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
Building Public/Private Partnerships in Mental Health
National Association of Psychiatric Health Systems
March 19, 2006
Washington , DC
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
Slide 2/Gro Quote
“ In a world filled with complex health problems, we cannot solve them alone. Governments cannot solve them alone. Nongovernmental organizations, the private sector and Foundations cannot solve them alone. Only through new and innovative partnerships can we make a difference. Whether we like it or not, we are dependent on the partners to bridge the gap and achieve health for all.”
I give you these words from former director-general of the World Health Organization, Gro Harlem Brundlandt, because they speak to the reason we are here today. We need innovative public-private partnerships to address the complexities of mental health issues in ways that offer real hope to those we serve. We must forge public-private partnerships to realize the promise of a transformed mental health system that meets the needs of our nation’s people.
I am here this afternoon to enlist your support in this urgent mission. As I look around at this assembly of distinguished leaders from behavioral health care systems in the private sector, I see remarkable potential to create exactly the kind of collaborative relationships that will be necessary to build the infrastructure for change. We must work together to seize the opportunities that public-private partnerships can offer us to propel the transformation of our national mental health care system. Each of us must wrap ourselves around this powerful concept. We must operate from a position of consensus building…not from our singular agendas. We must become champions in fostering public-private partnerships across every level of government…within every discipline…linking every people-serving system. And, we must do it now.
Why? The reasons are really very simple. First, public- private partnerships provide a way to do more…with less. With shrinking funds in the Federal sector and the growing need for treatment, we must find new ways to finance our efforts. Collaborative funding has proven to be effective in expanding public services while protecting the public good. Public-private partnerships are a practical and viable alternative for maintaining quality services without increased funding.
Slide 3/ATP
Achieving the Promise, the landmark final report of the President’s New Freedom Commission on Mental Health, drove that point home when it called on the federal government to partner with States, private foundations, advocacy groups and professional organizations as a way to accelerate research, advance evidence-based practices, improve the workforce, and increase access to quality, culturally-competent care. Achieving the Promise described public-private partnerships as the fuel that would drive transformation in these tough fiscal times.
Former Speaker of the House and founder of the Center for Health Transformation, Newt Gingrich, supports the use of public-private partnerships as a way to do more without spending more. He has said, “ When something can't be privatized or outsourced, the next question should be whether or not there is a useful public-private partnership that might be used to accomplish the same goals with fewer taxpayer resources and more creativity, energy and flexibility."
Partnerships with diverse players bring creativity, energy and flexibility to the table. They reduce duplication of efforts, and bring economies of scale. But, perhaps the most essential motivation for building public-private partnerships is this: There is no other alternative…to help the people we are here to serve. People with mental disorders have complex needs that span agencies, sectors, and systems. No one agency…no one sector…no one system can address these needs on its own. We have to join forces to meet the complex and multiple needs of consumers.
The arguments for public private partnerships are clear. The process of forging these partnerships, choosing the right partners, and providing incentives to bring these partners to the table is more complex. Despite the complexities, we can realize our goal. But it will require a change of perspective.
Slide 4/Einstein Quote
I believe, as Albert Einstein once said: “Problems cannot be solved at the same level of awareness that created them.” I believe we have to change the way we approach the problems of developing, financing, and delivering care in order to truly help people. And that means coordinating the efforts of unlikely partners to create synergy and momentum that stand-alone organizations can not achieve. I believe that p ublic-private partnerships offer us a fresh approach to overcome the challenges we face in transforming how our Nation views and provides mental health care.
By engaging in public-private partnerships, we move closer…and faster...to realizing the future envisioned in Achieving the Promise—“a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports—essentials for living, working, learning, and participating fully in the community.”
Community-based care is critical to that vision. Community-based care reflects a public health approach to mental health. A public health approach is concerned with the health of an entire population, including its link to the physical, psychological, cultural, and social environments in which people live, work, and go to school. It affirms what we know about mental health: it is essential to our overall health and to the overall health of our communities.
Making sure that individuals with mental illnesses have access to appropriate community-based services...making sure that they do not end up misplaced in the criminal justice system or in the emergency rooms across this country…is vital to mental health system transformation.
