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
CMHS Priorities For 2005
National Association of County Behavioral Health and Developmental Disability Directors
Annual Legislative Conference
Washington, DC
March 4, 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. Cover]
A life in the community for everyone...
...A system of care that helps men, women, and children recover and live rich, rewarding lives.
...this is SAMHSA’s vision.
The mission of the National Association of County Behavioral Health and Developmental Disability Directors—to promote excellence in the delivery of county and county-sponsored behavioral health and developmental disability services—demonstrates your commitment to the well being of consumers and families in every community…to the care and protection of our Nation’s most vulnerable populations…and to the strengthening of the public behavioral health and developmental disability systems. Today, I want to focus on the mission and vision we share—where our work intersects…and the solid foundation we can build together to work towards the goals we share—in 2005 and beyond.
On behalf of my colleagues across SAMHSA, I salute you for the important work you do everyday. Thank you for your dedication and determination in serving people with behavioral and developmental disabilities. You are making a difference all across the country…developing alliances that strengthen and advance your mission within the behavioral health care community…advocating for those issues of critical concern to county behavioral health authorities and State associations…supporting the exchange of ideas and information among county behavioral health professionals that enhances leadership and promotes an informed, articulate voice. From Washington to California, you are doing incredible things.
I would especially like to recognize the NACBHD Executive Director, Melissa Staats, for her leadership and fortitude in organizing this yearly meeting, and for inviting me to join you today to talk about the unique role you each can play in the Center for Mental Health Services’ vision for the Nation’s behavioral health care system.
In the past, systems serving individuals with mental illnesses have differed significantly from those serving individuals with developmental disabilities. Mental health care systems have traditionally been structured according to a model of treatment, while developmental disability systems use an approach that emphasizes the concept of supports. At times, these differences—some real, some perceived—have eclipsed the areas where we hold the same principles.
As some of you may know, before I came to the Center for Mental Health Services, I was the President of the National Association of State Mental Health Program Directors (NASMHPD). While serving at NASMHPD, I convened a meeting to discuss and strategize solutions to this very issue—how our systems can work together to better serve those among us with co-occurring developmental disabilities and mental illnesses. I’m very proud to be here this afternoon to talk with you about how we’re coming full circle on many of the issues discussed at that meeting to ensure that no person falls through the cracks in care….that every person has the care they need and deserve.
[PAUSE]
Today, SAMHSA is harnessing the power of collaboration to eliminate the disparate systems serving consumers and self-advocates...to create a single entryway to better care. The Final Report of the President’s New Freedom Commission on Mental Health provides an important impetus for…and presents extraordinary new opportunities to create…the seamless system of behavioral health care we all seek.
As you know, about a year and a half ago, the Commission released the landmark report, Achieving the Promise: Transforming Mental Health Care in America.
[SLIDE 2. Achieving the Promise]
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 strategy the Commission outlines for this transformation called for collaboration among all levels of government and the private sector.
[SLIDE 3. Goals of a Transformed System]
Fortunately, Achieving the Promise provides us a vision of transformed mental health care with six goals and specific recommendations for achieving this vision—
- Americans will understand that mental health is essential to overall health.
- Mental health care will be consumer and family driven. An individualized plan of care will be in integral part of the approach.
- Disparities in mental health services will be eliminated.
- Early mental health screening, assessment, and treatment will be common practice.
- Excellent mental health care will be delivered and research will be accelerated.
- Technology will be used to access mental health care and information.
These goals, and the specific recommendations that accompany them, are the priorities…the driving force behind all of the current decision-making at SAMHSA…and in the behavioral health field. These goals will provide the roadmap for our combined efforts to advance transformation across the behavioral health field.
What will it look like when these goals are realized? Our transformed national system will be focused on recovery and self-determination. It will uphold the dignity of every individual. It will be oriented to the full emancipation of every member of our society.
[SLIDE 4. Defining Transformation]
Clearly this will be no easy task. The transformation called for in Achieving the Promise 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 for their unique possibilities and, for what we can do now that we couldn’t do before.
One of the underlying principles of Achieving the Promise is that the mental health system must identify programs, services, and models that work …and replicate these practices. At the NASMHPD meeting, we recognized areas of strength in the developmental disability service delivery system that, more recently, Achieving the Promise also recognized and endorsed. As we work to facilitate this momentous transformation, SAMHSA is investigating strategies and services that have already taken off in the developmental disabilities world—models and practices that have been tested and proven through years of your leadership.
