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

Welcome Remarks
Data Infrastructure Grantees (DIG) Annual Meeting

February 14, 2006
Baltimore, MD

PowerPoint version

Good afternoon. Thank you for that kind introduction, Dr. Berry. I’m pleased to be here this afternoon so that I can encourage this accomplished group of data analysts and planners to apply their talents, expertise, and knowledge to one of the most vitally important tools for transformation―databased decision-making.

Baseball legend Yogi Berra once said, “If you don’t know where you’re going, you might end up someplace else.” Yogi had a notoriously amusing way of expressing himself, and in this case, for stating the obvious. But inside Yogi’s words there lies a lesson that—however obvious—is too seldom applied. Too often, policy and program decisions are made without a clear goal or without sound information on which to base decisions. In terms of mental health transformation, we know where we want to go. Our destination is a community-based and consumer-driven system focused on recovery. Our challenge is to determine the best route to reach it, with data analysis and planning providing the direction.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has been pushing forward aggressively with the transformation agenda. Since we met last February, we’ve made significant progress in many areas. Nine Federal departments, the Equal Employment Opportunity Commission and the Social Security Administration now are represented in the Federal Partners Workgroup for Transformation.

SLIDE 1 -- Listing of the Federal Partners

The U.S. Departments of Agriculture, Transportation, the Equal Employment Opportunity Commission, and Defense are the most recent members. They join the U.S. Departments of Health and Human Services, Education, Housing and Urban Development, Justice, Labor, and Veterans Affairs, as well as the Social Security Administration.

There is a reason for such broad representation. Each of these departments and agencies plays its own distinctive role in promoting and protecting the mental health of our citizens. Consider the U.S. Department of Defense. Most service members have sound mental health and an inner resilience that enable them to deal successfully with combat-related stressors and trauma. We select and train our military personnel well. A recent study published in the New England Journal of Medicine confirms this. Fewer than 20 percent of U.S. troops returning from Iraq and Afghanistan experience serious symptoms of depression, anxiety, or post-traumatic stress disorder.

This percentage represents a significant decline in mental health disorders when compared with prior engagements, such as Vietnam. About 30 percent of Vietnam veterans developed PTSD at some point after the war. I credit the military’s growing appreciation of mental health status and its focus on mental health care for this decline. The Department of Defense now requires that every service member be briefed on mental health before, during, and after deployment. DOD’s policy embraces the full spectrum of necessary mental health care, from prevention of mental illnesses through treatment and recovery.

Each Federal and State organization that affects the lives of children, families, and adults plays a part in ensuring that all Americans are able to have a full and productive life in their community. For those individuals who have a mental illness, each organization plays a part in ensuring that they have access to the variety of services that will help them achieve and sustain recovery, whether it is a home, a job, or transportation so that they can access the services. The Federal Partners Workgroup reflects a genuine government-wide commitment to achieving real progress in mental health care service delivery. The workgroup also is a perfect example of the critical collaboration called for to develop and drive the systemic change needed for transformation.

Successful transformation will require collaboration across and between all levels of government, across agencies, between the private and public sectors, between service providers and consumers and their families. Collaboration is the lifeblood of the transformation process.

SLIDE 2 – Transformation Will Require Simultaneous Work Across Many Areas of Performance

One of the first actions of the Federal Partners Workgroup was to form a Federal Executive Steering Committee. The committee includes individuals at the highest level of their agencies. These senior-level personnel have assumed the responsibility of ensuring that resources will be available so that transformation activities promised by their agencies will take place.

SLIDE 3 – The Federal Action Agenda: Fundamentally Altering the Mental Health System

What are the promised activities? Last July, we released Transforming Mental Health Care in America: The Federal Action Agenda. You will have received a copy of this document as part of your conference materials. This document outlines the important first steps that organizations within the Federal Partners Workgroup will take on the road to transformation. It describes time-limited, realistic priorities...and actions that can yield immediate results. It provides a roadmap of how we will move from a vision of transformed mental health care to its reality.

The Action Agenda describes the “state of success” for each principle around which the President’s New Freedom Commission built its recommendations for a transformed mental health system. These are recommendations such as creating a comprehensive State mental health care plan and using health technology to improve access to and coordination of mental health services. Our agenda highlights current activities and proposes Year-1 action steps for each principle. In the years to come, as we continue to make progress, we will select new priorities and strategies to achieve them. Our action agenda tells the American people where we want to go with transformation and how we intend to get there.

