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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
Mental Health Transformation Needs You!
April 14, 2008
Cambridge, MA
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]
Introductory Remarks
- Thank you. Dr. Shore (Miles Shore, M.D., Professor of Psychiatry and Advisor to the Health Policy PIC), for your kind introduction and for your ongoing leadership in the field of mental health. You’ve made your mark not only as a clinician but also as a principal supporter of the need for today’s students to be schooled in health policy and leadership, two topics that are the basis for my role in public life.
- Indeed, I believe this is an exciting time to be a leader in the field of public behavioral health care. We have an unparalleled opportunity to effect positive change in individuals’ lives by transforming the systems that serve them.
- In my brief remarks this evening, I want to share with you what I like to think of as the "who, what, where, when, how, and why" of mental health transformation. My goal is to help you see how important your roles will be as the leaders of tomorrow.
What Is Transformation?
[Slide 2: NFC vision statement]
- What do I mean when I speak about "transformation?" First and foremost, transformation is a vision, a vision of a preferred future. The members of the President’s New Freedom Commission on Mental Health articulated their vision of the future when they said:
We envision a future when everyone with a mental illness will recover, 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.
[Slide 3: Defining transformation]
- Second, transformation is a process, a deep, vast, and ongoing process along a continuum of innovation. It implies profound change—not at the margins of the system, but at its very core. In a transformed mental health system, new sources of power emerge and new competencies develop. Opportunities and challenges are looked at with a new perspective.
- Finally, transformation is an outcome. When we apply transformative processes to our vision of a preferred future, we achieve a set of desired outcomes, not for us and our organizations, but for the people we serve. In a transformed system of care:
- Recovery is the guiding principle.
- Consumers—working in partnership with their care providers—direct their own care.
- Prevention is as important as treatment.
- Everyone shares equally in the hope of recovery from mental illnesses, regardless of race, gender, ethnicity, or geographic location.
- The use of evidence-based, state-of-the-art treatments and supports is standard practice.
- Services and supports are readily available and accessible and coordinated across multiple systems.
Why Is Transformation Important?
- Clearly, transformation is a tall order, but you may wonder, "Why is mental health transformation important?"
- The members of the New Freedom Commission on Mental Health made very clear that nothing short of fundamental transformation is sufficient because our current mental health system is broken. Services are fragmented, financing is outdated, and all too often, individuals receive outmoded treatment rather than state-of-the-art services and supports.
- The Commission concluded that the mental health system in our country isn’t oriented to the single most important goal of the people it serves—the goal of recovery.
- The concept of recovery is fairly new to mental health. In fact, it wasn’t all that long ago when mental disorders were believed to be debilitating, lifelong conditions; when people were given no hope for recovery; when they spent years confined to life in an institution.
- Today, we know that—given the right combination of treatment and support and a voice in decisions concerning their care—people with serious mental illnesses can and do recover. For a system that was designed specifically to provide long-term, custodial care to people with mental illnesses, the concept of mental health recovery represents a seismic shift in attitudes, beliefs, and priorities.
- Even the language we use has to change, because old language cannot convey new ideas.
[Slide 4: Consensus definition of recovery]
- To help guide the discussion around recovery, the Substance Abuse and Mental Health Services Administration (SAMHSA) convened a group of 110 experts—including mental health consumers—in 2006. We examined topics like recovery across the lifespan and recovery in different cultural contexts. We considered how recovery applied at individual, family, community, provider, organizational, and system levels.
- Our meeting led to this consensus definition of recovery for adults:
Mental health recovery is a journey of healing and transformation for a person with a mental health problem to be able to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential.
- The process of recovery builds on the strengths of each individual. It is nonlinear and self-directed. It is holistic and person-centered, and it involves personal and community respect, responsibility, and hope. It empowers consumers to make decisions that impact their lives. It recognizes the valued role of consumers in supporting and encouraging others as they continue on their own journey toward recovery.
- Recovery is not an end point, however. Our definition implies a continuum of support and a breadth of services that acknowledge the whole person and not just the disorder. The scope of this definition changes our entire perspective on how we should provide care.
[Slide 5: Mental health continuum]
- In particular, we can no longer afford to be reactive and respond to an individual once he or she becomes sick. We must be proactive in promoting health and preventing illness before it begins. This is the very essence of the public health approach to health care, which is vital to our efforts to address a glaring disparity in health care outcomes.
[Slide 6: Global burden of disease]
- Research tells us that life expectancy for individuals with serious mental illnesses is about 25 years less than the general population.
- Further, the increased morbidity and mortality are largely due to treatable medical conditions that are caused by modifiable risk factors, including smoking, obesity, substance abuse, and inadequate access to medical care. This is simply unacceptable.
- At a wellness summit that SAMHSA held last fall, we issued a national call to action to reduce the life expectancy disparity by 10 years within the next 10 years, or what we call the "10 by 10" program. Summit participants also made a voluntary pledge to personally foster consumer wellness.
- Fostering consumer wellness is more than the right thing to do. As a Nation, we depend on the ability of all of our citizens to be healthy, productive, and able to contribute to our families, our schools, our businesses, and our communities.
Where Is Transformation Happening?
- Because transforming the mental health system around the goal of recovery requires changing not only services and systems, but also hearts and minds, you might think that transformation is a good idea in name only. However, if you were to ask me, "Where is transformation happening?" I would be delighted to tell you that it’s happening all over the country!
[Slide 7: T-SIG States]
- Many of the innovations are being led by nine States that received Mental Health Transformation State Incentive Grants or T-SIGs, as we call them, from SAMHSA. These nine States are living laboratories for the type of system-level changes that will lead to changes in the way services are delivered, and, ultimately, we believe, to positive changes in client outcomes.
