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
California Mental Health Policy Forum
The Mental Health Services Act:
A New Vision for California
San Diego, CA
February 10, 2005
Mental Health System Transformation:
Changing Lives in California
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]
EUREKA!
It’s been said that frenzied gold seekers from around the world used this Greek term for “I’ve found it,” when they invaded California in the late 1840’s seeking to change their lives and fortunes. The Gold Rush, and the forces it unleashed, forged a new California…a new world…with new horizons and opportunities.
“Eureka" became California’s official State motto in 1963. But, some 40 years later, Eureka! remains a fitting opener for our conversation. This morning, I want to talk to you about the new world in mental health care—one we are exploring together—in our quest for the new currency of hope and recovery for millions of Americans here in California and throughout the Nation.
I am truly delighted that one of my first engagements of the New Year is to be here with you to celebrate the passage of the Mental Health Services Act in November 2004! The California Council of Community Mental Health Agencies (CCCMHA), Service Employees International Union, and the broad coalition of consumer and service organizations—you in this very room—are to be congratulated on this significant achievement. Inspired by your advocacy and passion, 53 percent of Californians voted for, and passed Proposition 63, a referendum that will provide an estimated $800 million in additional funding for community mental health services in the State.
I want to thank you for coming together in that same spirit of collaboration to create a vision for the implementation of these funds. The California Institute of Mental Health, under the leadership of Dr. Sandra Naylor Goodwin, the California Mental Health Directors Association with Patricia Ryan as Executive Director, the half-dozen co-sponsoring organizations—each one of you is to be commended. Your participation provides evidence that you truly understand the importance of collaboration. Together you are making transformation come alive here in California.
I thank you for braving this new world in mental health care with foresight—just as the first Californians explored the new territory long ago. Our reward will not be paid in gold, but in something much greater—the millions of lives changed by a system that gives consumers a sense of hope…a system that gives them back their lives…and their dreams.
I am honored to follow Dr. Steve Mayberg, a good friend and wonderful colleague. Steve’s work on the President’s New Freedom Commission on Mental Health has laid a strong foundation for the work we now embark on together. Today, his message has aptly set the stage for the remainder of this forum…challenging each of us to live up to the promise of creating a new vision for California and our National mental health system.
[SLIDE 2. Achieving the Promise]
As you know, about a year and a half ago, the President’s New Freedom Commission on Mental Health released the report, Achieving the Promise: Transforming Mental Health Care in America. Achieving the Promise confirmed that our society…our system…is not meeting the needs of millions of our citizens with mental illnesses. Achieving the Promise declared that our mental health system is disconnected and struggling to meet the needs of the consumers and families it serves…that the time has long passed for yet another piecemeal approach to reform. The report reached a bold conclusion: we must fundamentally transform our Nation’s approach to mental health care.
The task of transforming mental health across the entire United States is no less than monumental. But fortunately, Achieving the Promise provides us a vision of transformed mental health care along with 6 broad goals for achieving this vision.
As I describe the goals, I urge you to think carefully about how each one applies to the current status of mental health care here in California. It will be your responsibility to make these goals a reality in this State.
[SLIDE 3. Goals]
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 California…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 in 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. Our world is changing demographically and dramatically. Nowhere is this understood more clearly, or felt more keenly, than here in California…where one in every four residents was born outside the U.S. I know you have been working on this issue for many years. I am impressed to learn that every county in the State has developed a cultural competency plan…a plan that includes an assessment of their communities’ specific needs and how to address them. This work to reduce disparities and outreach to special populations is going on all across the State. I firmly believe this is just one of the areas where you are already leading other States on the journey toward transformation. But, could more be done?
- Early mental health screening, assessment, and treatment will be common practice. Promoting and caring for the mental health of our children is extremely important to the future health and well being of our communities. Again, California is already leading the way—the Mental Health Services Act dedicates resources specifically for early intervention and prevention services. 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. I know that California is already making great strides in this area—for example, CIMH has already identified more than 100 effective cultural competence practices and is working tirelessly to shorten the gap between science and service. I urge you to ask and answer, “What other important practices need to be identified and widely disseminated to create the transformed system we envision?”
- 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 Californians?
The Report also identified specific recommendations for achieving each of the six transformation goals. These goals and recommendations present the idea of transformation as a new paradigm for moving forward in the coming years.
[SLIDE 4. What is Transformation]
What exactly do we mean when we say “transformation?” With a show of hands—would you say “transformation” is a synonym for change? (Pause) For reform? (Pause) For modernization? The truth is, you are all right. Even those of you who didn’t raise your hands are right…because “transformation” embodies all of these concepts…and yet, it entails so much more.
