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

Rollout of the Ohio Mental Health Transformation Project
Moving Toward a New Day: On the Horizon of Ohio's Mental Health Care

May 4, 2006
Columbus, OH

PowerPoint version

[SLIDE 1: Title slide]

Good morning! Thank you, Mike, for providing such a good lead-in to my remarks. Ohio is a land of opportunity. Throughout history, Ohioans have seized opportunities for innovation and change…becoming an industrial giant in the 19th century and a leader in transportation, communication, and service industries in the 20th century. Today, your State is an important educational, social, and political leader. It was your votes that decided the presidential election of 2004.

[SLIDE 2. NAMI report card for Ohio]

Many States aspire to the outstanding mental health system that you are developing. The National Alliance on Mental Illness, or NAMI, recently evaluated the services provided by every State in the Nation. Ohio’s mental health system was rated as one of the top two in the Nation. Ohio received a grade of “B” for the infrastructure you’ve developed, the services you provide, and the recovery services you offer.

Ohio received an “A” for information access. That’s absolutely phenomenal! Information is power, the kind of power that must be available to consumers and their families if we truly are to have a consumer-driven system. Too often, consumers are not educated, encouraged, or empowered to be informed decisionmakers in determining their own health care. This makes no sense. Consumers have serious decisions to make…decisions about treatment goals and about services, medications, and providers. These are the decisions that affect their ability to lead full lives in the community.

Information access also is vital to eliminating stigma and discrimination. As the New Freedom Commission noted, too many Americans fail to realize that mental illnesses are treatable and that recovery is a real possibility. Mike Hogan alluded to this problem last month, when he spoke at a reunion of the New Freedom commissioners on Capitol Hill. He made this observation: “…[A]lthough mental illnesses affect so many people and touch so many families, these illnesses still are too often invisible to the larger community.”

I applaud your State’s efforts to make more of your citizens aware of mental illnesses…of recovery…and of the vital role of the community in making recovery possible. We must get this message across: treating mental illnesses and promoting mental health is a public health measure. We protect the health of a community when we promote and protect the health of its individual members.

Of course, the real recipients of NAMI’s recognition for Ohio’s mental health care are the individuals sitting in this audience. Systems and services are created by people and not by institutions. It is dedicated people such as yourselves who have earned Ohio’s ranking as one of the top mental health systems in the Nation. You deserve to be congratulated on your efforts. But what is even more important? It is your determination to make your services even better…to create a “new day” in mental health care.

[SLIDE 3. New Day logo]

I’m not surprised that you have chosen “a new day” as the slogan for your program to transform your mental health system. Ohioans traditionally have been able to look beyond today to the great promise that tomorrow holds…to place greater faith in a vision of what could be rather than what is. It is this unshakable faith in a better, brighter future on the horizon that has inspired such famous Ohioans as Orville Wright, a co-inventor of the airplane; John Glenn, the first American to orbit the earth; and Neil Armstrong, the first astronaut to walk the moon. Judy Resnick, the second American woman to go into space, also was born in your State.

By the way, what is it about Ohio that inspires its citizens to stretch our expectations of what we can achieve as individuals and as a Nation? The accomplishments I’ve just mentioned embody inspiration, dedication, and relentless pursuit of a vision. These are the traits we need to move mental health transformation forward.

So what do Ohioans expect from a new day in mental health care? What can you achieve through mental health transformation? According to your vision statement, it is this: a future when everyone with a mental illness or emotional disorder and their families will have a life well lived in the community. A life well lived…what a powerful concept. What does it imply? A lifetime of learning, working, contributing, and being able to give and receive love and respect.

The time to work for this new day in mental health care is now—not just in Ohio but across this Nation. Never before have we known so much about mental health and how to enable individuals with mental illnesses to live, work, go to school, and participate fully in their communities. Never before has science given us such powerful evidence-based tools. Never before have consumers and their families rightfully been able to demonstrate the amazing healing power of self-direction and peer support. On the horizon is a system of care in which recovery—and not disability—is the expected outcome of services.

Momentum for mental health transformation—as called for by the New Freedom Commission—has been growing at the Federal level. Shortly after the Commission released its final report, President Bush charged the Substance Abuse and Mental Health Services Administration [SAMHSA], through the U.S. Department of Health and Human Services, to study the report…to do what we could on the Federal level to achieve its goals and recommendations.

[SLIDE 4. Federal Partners Workgroup]

Since then, SAMHSA has engaged nine Federal departments, the Social Security Administration, and the Equal Employment Opportunity Commission, in a Federal Partners Workgroup for Transformation. We’ve developed a Federal action agenda outlining the first steps we will take to achieve the promise of transformation. Copies of our agenda are available to you at this conference.