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, acute care is the only doorway to treatment for people with mental illnesses. Achieving the Promise identified acute care as one of the critical, although understudied, policy areas. CMHS tasked an Acute Care Work Group which has brought together key stakeholders in the field to examine the knowledge base on acute care within our national mental health care system.
Slide 5/Acute Care Work Group
I salute former NAPHS president, Dr. Anil Godbole, for his work on the New Freedom Commission’s Acute Care Work Group. The Work Group has recently completed a rich draft report that focuses on how to improve the delivery of acute care services for individuals in a psychiatric crisis. Although the report is not yet publicly released, I’d like to share some of its overarching themes with you today. Importantly, broad-based collaboration from both the private and public sectors figures prominently in the report’s recommendations for transforming the Nation’s acute care service system.
For instance, the draft Work Group report recommends that we partner with public and private organizations to develop a standard definition of acute care, and to establish and apply evidence-based acute care standards. It recommends that we fully involve consumers, and it will urge the use of safer alternatives to seclusion and restraint and restrictive transport modes. Assessments of community readiness, community-based alternatives to inpatient and residential acute care, training for the acute care workforce, a single point of acute care information, and innovative ways to finance the full continuum of acute care services are among the other transformative activities the report will highlight.
The Acute Care Work Group concluded that acute care involves the entire mental health continuum of care—including housing, employment, and natural support systems. The report provides another clarion call for the value of public-private partnerships.
But how do we begin? Who are the right partners? At the federal level, we have started with ourselves.
Slide 6/Action Agenda
As part of an unparalleled commitment to collaborate to change the status quo, SAMHSA—along with agencies from nineFederal Departments—has released the Federal Action Agenda—the roadmap that is guiding our steps as a nation toward the wholesale transformation of our mental health system. This Action Agenda identifies the first, time-limited, realistic steps that the Federal partners—across all of the key health and human services agencies—will take during the next year to move transformation forward.
I have copies of the Action Agenda available for you today. Please read it and share it with your colleagues. This document is our pledge to take action. It is tangible evidence of how we will move from a vision of transformed mental health care to its reality. And, we expect the Action Agenda to become a model for an equally unprecedented level of collaboration in every State…where it will lead to even greater action…and transformation with an even greater sense of urgency!
Slide 7/SIGS
To help encourage the States to follow our lead, a few months ago, we awarded the first Mental Health Transformation State Incentive Grants (SIGs) to seven States — Connecticut, Ohio, Oklahoma, Washington, Maryland, New Mexico and Texas. With this $2.7 to 3 million dollar per year investment, over the next five years, these States will begin to make the systemic changes needed to meet multiple consumer needs and foster recovery. We are asking these States to do something truly revolutionary—to unite all of their State agencies involved with adults and children behind a common vision of mental health care as it should be! These States have an unprecedented opportunity to lead by example. What these States learn can help speed the pace and extent of transformation by others.
Last year, SAMHSA and other stakeholders asked the Institute of Medicine to partner with both the public and private sectors—consumers, providers, and researchers in general health, mental health, and substance abuse treatment—to develop specific steps that Federal and State organizations and other stakeholders could take to transform mental health care.
The report developed by this broad-based partnership—Improving the Quality of Health Care for Mental and Substance-Use Conditions—concluded that America’s health care system cannot be improved adequately unless equal attention is given to the problems of mental illnesses and substance use disorders. The broad base of support that has emerged from this public-private partnership lends credence to the urgent call for mental health system transformation.
SAMHSA is on an urgent mission to enlist private sector partners as agents of transformation. One notable example: we have launched a collaborative effort with the National Business Group on Health that will result in improved behavioral healthcare services for persons served in both the public and private sector. The first outcome of this partnership is the publication of a new guide—entitled An Employer’s Guide to Behavioral Health Services—that recommends that private employers add public sector providers to their networks to enhance care for persons with serious mental illnesses and/or substance use disorders.
The result: effective, evidence-based, public sector treatments and services—including assertive community treatment, therapeutic nurseries, and therapeutic group homes—will hopefully become available to the more than 50 million Americans who receive their health coverage through private sector plans.
