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
Meeting of the HUD Internal Task Force
On Ending Chronic Homelessness
Washington, D.C.
April 28, 2005
PowerPoint version
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
[Side 1/Cover]
Thank you for that warm introduction...and thank you members of the CHAMP task force for inviting me here to speak to you today.
What a powerful acronym...CHAMP! You are, indeed, champions... defenders...supporters...advocates for the hundreds of thousands of Americans who experience chronic, long-term homelessness. I salute you for the work you are doing to find creative ways to identify...and remove...the programmatic and regulatory barriers that stand between people in need and the mainstream housing programs that can provide the key that opens the door to a new life.
I am here today because ending chronic homelessness is a cause we can...and we must...champion together.
An estimated 20 to 25 percent of homeless people have a serious mental illness...and up to half of those with a serious mental illness also have alcohol and/or drug problems. This group is often the most difficult to reach...the most complex to treat...and the most in need of renewed hope in recovery.
Our vision at SAMHSA is to provide a life in the community for everyone. Preventing and overcoming homelessness is crucial to realizing this vision because a life in the community begins with a home...a safe, stable, healing place to call one’s own.
People who are homeless and have mental illnesses and substance use disorders have a broad spectrum of other needs that cannot be effectively addressed without the stability provided by a home. Having a stable home can be a homeless person’s critical first step to accepting and benefiting from treatment for mental illnesses and substance use disorders. We know that with housing and a diverse array of appropriate supports, persons with the most chronic, most severe mental illnesses…and those with long and extensive histories of substance use… can leave the streets and lead stable lives.
[Side 2/SAMHSA Matrix Priorities]
As a result, homelessness is an issue that occupies a prominent spot on SAMHSA’s matrix of priority programs—a tool that keeps the Agency’s work focused on critical issues in behavioral health. HUD is an essential partner in our work. You...and your efforts through this task force...are fundamental to our ability to realize our vision.
Working together, we can help chronically homeless people overcome their complex and multiple challenges. Together, we can help these men, women, and families move off the streets, into housing, and back into productive lives. And we can take steps now to eradicate the root causes of chronic homelessness—lack of adequate income, a shortage of affordable housing, diminished social support—so that we can prevent the homelessness of tomorrow.
[Side 3/Achieving the Promise]
Achieving the Promise: Transforming Mental Health Care in America —the groundbreaking final report of the President’s New Freedom Commission on Mental Health published in 2003—has provided a mandate from the highest levels of the government to create a new, recovery-oriented national mental health system that understands, anticipates and meets the needs of people who are homeless and have mental illnesses. Achieving the Promise presents a bold vision of a future when anyone with a mental illness will recover...when everyone will have access to the essentials for living, working, learning and participating fully in the community. Achieving the Promise calls for a wholesale transformation of the mental health system...and urged all stakeholders in mental health to work together to realize this vision.
I know many of you are very familiar with Achieving the Promise and with the kind of fundamental change it entails. I salute your Director, Pat Carlisle, for her work on the Commission. For those of you who may not be as familiar with the Report, I’d like to take a moment here to define transformation...and to look at the steps the Commission recommended for achieving this dramatic and fundamental change.
[Side 4/Transformation Definition]
What do we mean by transformation? Transformation is a deep, on-going process along a continuum of innovation—a process without end. Transformation is a complex and dynamic phenomenon that relies on ongoing change. Transformation is not a destination…or a point on a continuum that we can put our finger on. Rather,transformation is a process that unfolds
…in multiple directions and on multiple levels;
…in a combination of continuous small steps…that focus on core missions, improving what the system is already doing;
…exploratory medium jumps that push the boundaries of core competencies, trying to create something new within the existing paradigm;
…and in a few big jumps…where new rule sets that leverage new ideas are born.
In transformation, new sources of power emerge. New competencies develop. When we do transformative work, we look for what we can do now that we couldn’t do before.
[Side 5/Goals]
Achieving the Promise recommended six goals and 19 specific recommendations for bringing about this kind of fundamental systems change. In a transformed system:
- Americans Understand that Mental Health Is Essential to Overall Health.
- Mental Health Care Is Consumer and Family Driven.
- Disparities in Mental Health Services Are Eliminated.
- Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice.
- Excellent Mental Health Care Is Delivered and Research Is Accelerated.
- Technology Is Used to Access Mental Health Care and Information.
Over the last year and a half, those of us at the Federal level…the States…and a wide array of public and private partners have taken critical steps toward realizing this vision. I am very proud to say we are making real progress. The transformative activities that have taken shape since the release of Achieving the Promise are nothing short of revolutionary!