All of these Federal actions form a model that States can adopt in their transformative activities. Your own experience tells you that no level or branch of government alone can achieve the depth, breadth, and scope of needed change. Consumers and families living with mental health problems have complex, multiple issues. These issues cut across departments, agencies, and systems. Consequently, only systemic change…and change that is collaborative, coordinated, and based on sound planning and data analysis…will provide all that successful transformation requires.

Change, however, doesn’t simply happen. People must make it happen. Your critically important role is to collect, analyze, and interpret data so that it will guide future improvements in service delivery. The State level is where true transformation will take place. The Federal government can motivate, facilitate, and compel changes in the mental health care system at the Federal and State levels, but the State level is where the actual decision-making takes place. The State level is where individuals in need merge with services provided. Your job is to make sure they don’t encounter any detours or dead ends on the road to recovery.

The data necessary to support transformation will figure prominently in your block grants. As you may know, on February 6, the President presented his FY 2007 budget to Congress. The budget contains an important initiative for mental health transformation related to reforms of the Mental Health Block Grant. The budget requires two things: that States set aside a portion of their mental health budget allocation for transformation activities, and that they report on the use of the funds and their outcomes. This change highlights the vital importance of your work in helping us to demonstrate the effectiveness of mental health services. CMHS will be working to provide support and guidance in helping States determine how to proceed in meeting the new requirements.

If we do not want to end up, as Yogi Berra said, someplace other than where we want to go, we must have data to guide us and databased planning to direct our decisions and the implementation of resources. Congress is looking at the work we do as a business. Therefore, like any other business, we must operate efficiently and effectively and provide all of the services needed and desired by our consumers.

Last April, SAMHSA Administrator Charles Curie testified before the House Appropriations Committee on the National Outcome Measures, or NOMs. During his testimony, he publicly released NOMs data gathered by the States thus far.

SLIDE 4 – FIRST RELEASE OF NOMS DATA

Administrator Curie emphasized to Congress that SAMHSAand the States are working together closely to develop a data system that will improve the delivery of substance abuse and mental health services. In addition, he pledged that the NOMs, when fully implemented, will provide a much clearer reporting mechanism that Congress and American taxpayers can use to judge the effectiveness of their investments in our programs.

NOMs data will be our principal means of accountability to Congress and to the people we serve. Currently, only the State block grants incorporate selected NOMs requirements. However, we will be asking the States and other grantees involved in future discretionary grant programs to evaluate their performance according to the NOMs. For block grants, the States, in collaboration with their mental health planning councils, are selecting targeted objectives and measures they will achieve during each grant year. This process reaffirms our efforts to generate data that are both usable and meaningful to all those involved in service delivery, from State planners to consumers and their families.

The importance of the NOMs cannot be overstated. We absolutely must be able to demonstrate clearly that our system is delivering real, measurable, concrete improvements and outcomes for those we serve. And those we serve include children, women, racial and cultural minorities, and other underserved populations. We have a tremendous responsibility to ensure that the NOMs system will meet everyone’s expectations.

Therefore, your role in data collection, analysis, and planning is particularly important. Consider just the two NOMs that you are pilot-testing through your grant programs: decreased symptomatology and improved functioning, and social connectedness and support. These NOMs define a consumer’s expectation of recovery, which will vary across cultures and across the lifespan.

We know that, in terms of mental health, recovery does not necessarily mean a “cure”. Instead, it is a process, sometimes lifelong, through which a consumer achieves independence, self-esteem, and a meaningful life in the community. By this definition, improved functioning and the ability to interact with others in significant contexts, such as a work environment, are essential to a life in the community.

Recovery can be facilitated by particular features of care and the care system. For example, treatment plans developed in partnership with consumers have proven more effective than plans determined solely by providers. Consumers report that having hope and the opportunity to regain control of their own lives is vital to their recovery. Recovery also can be inhibited, so we must speak of recovery-oriented planning and recovery-oriented services. This focus on recovery places the needs of consumers, rather than bureaucracy, at the center of decision-making.

