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
NAPAS/TASC CEO Meeting
Crystal City, VA
April 18, 2005
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
“ The future is not some place we are going to, but one we are creating. The paths are not to be found, but made, and the activity of making them, changes both the maker and the destination.” So says w riter and Professor Emeritus of Political Philosophy at the University of California, John H. Schaar.
I am inspired by this passage as I think about today’s discussion on the future of the PAIMI Program because the new pathways that each P&A System will create as it navigates the dramatic wave of change that is on the horizon in mental health care will reshape your roles as advocates and champions for persons with mental illnesses. And in the process, you will help to blaze a trail of transformation that will reshape the very future of mental health care in America.
The landscape of mental health has been changing for some time. I saw it first in my former role as Director of the Department of Mental Health, Retardation and Hospitals in Rhode Island. Now, from my vantage point here at SAMHSA/CMHS, I see it happening across the Nation: our mental health care system has undergone a profound shift.
In the past 30 years, States have dramatically reduced the number of public inpatient psychiatric hospital beds. SAMHSA data show that, in 1970, there were some 525,000 psychiatric hospital beds nationwide. By the year 2000, that number had dropped to 215,000…a 50% decrease.
For those persons still being treated in these facilities, the stays are considerably shorter. Once, those who went to the hospital often stayed for several months, even years. Now, the average length of stay for adults receiving inpatient care for mental disorders is less than a week.
Over the last several decades, the public mental health system has shifted from institution based care to community based care. The concept was sound. Done well, community based care certainly is a more cost-efficient...and more effective way to promote recovery. Unfortunately, the community based mental health care delivery system that was supposed to replace the mental hospitals, and support these displaced Americans on their journey to productive lives in the community, has never materialized.
As a result, our Nation’s jails, prisons, juvenile detention facilities, nursing homes, and homeless shelters have become defacto mental hospitals.
You know the statistics! They are startling! Over the next year, nearly 750,000 people with mental disabilities will find themselves incarcerated in jails and prisons. Currently, there are 10 times more persons with psychiatric illnesses incarcerated than in State psychiatric hospitals. Based on SAMHSA’s latest survey, 16% of the inmates in State prisons and jails have been identified as having a mental illness. An astounding 80 percent of children entering the juvenile justice system have mental disorders. Of all residents in nursing homes, 23% have been identified as receiving mental health services. One third of all homeless individuals have mental disorders.
These realities are harsh, but not new to you. You’ve been advocating for the rights of these special populations for over 25 years. How can we adapt—and we must adapt—in order to guarantee that more of these persons receive the essential tools for building a life in the community?
As PAIMI advocates, you must create new pathways...into systems and places previously unexplored. In order to stay relevant...and vigilant...you must find new ways to reach out to persons who too often go unheard, unseen and ignored...to continue to provide the safety net they so desperately need...wherever they are.
I know that blazing these new trails will not be easy...with all you already have on your plates right now.
The PAIMI program has been substantially expanded and the eligible population you serve is increasing exponentially. With The Children’s Health Act of 2000, Congress added even more responsibilities. The new legislature created a 57 th PAIMI Program—the American Indian Consortium. It extended your advocacy to persons in community settings including an individual’s own home. It gave you authority to monitor deaths from seclusion and restraint in Federally-funded facilities. And it increased your advocacy role to include the monitoring of public or private non-medical, community-based facilities for children and youth.
Yes, the landscape is changing dramatically...and the challenges are mounting. What's more, the impact of the changes we have witnessed over the past few decades will be magnified as we move toward the transformation of the mental health system called for in Achieving the Promise: Transforming Mental Health Care in America—the final report of the New Freedom Commission on Mental Health. Achieving the Promise calls for a new paradigm in how we deliver mental health care in this country. Now is the time to seize this opportunity to define a new paradigm for how you will protect and enhance the rights of individuals in this transformed system.
With its 6 goals and 19 recommendations for creating a more consumer-focused, recovery-oriented system of care, Achieving the Promise has provided a bold vision for a transformed national mental health care system. Today, as we come together to examine the future of the PAIMI program, I ask you to consider how you can support the goals and recommendations of Achieving the Promise and become a powerful, proactive force for change. I urge you to consider how the State P&A system can become an agent of transformation...and help move this vision to reality.
As leaders of your organizations, you wield enormous power to drive the transformation process. As today’s discussion unfolds, I urge you to ask yourself:
How can I be more effective to those who are in jails...or on our Nation’s streets?
How can I better partner with advocates for children in the foster care and welfare systems to enhance their rights?
How can I help to level the playing field for all people in need of mental health services...wherever they are?
I ask you to consider:
How can I use my authorizing statutes and regulations to give consumers greater voice...to ensure that they are educated, empowered, and encouraged to make decisions about the type and level of care that works best for them?
What more can I do to partner with States to ensure that those who provide care know about the law and the rights of consumers?
How can I make greater use of technology to network, share, learn, and advocate for system transformation?
Asking...and answering...these kinds of questions is just the starting point.
Alan Kay, a renowned visionary and inventor of the computer mouse, once said, “The best way to predict the future is to invent it.” In Rhode Island, I was able to “invent” a brighter future for our State system, in large part, because I was fortunate enough to have a core of community-based behavioral health leaders who were unafraid. They weren’t afraid to take risks...to try new services...to engage with consumers...to reframe problems in different ways to surmount challenges. They weren’t afraid to fail...and to keep moving forward. I was able to accomplish my mission because I had people and organizations around me that dared to see the opportunity and the possibilities!
Transformation provides limitless possibility and infinite opportunities to improve mental health care. Through transformation, you can help to invent the future millions of Americans living with mental illnesses deserve. You can start by daring to change what you believe...what you do...and how you go about doing it. Then you can go about inspiring others to follow.
Now, let’s begin with the possibilities...
|