I would like to take a moment here to commend NAPHS for your efforts to partner with NASMHPD and the NASMHPD Research Institute to develop a model of performance measures that can be used across the behavioral health continuum. I know that you have seen, firsthand, how sharing goals, responsibilities, and outcomes can magnify the benefits—and enable you to realize them faster—than working alone in separate silos. I also applaud your initiative to partner with the Joint Commission on Accreditation of Healthcare Organizations and the American Psychiatric Association (APA) to identify a set of standardized core measures for hospital-based inpatient psychiatric services. This is public-private partnership in action.
I believe that the next frontier of public-private partnerships will involve collaboration with foundations and the philanthropic community. Foundations, universities and other organizations can reach places…influence and persuade sectors…that others simply cannot. These organizations can look deeply into complex issues. They are less fettered by political processes. They can take risks that others can’t. Foundations can leverage national and local relationships to rally communities around the key messages of transformation—treatment works…evidence based practices yield better results…recovery is not only possible, but it is the expected outcome of treatment.
An exemplary model of private-public collaboration in the health arena is the Global Alliance for Vaccines and Immunization, or GAVI. GAVI, a coalition of public and private sector entities, launched a global immunization effort to protect the world’s poorest children against preventable childhood diseases. GAVI’s model is unique because unlike most international immunization programs, it did not create a new organization that spends large amounts of money sustaining itself. As a result, 98 percent of its funds go directly to the countries where immunizations were needed.
We can learn much from the GAVI partnership. It provides a perfect example of “thinking outside the ideological box…”departing from the way things have always been done…applying a pragmatic approach to solving serious public health problems─and solving them, most effectively. We must look to the GAVI model as we begin building our own public-private partnerships around mental health issues.
Slide 8/How to Bring Partners to the Table
But how do you get these partners to the table? Choosing partners who are champions is central to your success. In our work with partners at every level, we have learned a number of valuable lessons that I would like to share with you today.
Finding the common ground is critical to engaging partners from diverse professions, disciplines, and systems. It is essential to motivating partners to apply their unique skills and passion to address common needs. We have had real success finding the common ground among our federal partners.
Our Federal Executive Steering Committee on Mental Health —a group of 21 Assistant Secretaries and Deputy Commissioners representing the nine Federal Departments and Agencies── is overseeing the creation of 15 cross-agency workgroups that will focus on cross cutting issues…issues like suicide prevention, integration with primary care, financing, employment, disaster response, and others… issues that resonate with each of the partner agencies. The success of the federal collaboration hinges, in part, on the fact that we have carefully picked partners who share common interests.
As we work to develop partnerships, we must learn to speak to the prospective partners’ agendas. We have to frame our invitations to collaborate in terms of problems we can help our partners solve. For example, if you are trying to build partnerships with criminal justice, talk about how people with mental illnesses are arrested and incarcerated in disproportionate numbers…and how many people can be helped when we use jail diversion programs, crisis intervention teams, and re-entry initiatives to divert these adults and juveniles into appropriate services.
Another successful strategy: Identify a champion outside the circle of mental health, perhaps from another State, who can come in to talk to you and your partners about why mental health is important to their work.
We have learned that flexibility is key—you should not enter into collaborative activities with too many plans too firmly laid out.
We have also seen, firsthand, the power of a facilitated process. The “policy academy” model—which brings together relevant players from different disciplines—is a very effective one. People really appreciate…and benefit from…the opportunity to get out of their “silos” and share insights and perspectives with people from outside of their circles.
And finally, patience is a virtue when it comes to transformation—we have to realize that it is going to take a significant time to get all of the necessary partners on board. This will not be easy work. It will not happen overnight. But it must happen. We must forge public-private partnerships to realize the vision of a transformed mental health system.
The process of creating those partnerships is complex…but it can and must be done. It will require commitment. It will demand unwavering effort from each of us. We must be steadfast. We must remain focused.
Slide 9/End Quote
Let us heed the wisdom of Albert Einstein who modestly admitted, “ It’s not that I’m so smart, it’s just that I stay with problems longer.”
Let us, too, stay with the challenges of transformation…as long as it takes…until we achieve the vision….recovery for all Americans. Thank you.
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