affecting the future of mental health care in this country!
[SLIDE 2. The Commission's Vision]
“Achieving the Promise” envisioned a transformed system in which every American, at any stage of life, would have access to effective treatments and supports—the essentials for living, working, learning, and participating fully in the community.
“Achieving the Promise” established six goals for a transformed system. As I describe them, think about how each one applies to the current status of mental health care here in Rhode Island. It will be your responsibility to make these goals a reality in this State. Think about how you can engage in this important work at your personal and professional levels.
[SLIDE 3. Goals of a Transformed System]
In a transformed system—
- Americans will understand that mental health is essential to overall health. What are you doing to create a healing environment here in Rhode Island…an environment in which people can seek care—willingly, openly, and with hope in their recovery?
- Mental health care will be consumer and family driven. An individualized plan of care will be an integral part of the approach. What constitutes a solid plan of care? Are these services adequate here?
- Disparities in mental health services will be eliminated. How are these disparities being addressed in your community? How are you meeting the needs of all groups equally? Could more be done?
- Early mental health screening, assessment, and treatment will be common practice. What additional steps can you take at your community and State levels to protect your children’s mental health and to improve their access to appropriate and timely care?
- Excellent mental health care will be delivered and research will be accelerated. What are you doing to promote evidence-based practices among your public and private providers?
- Technology will be used to access mental health care and information. How can you make better use of technology to ensure access to quality mental health care for all Rhode Islanders?
You may have noticed the report does not just call for change, but calls for “a complete transformation” of our mental health care system. What exactly does that mean?
It is important to understand what transformation will entail because each of us is critical to its success.
[SLIDE 4. Defining Transformation]
Transformation suggests profound change—a complete upheaval and reorganization of what we know, what we do, and how we go about doing it. This kind of change occurs at the very core of a system, not on the margin. Transformation is revolutionary. It is about new values, new attitudes and new beliefs. It leads to new behaviors and competencies. In transformation, we can do things we were unable to do before.
Transformation allows us to identify, leverage and even create new underlying principles for the way things are done. New sources of power emerge. Once the process of transformation begins, a profoundly different system materializes—a system changed in structure, culture, policy and programs. It is a very exciting process!
[SLIDE 5. The Transformation Equation]
What will it take to transform our mental health system? This is what I call the Transformation Equation. Transformation will require vision plus belief plus action…multiplied many times over by continuous quality improvement to the second power. Why is CQI squared? Because we must continuously ask ourselves if the resources and services we provide are effective and meeting the mark. We must continuously seek to improve. Without these elements, transformation cannot, will not, happen. Achieving the Promise has given us the vision. We have to complete the equation with belief…and with action.
[SLIDE 6. Steps Toward Transformation]
How do these exciting concepts translate into practice? How do we get from here to there? Transformation proceeds through a series of steps (Refer to steps on slide).
[SLIDE 7. Federal Partners]
I’m proud to say this process is well underway. During the past year, an executive team at SAMHSA has met with senior staff from 20 other Federal organizations to decide how we can jointly respond to the Commission’s report. The outcome of our effort is the Federal Action Agenda.
[SLIDE 8. Federal Groups Responsible for Implementing the Action Agenda]
This team of partners—our Federal Partners Workgroup—is responsible for overall coordination and implementation of transformation efforts government-wide, as well as for SAMHSA’s transformation-focused activities. SAMHSA’s Internal Matrix Workgroup on Transformation will spearhead progress in individual program areas, such as children and families or criminal justice. We also have created a Federal Executive Steering Committee. Formation of this group is an outcome of our Federal Action Agenda. This group is made up of senior administrators from the different agencies participating in the Federal Partners Workgroup. Members of this group are responsible for ensuring that resources are made available to carry out agency initiatives related to transformation.
The Federal Action Agenda responds to each of the 6 goals and 19 recommendations proposed in Achieving the Promise. However, it is not a universal, all-encompassing document. SAMHSA and our Federal partners made a conscious effort to set time-limited, realistic priorities for Year 1 of what we see as the first 5-year arc for transformation. The Action Agenda describes the first measurable steps that we will take over the next year to motivate, facilitate and compel change at the State and local levels and begin the process of transforming the Nation's mental health care system. We will develop new agendas, addressing new issues, as we make progress.
Effective acute inpatient care, an issue I know many of you are concerned about, is an essential component of a transformed mental health care system. Too often, it is the only doorway to treatment for many people with mental illnesses. Achieving the Promise identified Acute Care as one of the critical, although understudied, policy areas.
The report acknowledged that inadequacies of acute care span the country.
[SLIDE 9. Acute Care in the News...]