States from California to the Carolinas have created statewide commissions to study their unique concerns and report to their respective governors. As a result, States are restructuring and reordering their funding priorities to provide services that are essential to recovery to all Americans with serious mental illnesses. One notable example: New Mexico has launched a particularly ambitious initiative to transform its behavioral healthcare system. The State has created an Interagency Behavioral Health Purchasing Collaborative—which includes the Governor’s office and heads of Labor, Corrections, Aging, Long-Term Services, Public Education, Finance, Vocational Rehabilitation, Courts, the Mortgage Finance Authority and Indian Affairs. They are drafting a plan to pool funding and jointly select a single entity to manage behavioral health care across the State.
Likewise, associations, guilds and advocacy groups are moving mental health system transformation to the forefront of their agendas. The Texas Mental Health Association recently released a landmark report, presenting its State legislators with a comprehensive agenda for improving the lives of the 4.2 million Texans who live with mental illnesses. The National Governor’s Association, in cooperation with the National Association of State Mental Health Program Directors, is assisting the Governor’s office in Kansas with a kick-off meeting to celebrate the formation of a one-of-a-kind transformation task force that address infrastructure concerns, coordination of funding streams and other issues critical to advancing transformation.
Everyday I learn about provider groups, third party insurers, corporations and others who are recognizing their stake in mental health...and embracing the principles and values of mental health transformation. One corporate giant, IBM, has developed an innovative “holistic” strategy of care to promote early identification and intervention as well as care coordination across carriers for individuals who may have co-occurring behavioral health problems and other medical conditions. The early results of this approach are impressive. The program is generating hundreds of thousands of dollars in outpatient cost savings each year...all while increasing utilization. What a difference transformation makes!
I am most proud of the extraordinary level of collaboration that is taking place at the Federal level. At CMHS, at SAMHSA, at HHS, and across the Federal government, we are leveraging resources and programs to facilitate and compel the change in behaviors and attitudes needed for transformation.
[Side 6/Federal Partners]
As many of you know, SAMHSA is leading an unprecedented coalition of senior level staff from 8 Federal Departments—including HUD—and the Social Security Administration to conceptualize and achieve change at the Federal level.
Together with our Federal Partners, we have developed the first Federal Action Agenda for Mental Health Transformation. The collective Action Agenda (to which CHAMP members contributed) includes 75 time-limited, realistic action steps that HUD, SAMHSA and the other Federal Partners can take during the next year to motivate, facilitate and compel change at the State, community and individual lev els. We are currently working on the second inventory. This partnership is a model for the State-level integration of services that will be necessary to support recovery in communities across America.
The upcoming Federal Executive Steering Committee demonstrates commitment to transformation at the highest levels. (The FESC will include senior-most representatives from all of the Federal Partner Agencies and Departments. The purpose of the Committee is to facilitate the coordination of responsibilities and the alignment of Federal policy to reduce fragmentation of mental health services).
[Side 7/Key Priority Areas]
At the same time, we have worked to infuse our own organization with the culture of transformation. Internally, at SAMHSA, we have advanced the work of a cross-center matrix workgroup and are aligning our investments with transformation priorities. As part of this effort, we have identified these six key areas of concentration for FY 2005—prioritized critical system needs—for moving forward. (Refer to slide)
One of the most exciting outcomes of this process has been the incredible synergy that has resulted...as so many of the Agencies that touch the lives of people with mental illnesses come together—Housing, Labor, Education, Justice...and most recently...Transportation, Agriculture and Defense. Together, we are breaking down the barriers...the silos that have existed for so long...to determine how we can cooperate and collaborate to better serve the whole consumer...mind and body.
Of course, the process of organizing disparate and independent efforts across multiple Departments and Agencies to develop a collaborative network has not been without its challenges. This effort has certainly tested our ability to navigate both a variety of complex internal and external political landscapes.
Just a few weeks ago, we took an exciting step to ensure that we sustain and expand the level of collaboration and commitment among the Federal Partnership. We have developed a Mental Health Transformation Extranet Website—modeled after the site created for the members of the New Freedom Commission during its deliberations. This site, accessible to key members of the Federal Partners Workgroup, is designed to foster frequent communication and enable the Partners to monitor progress toward activities proposed in the Action Agenda.
The Team Component of the site allows Partners to share ideas, post topics, and have focused online discussions. The Monitoring Tool—which will go live in the next few weeks—will allow users to update and track progress toward specific action steps. The transformation extranet opens up tremendous opportunities for sharing strategies that work...for exchanging best practices...and for keeping the lines of communication open between members of the Partnership. This kind of site represents a golden opportunity for replication...it’s a very effective way for any group with shared interests to extend and expand its collaborative efforts.
Collaboration is the key to transformation. SAMHSA/CMHS and HUD are effectively collaborating on a number of initiatives designed to tackle the complex interplay of problems that perpetuate chronic homelessness.
[Side 8/Collaborative Initiative to End Chronic Homelessness]
The 3-year Collaborative Initiative to End Chronic Homelessness is bringing an unprecedented comprehensive approach to bear on the problem. With SAMHSA funding mental health care, substance abuse treatment and related support services...HUD funding permanent housing...the VA offering medical services to homeless veterans...and HRSA funding primary health care, it is a model at the Federal level of the kind of collaborative relationship we encourage at the local level.