Over the past few years, we’ve made great progress in developing data sets based on the concept of recovery. The NOMs have evolved from the Uniformed Reporting System (URS). We are continuing to work together with States to refine the URS. Together, we are developing standards that build on our partnership to achieve positive, measurable outcomes for consumers. The URS is generating the basic data for individuals served, services provided, and financial and staffing resources. Through the URS, the States have increased their capacity to report meaningful data as well as to integrate these data into the State mental health planning process.

We are not using the data you collect to compare one State to another. Rather, we intend that States use data for planning and quality improvement within their State. States can use the URS and NOMs data to identify the gaps between service needs and service delivery, to set outcome goals, and to identify priorities for action. This is a recovery-focused process. It pinpoints where change is most needed to ensure that consumers have access to the treatment and supports they need. This knowledge, in turn, can guide planning and improved service delivery.

SLIDE 5– A SHORT HISTORY OF PERFORMANCE MEASUREMENT (MHSIP)

The NOMs represent one more step in a journey that SAMHSA and the States have been taking for decades.

In 1966, we introduced the Mental Health Statistics Improvement Program (MHSIP) consumer-oriented report card. It provided us with the logical framework for performance measures: access, quality, and outcome. States were our partners in evaluating the MHSIP indicators. A 5-State pilot project grew into a 16-State demonstration project.

SLIDE 6–A SHORT HISTORY OF PERFORMANCE MEASUREMENT: DATA INFRASTRUCTURE GRANTS

In 2002, we launched the Data Infrastructure Grant (DIG) Program to begin collecting measures from all the States. As you know, a primary objective of the DIGs is to enable States to develop the infrastructure needed to support uniform data reporting across State Mental Health agencies and across multiple local agencies. Phase I of the DIG Program focused on State testing and infrastructure development related to the evolving (URS). I am deeply grateful to the States and to NASMHPD for their efforts to collaborate with us in creating a performance measurement system that contains common measures and definitions that all States can use and that can support aggregated data at the national level.

As I mentioned earlier, the NOMs evolved from the URS. Eight of are already part of the URS. The additional two NOMs being pilot tested through the current DIG program are examples of consumer-and recovery-oriented measures. They emphasize positive outcomes for the people we serve. They are a test bed for measuring our basic concepts of what recovery means to consumers.

SLIDE 7 – CMHS DATA STRATEGY

As part of a SAMHSA initiative, CMHS also is working to develop a renewed data strategy that will move us further toward consumer-level data, which are data gathered over time and specifically outcome-based. We are altering this year’s consumer/patient survey and conferring with States that have moved effectively toward gathering and using data that are more consumer-driven.

CMHS is seeking to supplement NOMs data with:

1. Data for policy that will ensure the availability of national data or estimates necessary for the development and assessment of national mental health policy.
2. Data for management that will ensure the availability of information to assess the effectiveness of CMHS programs .
3. Data to assess public system performance that will ensure the availability of performance data that reflect the breadth of State-supported mental health services and not just that part of the service system directly operated or administered by State Mental Health Authorities, and
4. Data to assess public system performance to promote State data system reform that increases the compatibility of mental health, substance abuse, and Medicaid data, makes mental health and substance abuse data person-based and achieves Health Insurance Portability.

In addition, we are facilitating State data system reform that will increase the compatibility between Medicaid data and mental health and substance abuse data. This is reform that will make mental health and substance abuse data more person-based and complies with the Health Information Portability and Accountability Act.

To move this strategy forward, CMHS is setting up an internal workgroup that will be informed by an external counterpart. This group will review CMHS actions and suggest improvements and changes in strategy.

Your work is vital to determining how we translate consumer-driven “recovery” into measurable feedback and data-based decision-making. As DIG implementers, you are creating a strong and sound data infrastructure to aid the reporting of useful information at both the State and local levels. And you are creating a strong and sound data infrastructure to aid the reporting of useful in formation at both the State and local levels. You are testing how best to use these data to plan, deliver, and analyze services…and to make sound decisions for future actions. Yogi Berra also said, “The future ain’t what it used to be.” The whole point of mental health transformation is to make plans now so that the future of mental health care isn’t what it used to be…that it is better, more hopeful, and far more focused on recovery than it is now.