The word transformation appears 11 times throughout the pages of Achieving the Promise. While the Report provided a clear vision of a transformed system, it did not clearly define transformation…or provide a specific blueprint for achieving it. The challenge, for us then, is to come to consensus on what we mean by transformation of the mental health care system…and then, to chart a course toward this vision.
Our first inclination might be to look across the field for examples of how this has been done. But, there simply are no examples of change of this magnitude…across whole systems and affecting every dimension of care…in all of healthcare. It becomes imperative for us to look to other fields for help with how to define…as well as how to operationalize transformation.
In a recently-released report, Concepts of Transformation, author, Noel Mazade examines theories and operational definitions from other fields to conceptualize transformation.
In the report, Mazade examined the National Aeronautics and Space Administration, NASA, and found that this Agency approached “transformation” as a way to “eliminate its stove pipes, promote synergy across the Agency, and support its long-term exploration vision in a way that is sustainable and affordable.”
Mazade looked at the Department of Defense, a major proponent of transformation, and discovered an organization whose vision of transformation involved the “process of changing the form or structure of the military forces…and the nature of military culture.”
In the field of information technology, Mazade found that transformation is viewed as “a process of continuous evolutionary change driven by the dynamic needs of the enterprise.” In the energy field, he discovered that transformational activities typically focused on a process…a process in which energy efficiency innovations are introduced into the marketplace and, over time, they penetrate that market. This kind of market transformation is a complex and dynamic phenomenon that relies on ongoing change to ensure that innovations “stick”…that the market doesn’t regress to lower levels of efficiency over time.
What do these diverse industry views of transformation have in common? In every case, “transformation” involves a deep…and profound…and continuous process along a continuum of innovation—a process without end!
As these examples illustrate, transformation is not simply a fancy word for reform. It is far more encompassing than that. Transformation is not merely a synonym for modernization; it is much more than the process of improving current capabilities. Transformation certainly involves change; but change, alone, speaks to the predictable and possible.
Instead, Mazade says, transformation is “imbedded in the unpredictable and the impossible. Transformation is life altering. It is the way we create something completely possible from the perceived impossible.
One theory suggests that we learn about the world by navigating in three realms: what we know…what we don’t know…and what we don’t know we don’t know. Change occurs in the first two realms. Transformation occurs in the third. Mazade says to get there, “we must suspend certainty and receive the impossible.”
[SLIDE 5. Defining Transformation]
Transformation, then, is revolutionary. It implies profound change—not at the margins of a system, but at its very core. Transformation assumes the need for a fundamental shift to another level of thought and action. In transformation, new sources of power emerge. New competencies develop. We look at opportunities and challenges, with the bright eyes of a child…as we are seeing them and all of their possibilities for the first time. We look for what we can do now that we couldn’t do before.
[SLIDE 6. Steps Toward Transformation]
Transformation does not happen overnight. It unfolds in a series of steps (Refer to “Steps Toward Transformation” listed on slide).
[SLIDE 7. Transformation Equation]
What will it take to transform our mental health system? This is what I call the transformation equation. Transformation equals vision, plus belief, plus action…multiplied by continuous quality improvement to the second power. Why is CQI squared? Because we must continuously ask ourselves if the resources and technical assistance 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. Each of us must complete the equation through personal action. Each of you is critical to this undertaking. Transformation cannot happen without you. You are the true center of gravity for transformation!
Achieving the Promise gave enormous responsibility for transformation to the States. This is where we have the opportunity to impact the greatest number of lives. This is where Achieving the Promise will come to life. This is where we have the opportunity to impact the greatest number of lives. This is where Achieving the Promise will come to life. The speed of transformation will be up to you. How much we can achieve within the short-term will depend largely on how much time and effort you are willing to invest. You have the power to ignite the flame of transformation here in California!
And it appears you are using that power well! I am inspired by how far California has come in its own transformation. The passage of Proposition 63 is a testament to your fortitude. Importantly, the Mental Health Services Act and the New Freedom Commission Report are wonderfully aligned. At its core, the Act is really about transformation. The additional funding from this Act will provide a springboard for transformation…but with a few critically important caveats.
The transformation that will ensue here in California must not simply throw new money after old. Transformation in California should not be about getting “bigger,” in the number of programs and services offered, but about making services “better” in their quality and effectiveness. Transformation of your mental health system must be focused on a change in structure, process, and pattern that inspires forward thinking and progress! Like Achieving the Promise, the Mental Health Services Act focuses on building a system of community-based mental health services that will support the comprehensive needs of your citizens across the lifespan.