One of the 11 grantees of the Collaborative Initiative—the Fortwood Center in Chattanooga, Tennessee—provides a pointed example of the power of effective collaboration. At this site, HUD is providing technical assistance around site management and operations and SAMHSA is training the clinical staff in assertive community treatment—an evidence-based case management model. It became apparent after the Fortwood Center was awarded the grant that this grantee did not have everything it needed in place to follow through with its work. HUD and SAMHSA have worked together very effectively and carefully at this site to address these initial shortcomings. Today, we are seeing very positive steps being taken to help grantees succeed.
In an effort to assist all of our grant sites in becoming similar success stories, the Interagency Council on Homelessness that coordinates the Federal Government’s response to homelessness has taken steps to reconstitute the cross-agency policy group associated with the Collaborative Initiative. The policy group met two weeks ago for the first time in 18 months. This move to re-energize the assembly is a good one...and will enable our collaborative efforts to be as seamless as possible to the grantees.
[Side 9/SSI Eligibility]
SAMHSA’s 55-million per year formula grant program, PATH, or the Projects for Assistance in Transition from Homelessness program provides another example of the power of collaboration. PATH has been a around a long time...many of you may be familiar with the critical bridge it provides...supplying some of the only funding many communities have to support the range of services need to effectively reach and engage individuals with serious mental illnesses and/or co-occurring substance use disorders.
You may not know that, as part of the PATH program, SAMHSA/CMHS is working with HUD and the Social Security Administration on a portfolio of training materials designed to equip local providers to assist persons who are experiencing homelessness gain eligibility for Supplemental Security Income, or SSI….and to do so in the very first SSA decision. This is a groundbreaking effort! SSI eligibility is not only the gateway to Medicare and Medicaid…but it is also a route to employability…to stable housing…and to recovery! With these activities, we will give case managers across this country the tools they need to help thousands of people who are homeless and living with mental illnesses secure the resources that are deservedly theirs.
(Kathryn – add comments about your project in RI here if you wish)
We have prepared a draft curriculum for trainers of case managers who assist homeless SSI/SSDI applicants, which includes lesson plans, examples, and exercises. Our field tests have found the curriculum is right on target…and the training we have offered has made a significant difference in successful applications. We are working on a manual for case managers assisting homeless SSI/SSDI applicants. This will be available on the Internet in May. The published version will be available in July.
Within the next 3 or 4 weeks, we will offer, in collaboration with HUD and HRSA, a Technical Assistance package on this issue, on a competitive basis, to States whose policy academies have adopted SSI eligibility as a homelessness activity they want to implement. The TA package will consist of an initial 2-day meeting for stakeholders planning a local or State strategy to assist homeless SSI/ SSDI applicants, as well as training for two persons from each State who will be trained to conduct training workshops for case managers in their State.
[Side 10/ Blueprint for Change]
I would like to mention one other key resource from our homelessness portfolio—SAMHSA’s Blueprint for Change : Ending Chronic Homelessness. (Hold up copy) This is a comprehensive guide that States and local communities can use to design their own initiatives to prevent and end homelessness among people with serious mental illnesses.
It is a nuts-and-bolts, how-to guide. It includes information about the current state of community-based care, typical characteristics of the homeless population, the concept and practice of recovery-based treatment,sources of funding, evidence-based practices, and ways to measure results. With this guide, local communities and organizations can use a systems approach to better address all of the key domains of care for these very vulnerable Americans. We think it will be an invaluable tool in helping to achieve transformation at the community level.
SAMHSA continues to prioritize the national goal of ending homelessness. We do so through a rich portfolio of service grants and technical assistance activities. You can find out more about these resources on page 4 of the latest issue of our SAMHSA News, which features a cover story on the Initiative to End Chronic Homelessness. (Hold up issue).
SAMHSA/CMHS is deeply and firmly committed to ending homelessness. This CHAMP Task force demonstrates your continued commitment to this issue. Just as collaboration is the key to our ability to transform our national mental health system…it is also the key to ending chronic homelessness in America. Any successful effort must involve government at all levels as well as the private sector, community organizations, service providers, consumers and family members.
We are proud to stand with you to create a future when every American has an opportunity for a fulfilling life in the community. Let’s work together to inspire others—across housing and mental health...in every facet of government and the private sector—to champion this cause… to be champions for those who so desperately need defenders, supporters, and advocates to assist them on their path from homelessness to productive lives in the community.
[Side 11/Champions]
What does it take to be a champion? Golfer, Patti Berg says it takes “desire, dedication, determination, concentration and the will to win.” Boxing great, Muhammad Ali, says “Champions are made from something they have deep inside them—a desire, a dream, a vision. Champions have to have the skill and the will.”
We each possess the vision…the desire…and the dedication to win this battle against chronic homelessness. Together, I know we have the skill and the will to succeed! Thank you.
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