We have convened a Federal Executive Steering Committee to guide and monitor the Federal Government’s process of transforming mental health care. Twenty-one a ssistant secretaries and deputy commissioners are on this committee. Their charge is to promote consumer access to effective services by identifying and eliminating regulatory and funding barriers erected by their own organization’s policies or procedures.

Momentum for mental health transformation is growing on Capitol Hill. Last month, a bipartisan group of Senators announced a new Senate Caucus on Mental Health Reform to increase national awareness of mental health issues.

Momentum for change also is sweeping across the States. The majority of States have public education campaigns to reduce stigma and discrimination. The majority of States are working to better integrate mental and physical health care. The majority of States are working to develop recovery-oriented services.

Ohio is particularly well positioned among States to move transformation forward. Ohio already has created one of the most notable mental health systems in the country. Ohio also is one of only seven States to receive a Mental Health Transformation State Incentive Grant, or a Transformation SIG, from SAMHSA. Over the next 5 years, Ohio should receive $12 million to help fully orient your mental health and other related systems to recovery, resilience, and culturally competent practices.

In accepting this grant, Mike Hogan made this statement—and we at SAMHSA believe that Ohio can achieve the promise it contains. He said, “The Commission’s goal, one that we embrace in Ohio, is that every person with a mental illness should have a realistic expectation of recovery and resiliency. We know mental health is integral to overall health. This grant will help us to address mental illnesses with the same urgency as other medical problems, and to assure that all Ohioans with mental illness can live, work, learn, and participate fully in their communities.” 

Ohio joins Connecticut, Maryland, New Mexico, Oklahoma, Texas, and Washington as Transformation SIG States. In reviewing the winning applications, SAMHSA noted some common characteristics. I’m going to discuss what the winning States have in common, and make a few observations related to Ohio.

[SLIDE 5. Common characteristics of successful SIG applicants]

The first common characteristic is a Governor who is active and invested in the process and who is supported by dynamic leaders in government agencies. In Ohio, you have an active Governor . Governor Taft has been promoting more comprehensive community-based services since his first term as Governor. He also is preparing for challenges that might lie ahead. For example, one of Governor Taft’s accomplishments is a database of physical and mental health professionals who can respond if a disaster occurs.

Our Nation learned some hard lessons from natural disasters, such as Hurricane Katrina, and from some unnatural disasters, such as 9/11. We must become better prepared to deal with the short- and long-term consequences of trauma. I’m gratified that Ohio is being proactive in addressing the effects of trauma on mental health. Your Task Force on Childhood Trauma is another positive step forward.

Your State also benefits from dynamic leaders. You have Mike Hogan, who chaired the New Freedom Commission. He has served as the director of the Ohio Department of Mental Health since March 1991. His tenure, by the way, is outstanding. It is evidence that sustained leadership is essential for change.

To keep transformation moving forward continuously, we need dedicated leaders across, throughout, and deep within the system. Transformation implies a breadth and scope of change that goes far beyond reform. Transformation makes a sharp break with past practices and ushers in a new set of assumptions and values. It suggests a structural, procedural, and even cultural makeover of huge proportions with long-term consequences.

What kind of leaders can lead transformation successfully? Bernard Bass and Bruce Avolio are the authors of Improving Organizational Effectiveness Through Transformational Leadership. In their book, the authors present transformation as a process in which “regular and significant change is a natural, continual response to changing environmental and internal conditions.” A transformational leader, therefore, is someone who can create “a culture of change” in which continuous improvement becomes the norm. Ohio can be thankful that it already has that kind of leadership. NAMI’s scorecard for Ohio commended the strong leadership that is nurturing your innovative policies and procedures.

[CLICK for second characteristic]

Another common characteristic of States that received Transformation SIGs is collaboration across agencies. I’d again like to quote from Dr. Hogan’s recent remarks on Capitol Hill. His experience with the national mental health system is that “recovery, in terms of both spirit and outcome, is a realistic goal, but only if parties work together better and more effectively than they have in the past.”

I’m delighted that Ohio already is uniting so many of its stakeholders behind a common vision of recovery. Governor Taft recently announced a prevention framework for State agencies that promote healthy behavior. The framework is intended to facilitate better communication among the agencies. Your new framework is transformation in action! It provides you with an opportunity to coordinate programs across system boundaries, which is vital to creating better and more timely services for consumers.

I also commend your ongoing collaborations to address issues that span mental and substance use disorders and cut across the age span. For example, last year, your Ohio Association of County Behavioral Health Authorities and the Departments of Mental Health, Alcohol, and Drug Addiction Services established an Older Ohioans Behavioral Health Network. The network is addressing the unique behavioral health needs of elderly persons.