Indeed, you are already applying three very important principles of Achieving the Promise here in your State. Your efforts are firmly focused on creating a transformed system of care that is consumer-driven…that embraces promotion and prevention…and that delivers on the promise that recovery is not only possible, it is the expectation!
[SLIDE 8. Recovery]
I’ve talked about the transformation vision. Now I want to spend a few moments on the concept of “recovery” because it is equally powerful. It is why your work to develop a new vision throughout the State is so imperative.
I know you are working very hard to develop a recovery vision, and I commend you for including consumers and family members in every aspect of crafting this vision.
And who better to direct the vision of recovery? Recovery is the vehicle through which consumers lives are transformed. Recovery does not necessarily mean, “cure.” Recovery is a process...a continuum of personal achievements as each person moves toward his or her greatest potential. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms. For many, it means finally being able to help make important decisions affecting their own lives.
The expectation of recovery for everyone changes our entire perspective on how we view and provide care, from birth to death. A recovery-focused system sees each individual as a unique human being—and not just as a person with a categorical disability. It focuses on the overall health of the whole person, and accepts the mind and body as inseparable and integrated. It forces the dialog about care to revolve around the comprehensive services each person needs to promote his or her recovery and to lead a full life in the community.
Perhaps the most compelling element of a recovery-focused system is the belief that people with mental illnesses can take charge of their own lives, their own wellness, and their own care. This single belief has extraordinary implications for transforming mental health care. It demands change—from Federal and State agencies to the people we serve. Each of us must have the capacity, as well as the willingness, to become equal partners in determining care.
Transformation is a truly collective endeavor. I am here to assure and ensure you: I will support your efforts with every resource at my disposal! Transformation of our behavioral health system is not a task that any organization…or State…or Federal Agency could accomplish on its own.
SAMHSA has a clear role to play. The Department of Health and Human Services has charged SAMHSA with leading Federal efforts to implement all of the Commission’s goals and recommendations—to make certain that we do, in fact, “achieve the promise.” I’m proud to say this process is well underway.
[SLIDE 9. Federal Action Agenda Partners]
During the past year, an executive team at SAMHSA has met with senior staff from 20 other Federal organizations to decide how we can respond jointly to the Commission’s Report. We began by conducting an exhaustive inventory of programs and funding that each agency already had in place. By organizing our inventories around the Report’s six goals, we were able to identify ongoing programs that already supported transformation. These are programs we will maintain and enhance. We also were able to determine where we could collaborate on new initiatives to support transformation or better align existing ones. This process has resulted in a Federal roadmap for change, which we call our Federal Action Agenda.
Although not yet publicly released, our Action Agenda responds to each of the 6 goals and 19 recommendations proposed by the New Freedom Commission. Our agenda, however, is not a universal, all-encompassing document. SAMHSA and our Federal partners made a conscious effort to set time-limited, realistic priorities for year one of what we see as a 5-year arc for transformation. We will develop new agendas, addressing new issues, as we make progress.
One of our first steps is to invest additional resources in transformation. In fiscal year 2005, $20 million dollars are committed for State Incentive Grants to promote mental health transformation at the State level.
The Mental Health Transformation State Incentive Grants, or SIGs, will provide seed money for States to develop the infrastructure they need to transform their service systems. States, for example, can use funds to develop their policies and organizations, to train their workforce, or to implement quality assurance mechanisms. These grants will provide an unprecedented opportunity...one that will help States develop their own vision of a transformed mental health system.
[SLIDE 10. Key Transformation Activities]
The SIGs are a critical first step; however, many other transformation activities are underway across SAMHSA and our Nation. We are already—
- conducting a comprehensive evaluation of the mental health workforce, including an inventory of how cultural competence is being addressed in behavioral healthcare training programs;
- launching the National Action Alliance for Suicide Prevention to coordinate national efforts to prevent suicide;
- developing a prototype of individualized plans of care that promote recovery and resilience;
- expanding the science to service agenda;
[SLIDE 11. Key Transformation Activities, cont.]
- developing new toolkits on specific evidence-based practices;
- initiating technical assistance on recovery and resilience;
- providing technical assistance to help States develop comprehensive State Mental Health Plans;
- educating Medicaid and other public and private payers about the practicability of supporting evidence-based mental health services.
We are moving steadily and deliberately forward with transformation at the Federal level. I am happy to report that nearly every State has begun the work of transformation. Some are further along than others. Along with California, Nevada and South Carolina are two examples of States who have vigorously embraced the work of the Commission. The Nevada legislature has passed a law that mandates the creation of the Nevada Mental Health Plan Implementation Commission, a group tasked with formulating strategies to move the State toward the goals laid out in Achieving the Promise. South Carolina has appointed a proviso committee to make recommendations to its General Assembly on how to best incorporate all six of the Commissions goals into its State mental health plan.