As the headlines illuminate, from Maine to Montana… Arkansas to Alaska…emergency rooms are filled with mental health patients. Psychiatric units are disappearing and leaving a shortage of hospital beds in their wake. And these shortfalls not only affect persons in a mental health crisis…they also seriously impact emotionally disturbed children in foster care programs as well as juveniles and adults with mental disorders in the criminal justice system who get stuck either inside or outside of “the system.” Acute care needs are everywhere.
Yet, Achieving the Promise discovered that, besides the gap in care, there is a gap in knowledge. The Commission’s acute care subcommittee concluded, “The policy path is unclear because we do not know enough about the problems associated with acute and crisis care.” To realize transformation in acute care, we need more information. We need to assess and quantify the needs for short-term, 24-hour care. We need to identify ways to pay for acute care that are part of a comprehensive system of care. We need standards for coordinating care between short-term, 24-hour services and non 24-hour community services. We need standards for determining the appropriate content of care and what constitutes effective short-term 24-hour care and treatment.
[SLIDE 10. The Charge of the SAMHSA Acute Care Workgroup]
In response to these needs, CMHS formed an Acute and Crisis Care workgroup in August 2004, which has brought together key stakeholders in the field to examine the knowledge base on acute care within our national mental health care system. In the next few weeks, we are expecting recommendations from this workgroup…recommendations that will be meaningful, measurable and actionable …recommendations that will move us closer to the transformed system we seek.
Our ability to transform our approach to acute care is certainly critical to mental health transformation. But I contend that we must take a broader view. Rather than asking, “What does transformation mean to me and my work in acute care,” I urge each of you to unite with others across the field to pursue a common vision of recovery.
[SLIDE 11. A Recovery-Focused System]
A recovery-focused system will see each individual as a unique human being—not just as a person with a categorical disability. It forces the dialog about care to revolve around the comprehensive services each person needs to promote his or her own recovery and to lead a full life in the community. It forces us to understand…and act on…the fact that having a job, housing, education, a fulfilling spiritual and social life is not separate from the need for treatment and trauma care.
We must take a holistic approach to meeting people’s needs. That’s when we will achieve a truly transformed system. This is a tall order! It will take all of us, working together, to achieve it.
As I accept this award—in the spirit of Lila Sapinsley—I am asking for your help in this effort. We need you to advocate for transformation, to explain why it is needed, and to show that it can be done.
I urge you to follow Teddy Roosevelt’s advice—“Do what you can with what you have, where you are.” Don’t wait until you can do everything to do anything. The first step is to be aware of the need for change…and to begin the process…in whatever ways you can.
[SLIDE 12. What You Can Do To Advance Transformation]
Start by reading the Report. Immerse yourself in transformation literature and successful stories. Describe your vision of a transformed system and drive toward this vision. Spread the word that recovery is possible!
Recognize that you have a unique and powerful voice—you are mental health professionals with credibility and stature. People will listen to you.
Develop relationships with individuals who have the authority to make things happen. Set out to change minds in every conversation you have and put mental health on the agenda. One of the most critical contributions you can make will be to leverage your national, regional, and local relationships. Make the case to your legislators that mental health and transformation must become a priority. Push to keep mental health care at the forefront of your State policy priorities.
Earlier I suggested that you appeal to people in authority. But, I caution you: do not confuse being in a position of authority with leadership.
Each of you is a leader. Each of you can empower others to become leaders. But you must first think of yourself as a leader…and identify and articulate your own leadership philosophy…before you can guide and encourage others to exercise their potential for leadership.
I urge each of you to ask yourself, “what are the qualities of leadership that resonate with who I am.” Then begin to act on these qualities. Take action to achieve your mission and to take care of those you seek to lead.
Stephen R. Covey said this in his writings on "Servant-Leadership and Community Leadership in the Twenty-First Century:" Anyone can be a servant-leader. Any one of us can take initiative; it doesn’t require that we be appointed a leader, but it does require that we operate from moral authority.
Each of you has the moral authority to help lead this transformation. Each of you can apply your particular and rare gifts to realize the possibility in this moment. Each of you has a responsibility to deliver the message of hope and recovery across this Nation. Like Lila Sapinsley has done for so many people, for so many years, each of us has an obligation to ignite the spark for those whose light is waning.
Today, I hold this award in trust for its true owners: all those who are committed to creating the mental health system we want, the system millions of Americans deserve.
[SLIDE 13. You have the power to ignite the flame of transformation across Rhode Island.]
You have the power to light the flame of transformation here in Rhode Island. Today, we can become agents of transformation. Thank you.
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