For example, thanks to your unwavering advocacy, the developmental disability field has made great strides in helping those you serve overcome the social and cultural barriers created by discrimination and stigma. People with developmental disabilities enjoy a measure of acceptance that has not yet been realized in mental health.
Today, fueled by the recommendations in Achieving the Promise, we are using similar advocacy to help the American public understand and believe, as President Bush says, “Mental disability is not a scandal, it is an illness.” We are launching a high-profile national public information campaign and a number of new initiatives to increase public awareness, promote recovery, encourage help-seeking behavior, and shatter the misconceptions about mental illnesses that lead to discrimination in employment, housing, education, treatment and insurance.
Similarly, for more than 20 years, the developmental disability field has looked at the holistic needs of individuals, taking a very individualized, “person-centered” approach to care. This approach is based on the concept of self-determination…the notion that people should be in charge of their own health and well–being, and make decisions for themselves about their care. In this model, the role of the system is to provide an array of services and supports to enable and empower people to live as independently as possible.
Today, as the mental health system moves toward embracing the concept of person-centered recovery, we also acknowledge that a broad range of appropriate supports, such as housing, education and employment services are needed…that some kind of continuing care is necessary to ensure successful recovery. Indeed, these principles of recovery are essentially the same principles that characterize the concepts of independent living and self-determination that characterize the developmental disabilities service systems.
[SLIDE 5. Recovery Can Refer To]
I think it is important, here, to look closely at what we mean by recovery. Recovery does not necessarily mean “cure.” Recovery is a journey of hope…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.
The developmental disabilities field has long valued the circles of support concept…where there is “no wrong door” to seek services, because all doors lead to a centralized access point that ensures the delivery of services tailored to the individual’s needs. Inspired by this concept of focusing on individual needs and touch points, the mental health system now seeks to develop a similar “circle” of care. We are exploring ways to better connect those in need to natural supports—like family, teachers, and community members who not only help ensure that individuals have access to the services they need, but also provide the personal support that encourages consumers to continue to seek out these services.
We recognize that to truly support recovery, we must also look at the ways we provide the financial resources necessary to promote recovery. Achieving the Promise also recognized the limitations of current funding strategies, and the need to develop new mechanisms and streams of financial support. For more than 10 years, the developmental disability system has supported individualized budgeting approaches…grants that support the powerful principle of self-determination...grants that empower individuals to make choices about their care and put those choices into practice in their daily lives. We, in mental health, are looking carefully at a number of similar approaches.
These approaches that provide the opportunity for the women, men and children we serve to speak for themselves…to have and make choices…to become equal partners in their care…inspire the hope and the promise of recovery and self-determination. This is the fuel that will drive the transformation called for in Achieving the Promise. But this kind of transformation will require a critical change for much of the behavioral health field…a fundamental transformation in the way we think…and in what we do.
We have started with ourselves. SAMHSA, with CMHS at the lead, has been directing a carefully planned and deliberate effort to engage Federal agencies government- wide in transformation efforts.
[SLIDE 6. Action Agenda Partners]
Our first priority has been to make a broad-based group of Federal Agencies accountable for change. 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 Achieving the Promise and push forward with change. This process has resulted in a Federal roadmap for change, which we call our Federal Action Agenda.
Our Action Agenda describes how SAMHSA and its partners will respond to each of the goals and recommendations proposed in Achieving the Promise. It identifies specific steps that we can take during the next year to motivate, facilitate and compel change at the State, community and individual levels. We will develop new agendas, addressing new issues, as we make progress.
[SLIDE 7. 2005 Budget]
Of course, funding will be a limiting factor on how quickly and broadly we can implement change. At SAMHSA, we are looking for ways to embed our vision into our allocation of grant and contract dollars. (Refer to slide)
[SLIDE 8. MHT SIGS]
One of our first steps is to invest additional resources in transformation. Our budget for fiscal year 2005 includes $20 million dollars to fund a new grant program that will offer 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 to assist States that are most ready to develop and implement a Comprehensive State Mental Health Plan. These grants will support State efforts to develop their own vision of a transformed mental health system and build the infrastructure they need to transform the services they provide. We intend to solicit grant applications in the near future.