Again, this effort is transformation in action because it is consumer driven. It focuses on what is unique about effective prevention and treatment programs for a specific group. Our older citizens appear more vulnerable to depression. They also are highly vulnerable to prescription drug abuse or misuse because they are prescribed more medications than younger people. Prescription drug abuse is not a new problem, but it is one that deserves renewed attention, with a closer focus on the elderly.

[SLIDE 6. Ohio’s demographics]

America ’s population is aging. Ohio’s population is aging. Thirteen percent of your population is age 65 or older—a slightly higher percentage than the national average. In creating a new day for mental health, you also must prepare for the health care challenges that are looming on the horizon.

[SLIDE 7. Healthy Ohioans logo]

Some of the collaborative networks you already have built offer incredible opportunities to expand mental health transformation. Consider your State’s new health initiative. Healthy Ohioans—Small Steps, Big Strides is a multiyear program to increase public awareness of the importance of healthy lifestyles and choices. The ultimate goal of the program is to reduce chronic disease rates related to lifestyles.

Your Healthy Ohioans initiative focuses on four fronts: schools, businesses, State employees, and community efforts. Aren’t these the same fronts on which to promote mental wellness? Think about the possibilities presented by your schools. The National Institute of Mental Health recently released a report suggesting that mental illnesses are the chronic illnesses of youth. According to the National Comorbidity Survey Replication, half of all lifetime cases of mental illnesses begin by age 14, and three-fourths of all lifetime cases start by age 24.

[SLIDE 8. School children]

Our schools are a gateway to promoting the health of children as well as their families and other adults. Every day, more than 52 million students attend more than 114,000 schools in the United States. When combined with the 6 million adults working at those schools, almost one-fifth of the Nation’s population passes through our schools on any given weekday. What an opportunity! Let’s use our schools to promote healthy lifestyle choices that will reduce our children’s risk of mental illnesses.

Some of these choices are to avoid drugs and alcohol and to avoid bullying and other violence. Another positive choice is for children to seek help if they begin to feel overwhelmed by stress or depression. Despite the availability of effective treatments, there are long delays—sometimes decades—between the first onset of symptoms and when individuals seek and receive treatment. Untreated mental health problems in children can lead to more severe, more difficult to treat illnesses and to co-occurring illnesses.

The first goal of the New Freedom Commission’s report is that Americans will understand that their mental health is essential to their overall health. Use your Healthy Ohioans collaborative to promote healthy lifestyle choices that also reduce the risk of mental illnesses. As your initiative stresses, “The simple fact is that a healthy lifestyle is one of the most important health prevention tools available.”

[SLIDE 9. More common characteristics]

The next common characteristic of States that were awarded a Transformation SIG is the ability to build on existing strengths. Your State has a strong system of local control by county government, with much service delivery at the community level. As a result, your State has great diversity in your approaches to mental health care. You can use this structure as a framework for transformation. It offers you a unique level of local feedback and decisionmaking. It gives you an opportunity to partner with numerous local public and private organizations and consumer/family advocates to build local capacity and leadership. It also allows you to explore and expand on innovative programs that promote recovery. Jumping on the bandwagon of your own success is a surefire way to move your transformation goals forward.

[CLICK for last characteristic]

I’d now like to discuss one final common characteristic of the States that submitted successful Transformation SIG applications. This one is perhaps the most important. It is this: Consumers and families are active in and central to the process. Ohio has extremely strong consumer and family advocacy groups. I’m delighted that a goal of your SIG project is to better align your diverse advocacy community while still preserving the autonomy of key consumer and family organizations. Consumers are the reason for the difficult but necessary work of transformation. I t is their needs, their expectations, and their potential that should shape the new day of mental health care.

Ohio has a responsibility to provide the best mental health care possible for its citizens. However, as a leader in this area, I urge you to share your successful strategies with other States. One purpose of SAMHSA’s Transformation SIG program is to help transform mental health care in other States. We will be looking to Ohio to inform other States on which strategies work best in developing comprehensive service systems.

We already can point to Ohio as a leader in many areas. The NAMI scorecard praised Ohio’s use of best practices to reduce hospital stays and promote recovery. NAMI commended your State’s commitment to diverting individuals with mental illnesses from jails and prisons. NAMI referred to it as “a culture of jail diversion that penetrates almost the entire State.”

Please consider how you can share successful transformation strategies with other States. Florida already has used your “Emerging Best Practices in Recovery” as the foundation for its recovery model. North Dakota is looking to your Recovery Network for guidance. How can you help other States learn from your experience? How can you make your strategies to create a culture of recovery or to integrate evidence-based practices more accessible? In many ways, the speed of transformation is measured by the degree of collaboration.