The wheels of transformation are turning well here in California. Despite the economic climate, you have made considerable progress. Even with an influx of funds from the Mental Health Services Act, California will still have a deficit. You are in the unenviable position of having to reduce existing programs, while mounting this campaign to transform your system and increase services in a different direction. Transformation in this State will require a delicate and complex balancing act.
Change…reform…and ultimately, transformation of the system here in California is a process…one that will proceed in fits and starts. There will be bumps along the road. Change of this magnitude is inherently messy. But I want you to know I am impressed with your willingness to take on this task. I know you will not be deterred by the challenges.
Despite the obstacles, your political victory is a win for all Californians…a victory worthy of celebration. It also represents an opportunity to refocus your energy on the new vision and the tremendous work ahead. I urge you to use this opportunity to establish the necessary infrastructure to support long-term systems change.
[SLIDE 12. What You Can Do]
I would like to suggest a few ways you can begin to lay the groundwork for this monumental change—
- Use what you will learn at this forum to help your mental health authorities, legislators, communities, and citizens at large understand what is involved in developing a comprehensive State mental health care plan that is consumer-driven and focused on recovery.
- Work to achieve the broad-based involvement necessary to create a comprehensive plan. Involve consumers to the greatest extent possible. There is no one more qualified than a consumer and his or her family to determine the kinds of care that is needed.
[SLIDE 13. What You Can Do, cont.]
- Build public support for transformation! You have a head start with Proposition 63, but your mental health authorities will continue to need you to advocate for expanded services and funding on their behalf. As advocates, you can help shape State and local priorities by generating the community feedback and data that can influence these priorities.
- Provide a public forum to discuss which mental health services and supports focus on recovery. For example, help Californians understand that supported employment is far more effective (both clinically and economically) than day treatment for helping to build a person’s life in the community.
- Encourage government officials to promote the use of evidence-based practices. We know that evidence-based practices help give to consumers genuine hope for optimal recovery and fulfilling lives beyond mental illnesses.
[PAUSE]
California has the vision…the resources…and the resolve to advance transformation. What California, and every State and territory stand most in need of today are leaders …transformational leaders who can come from any walk of life…from any sector…with any type of experience.
I see from your Agenda that you share my commitment to building the leadership of transformation. The session later today on leadership during times of momentous change is a critical one. Effective leadership is critical to the success of a transformed system!
I know you will delve into this concept in more detail later, but I’d like to leave you with these thoughts.
[SLIDE 14. Essential Elements of Transformation]
Experts have defined five elements as essential to large-scale transformative change:
- vision – a shared image for the desired future state;
- alignment – of system structures and processes;
- culture – the environment of ideas and possibility needed to spur success;
- continual process – the understanding that transformation is an ongoing and permanent state, and
- leadership – the capability to develop a compelling vision and the skills to organize and manage its implementation.
While all of these elements work together, I suggest to you that without effective leadership, none of these elements will fully flourish. Leaders determine the direction of organizations. They have the ability to resolve issues and problems. Leaders guide, direct, and influence others to bring about fundamental change.
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. A deep desire to serve others…a desire to serve a higher power…lies at the heart of my approach to leadership.
You are also leaders. You can empower others to become leaders. But you must identify and articulate your own leadership philosophy before you can guide and encourage others to exercise their potential for leadership. 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.
Anyone can exercise the principles of leadership. You don’t necessarily have to be in a position of authority to be a leader.
Every woman and every man in this room has the power to take a leadership role in this great movement we are undertaking. Leadership is our duty…it is our responsibility… it must be our cause…because persons living with mental illnesses deserve a brighter future…they deserve the opportunity for recovery…they deserve to live a life…a FULL life…in their communities—and nothing less.
One view on leadership that I think is very appropriate to our discussion comes from an unexpected source, Marian Anderson—a trailblazer in her own right—who among other things, was the first African American to sing at the Metropolitan Opera.
[SLIDE 15. Marian Anderson quote]
This great American change-maker said once, “Leadership should be born out of the understanding of the needs of those who would be affected by it.”
I ask: Are you using your current knowledge to provide leadership within the systems you operate? Can you gain a greater understanding of the needs of those you serve in order to become a more effective leader?
Each of us is empowered to lead. Each of us has an important perspective and understanding to share. I urge each of you to consider how you can develop this essential ingredient of transformation within your organizations …within yourselves. With your leadership, you can ensure that the nearly 2 million citizens in California—children, adults, and seniors—that are affected by mental illnesses can live by your inspiring State motto and say, “Eureka! I’ve found it…my hope…my life…my recovery!
Thank you.
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