The SIGs are a critical first step; however, we have a number of other priorities for 2005, which we will fund with discretionary dollars.
[SLIDE 9. Transformation Action Center]
The Transformation Action Center, or TAC, will provide a cohesive, coordinated, and strategic structure for the provision of technical assistance within the Mental Health Transformation SIG program and for CMHS programs focused on assisting individuals in achieving recovery and promoting resilience. The TAC is a valuable resource for the entire behavioral health care community—one that the developmental disability system can and should make ample use of.
[SLIDE 10. Strategic Transformational Leadership]
The bottom line of transformation is that it takes people to drive it—people who are leaders and who can inspire others to follow. One of the issues we are examining at SAMHSA is how we can invest in leadership. We recognize that we need to be smarter about how we train people to be leaders. Our goal for this priority is to stimulate and facilitate interest in leadership development.
By definition, transformation involves collaboration across systems...across populations. For strong transformational leadership to develop, every sector of the behavioral health care community must be represented—in leadership positions, and in thought leadership. You are leaders in your field. Transformation presents a tremendous opportunity for you to lead others in bringing about the changes we seek.
[SLIDE 11. Disparities Reduction/Elimination]
This priority is the same as Goal 3 in Achieving the Promise. Thus, our goals for this program strongly reflect recommendations described in the Report. Essentially, we intend to expand and educate the workforce so that it can respond adequately to the mental health needs of underserved populations. We have proposed an entire portfolio of activities to address issues such as cultural competence, public education, and the adaptation and evaluation of innovative and evidence-based practices that reflect and embrace cultural diversity. Our goal is to develop a National Strategic Plan to eliminate disparities entirely.
I encourage you to avail yourselves of the programs and services we offer in this area.
[SLIDE 12. Science-to-Service]
We have a two-part goal for this priority. The first is to expand the number and distribution of evidence-based practices available through the National Registry of Effective Programs and Practices. The second is to implement additional strategies to ensure that States and providers can implement and sustain more widespread use of the practices.
As part of our National Evidence-based Practices Project, we are funding development of a series of EBP Implementation Resource Kits. These kits are evaluation versions. You can become involved in this effort by assessing these EBPs for their relevance for people with co-occurring mental disorders and developmental disabilities. Help us evaluate. Provide SAMHSA with the feedback we need to make the toolkits and practices successful from your important perspective.
[SLIDE 13. Individualized Plans of Care (IPC)]
Our goal here is to identify prototypes that will address the unique needs of individuals throughout the lifespan and that will create a foundation for coordinated services. NASMHPD is working with us to develop prototypes.
We also look to you to help with the development of these prototypes…and to encourage providers in your communities to adopt these model plans.
[SLIDE 14. Model Comprehensive State Mental Health Plans]
Our goal is that we will have a model plan template available by the time we award the first mental health transformation grants. Representatives of the developmental disability system should be at the table when States are developing these plans.
[SLIDE 15. Workforce Development]
Our goal for this priority is to develop a workforce that has been trained and is supported through a competency-based approach. We also want the workforce to respond to and shape an environment that supports recovery. Similar to our science-to-service priority, we will be building on activities already underway, such as our collaboration with the Annapolis Coalition.
With your input, we can build a workforce that is also diverse in the types of issues addressed…we need you to point out the unmet needs you see…the gaps that must be filled to ensure we can effectively meet the needs of consumers with developmental disabilities.
Clearly, we have ambitious goals for this year. To achieve them, we need your help. We look to you for input on where we should focus our attention. We need your feedback on further changes that should be made. We need NACBHD as our partner to engage the developmental disability community in the transformation of our Nation’s behavioral health system. The areas where our work intersects...where you have led for years...are areas of experience and expertise that we must draw from…because transformation is no small task. It will take all of us. A Yoruba proverb says: what you give, you get ten times over. To create the scale of change needed for transformation to take hold, we must all give…more than we ever have before. We must communicate and collaborate. We must change our perceptions about what will work. We must impact the lives of millions of men, women, and children—and provide a life in the community for everyone.
[SLIDE 16. Collage]
Together, we can achieve the promise. Thank you.
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