- Listen to what some of these States have accomplished thus far:
- Oklahoma developed a collaborative among researchers, State agencies, and consumers to form partnerships between science and service, including a grant process for research. The partnership has already resulted in five grant awards being made.
- New Mexico implemented curricula to train bilingual interpreters to work with behavioral health specialists and consumers.
- Maryland formed Consumer Quality Teams to strengthen self-advocacy and critical thinking in consumers and enhance the quality of mental health services by resolving individual consumer concerns at the local provider level.
- And Connecticut proposed legislation to regulate use of restraints and seclusion on special education students in public schools.
- This is transformation in action!
- But transformation is not limited to the T-SIG States. States and communities around the country are embracing not only the language of mental health recovery, but also the strategic approaches required to transform the way they fund, deliver, and evaluate mental health services.
- And transformation is happening at the Federal level as well. For the past 5 years, SAMHSA had led an unprecedented collaborative effort among Federal agencies and offices to work across traditional boundaries to support transformation at the highest levels.
[Slide 8: Action Agenda]
- Together, we developed the Federal Action Agenda, a set of 70 measurable action steps that reflects a broad-based commitment for collaboration on the part of all Federal agencies whose programs serve individuals with serious mental illnesses. This is a living document that allows us to track our progress toward transformation and update our strategies as new priorities emerge.
- The behavioral health needs of returning veterans and their families is one of these new priorities and is the focus of a subcommittee of our Federal Executive Steering Committee, which is guiding implementation of the Action Agenda. Other priority areas currently include suicide prevention, primary care and mental health integration, employment, and financing.
- As we continue to move forward with these efforts we will look to you, the leaders of tomorrow, to hold us accountable for producing the results that individuals of all ages with mental health problems need and deserve.
How Does Transformation Happen and Who Does It Involve?
- If transformation is taking place around the country, how does it happen and who does it involve? It is happening because of the committed leadership of people who began their careers just like you.
- There are many different theories of leadership, but personally, my own philosophy on leadership has been greatly influenced by the principles of "servant-leadership" as described by the late Robert K. Greenleaf. Robert Greenleaf was a retired AT&T executive who believed, as I do, that true leadership emerges from a primary motivation to serve a higher purpose. To me, there is no higher purpose than helping people with behavioral health disorders achieve a life of dignity in the community.
- I first became engaged in mental health issues back in 1975, when I got involved in rape crisis counseling and consumer advocacy.
- When I was working as a rape crisis counselor, I learned both the power of violent and traumatic events to destabilize individuals and the fact that their experiences had been systematically missed by the mental health field. These years helped hone my belief that, in order to change the status quo, leaders must promote change both at an individual level and at a system level. To this day, I remain a deeply committed advocate for women and men impacted by violence and trauma.
- Each of you in this room has the power to be a transformational leader, and I hope many of you will feel led to do so.
- A transformational leader—one who is not satisfied with change around the edges—must be courageous enough to take risks and be resilient and resolute in pursuing his or her vision.
- Having a vision is an essential quality of a transformational leader. A vision provides a shared image for the future.
- Another essential quality of a transformational leader is a commitment to something bigger than one’s self. As I mentioned, my own belief is that true leadership emerges from a primary motivation to serve a higher purpose... a purpose of helping others find meaning in their lives... helping them find hope and connection to family and community.
- Transformational leaders are action-oriented. They make things happen and motivate others to do so.
- A transformational leader must be able to engage other people who can move systems. Leaders draw on the skills of many different people.
- Transformational leaders are committed to continuous personal development. Leaders read relevant literature, attend conferences, and talk to colleagues.
- A transformational leader must have a strong belief in the power of one to make a difference.
- Most important, a transformational leader recognizes that maintaining the status quo is actually moving the organization backwards. The leader recognizes that when you’re doing things well, it is time to make them better.
When Does Transformation Need To Happen?
- Lastly, I would be remiss in not answering the all important question, "When does transformation need to happen?" That’s easy. It needs to happen NOW!
- I’m reminded of a comment made by Dr. Donald Berwick, President and CEO of the Institute for Healthcare Improvement. When he announced the 100,000 Lives Campaign to significantly reduce morbidity and mortality in American health care, Dr. Berwick said, "Some is not a number; soon is not a time."
- Adults with serious mental illnesses and children with serious emotional disturbances can’t afford to wait. Each and every one of them needs the best treatment that science has to offer and they need it now.
- They need the ability to direct their own care, including the money that finances it, and they need it now.
- Perhaps most important, they need hope for recovery and the knowledge that we who serve them believe with all our hearts and minds that recovery is possible. And they need our support now.
Closing Thoughts
[Slide 9: Schweitzer quote]
- I would like to leave you with this thought from noted physician and philosopher Albert Schweitzer, who said, "I don’t know what your destiny will be, but one thing I do know: the only ones among you who will be really happy are those who have sought and found how to serve."
- Whether your chosen career is in medicine, business, or government, I encourage you to find ways to serve.
- Find that within you which strikes a spark and seek out roles that will allow you to put your passion into practice.
- Remember, there are many among us who are less fortunate who can benefit from your immense knowledge, talents, and youthful energy.
- Finally, as Abraham Lincoln once said, "Don’t worry when you are not recognized, but strive to be worthy of recognition."
- There is enormous potential in this room and as you go forth to do good work, you do so with my support and my gratitude.
- Thank you. I’d be happy to take your questions.
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