Ohio, in turn, can learn from the successful strategies of others. Your State, too, must find ways to overcome recognized shortcomings in mental health care: those gaps in care that can keep a new day from dawning.

Ohio has yet to enact insurance parity legislation. As of this date, 26 other States have insurance laws mandating mental health insurance benefits. Nineteen of these States have parity between mental and physical health care. Connecticut, Maryland, Minnesota, Vermont, and Oregon are States with model parity laws that include substance abuse treatment. Their laws are learning opportunities for States that still grapple with parity issues.

I was reading an article in Connections, your monthly newsletter about mental health. The article was about Matt Mikolic [Meh-CO-lick], the youth representative on your Transformation Working Group. This is what he had to say about the economic effect of his illness on his family:

“We lost our house and are in major debt because of mental illness, because of the government and insurance companies being willing to pay for other illnesses, but not mental illness. [My illness] truly is not in my control. How is it different from any other disease?”

Matt is so right—and how right you are to have him on your board! The services and supports available to youth with mental health challenges will affect their lives and their future significantly .

As Matt noted, mental illnesses are not different from other diseases. A person’s opportunities to recover from any illness—physical or mental—should hinge more on their potential for recovery than on their ability to pay. As far as funding levels are concerned, government—from the national to the local level—must transform its view of mental health. Funding for mental health programs has more to do with investments in the health of our communities tomorrow than in expenditures today.

What other challenges does Ohio face? Your Transformation SIG application refers to cultural disparities of care, workforce shortages, co-occurring disorders, and suicide. Ohio shares these service gaps with every other State in the Nation. This situation is further proof that we need to collaborate across States to find effective solutions.

Every State also needs to better integrate physical and mental health care. A more holistic approach to health care is essential to transformation. Why?—Because m ost people with mental health disorders are not seen in the behavioral health specialty system. In fact, about 70 percent of the care for common mental disorders is delivered in general medical settings.

And yet, primary care physicians may not be fully trained to diagnose, treat, or make appropriate referrals for persons with behavioral illnesses. They may be unaware of evidence-based practices and advances in the field. They may not know about the vulnerability of women or the elderly to depression, or the significant overlap between mental and substance use disorders. In short, the front-line providers delivering the majority of behavioral health care may not be adequately prepared to serve people in need .

There’s another reason why mental and physical health care needs better integration. You identified it in your Transformation SIG application. Consumers with serious mental illnesses often have physical health problems as well. Their life expectancy is shorter. I ndividuals with serious mental illnesses live about 10 years less than the general population. The reasons for this difference?—Suicide, a high rate of accidents, and poor health! If Ohioans with mental illnesses really are to have “a life well lived in the community,” then they must be able to live it in good health. To promote recovery, physical needs must be addressed concurrently with mental health needs.

Let’s be clear about what we are trying to achieve through transformation. Transformation is not an exercise in reforming mental health service delivery. That definition is way too limited. Transformation is our opportunity to expand services across the many systems that are involved in the lives of adults and children. These systems include State mental health and substance abuse programs…and they include the physical health, judicial, and education systems, among others. The individuals we serve include adults and children with mental health problems…and they include those who may be at risk for mental health problems. Transformation implies better treatment of mental illnesses…and it also implies better prevention of mental illnesses.

[SLIDE 10. Flight montage]

Transformation is a continuous process. It is meant to create or anticipate the future. Transformation should inspire you to raise your expectations, inflame your passions for change, and challenge you to achieve the seemingly impossible. At one time, human flight was a fantasy…space travel was the subject of science fiction…and the moon was but a distant planet. With the help of a few Ohioans, we’ve created a whole new world of possibilities through flight. With your help, we certainly can transform the mental health system.

Let your vision of transformation take flight! Like your fellow citizens, move bravely beyond the old to the bold. Whatever is easy already has been done. Transformation ultimately is about newness…about new values…new attitudes…and new beliefs. It is about how these changes are expressed in the behaviors of institutions and people.

Keep your momentum going. You have strong leadership. You have strengths to build on and active collaborations to expand. You have consumers and their families who are central to the process. To reword your State motto, “with Ohioans, all things are possible.”

[SLIDE 11. Ending quote]

I’ll leave you with the wise words of Franklin Delano Roosevelt—one of the few American presidents who was not born in Ohio. He said, “ We have always held to the hope, the belief, the conviction that there is a better life, a better world, beyond the horizon.” For the citizens of Ohio, b etter mental health care looms large on your horizon.