URS and NOMs data will help SAMHSA fulfill its responsibility to support State efforts to provide mental health services that focus on recovery. Without hard data, we cannot help the States effectively. We must have comprehensive and current information about:

• Which services are most needed in your community and in others,
• How your planning process is addressing service needs, and
• How consumers rate the outcomes of the services they receive.

These are consumer-driven metrics based on recovery, which is the ultimate measure for the people we serve. These numbers represent children, adults, and families dealing with mental illnesses and their consequences every day. Their ability to have hope in recovery depends on how we use the numbers. We need to ensure that the services they need, or their children or families or friends need, will be available to them…and in sufficient quantity and of adequate quality.

Without the data systems necessary to record information in a comparable way, we may find ourselves stumbling along, taking the long road or the wrong road in fashioning a mental health care system. Without the numbers, what do we have? We may throw money at the problems we face without effecting significant change, or we may lose our ability to be accountable to Congress, taxpayers, and, most important, to the consumers who look to our system for the help they need and deserve.

Let me now identify each of the NOMs for mental health. As I read through them, consider how they support consumers’ efforts to achieve and sustain recovery, build resilience, and participate fully in their communities. In particular, note how they reflect SAMHSA’s vision of a life in the community for everyone throughout the lifespan – a life that includes a job or an education, a home, and meaningful relationships with others.

SLIDE 7 – NATIONAL INCOME MEASURES 1 - 3

1. Decreased mental illness symptomatology/improved functioning
2. Increased/retained employment for adults, return to/retention in school for children
3. Decreased criminal justice involvement

SLIDE 8 – NATIONAL INCOME MEASURES 4 - 6

4. Increased stability in family and living conditions
5. Increased access to services
6. Reduced utilization of psychiatric inpatient beds

SLIDE 9 – NATIONAL INCOME MEASURES 7 - 9

7. Increased social supports/social connectedness
8. Client perception of care outcomes
9. Use of evidence-based practices (which doubles as our measure of cost effectiveness)

The purpose of this meeting is for us to jointly identify ways in which current data efforts can evolve further to support improved service delivery, leading to better consumer outcomes. We have a common objective of creating a stronger data infrastructure without creating an undue burden in collecting, analyzing, and reporting data.

We will succeed if we leave this meeting with a new sense of collaboration and a renewed commitment to the productive partnership we have already built around performance measurement. I know I can count on you for a clear-eyed view of the challenges ahead and the identification of the steps we will take to address them.

As will be discussed later today by Paolo Del Vecchio, our Associate Director of Consumer Affairs, we must think of the year ahead as the Year of the Consumer. Consumer participation in transforming the mental health care system is more than just a critical piece of the process. Consumers are the reason for doing the difficult but necessary work of transformation.

Your challenges include answering such questions as, “How can we engage consumers in meaningful efforts to provide input and feedback in pilot-testing the NOMs?” “How will we involve consumers in implementing, monitoring, and refining the NOMs?” No one is better equipped to inform and guide our decisions about the mental health care system than those who experience it. No one understands better what is needed to promote and sustain recovery from mental illnesses than those who have grappled with them. It is within consumers that the primary source of wisdom about recovery resides.

We must provide a speedy route to transformation and we must map it out. I hope that you are inspired and motivated by your role in transformation. Each of us in this room bears some responsibility…some accountability…for achieving the promise of transformation.

We are all aware of the extreme need for change. More than 21 million American adults are affected by serious psychological distress. Up to 9 percent of our children have a serious emotional or behavioral disturbance. Each year, more Americans die from suicide than from homicide. Mental illnesses have become a public health crisis in America. The individual, social, and economic burdens of untreated or inadequately treated illness are staggering.

But…we have hope. And we have not only hope, we have your talent, commitment, knowledge, skills, compassion, and innovation. As Henry Ford remarked, “What’s right about America is that although we have a mess of problems, we have great capacity in intellect and resources to do something about them.”

We have a solution to America’s mental health care crisis; and it is to follow through on the goals of transformation by creating a consumer-driven system focused on recovery. In partnership with each other and with the people we serve, we can transform the mental health care system in our Nation: State by State, community by community, and consumer by consumer. The promise of transformation is yours to achieve. Thank you.