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
2005 Joint National Conference on
Mental Health Block Grants and National Conference on Mental Health Statistics
Transformation: Moving From Goals to Action
Arlington, VA
June 01, 2005
PowerPoint version
[SLIDE 1. Title slide]
Good morning and welcome to a conference that celebrates planning and statistics. I happen to find statistics extremely useful in my work. For example, I often start out a speech with a statistic. In the United States, nearly 12 million adults have a serious mental illness. Less than half receive treatment! Thirty-thousand Americans committed suicide in 2002—that’s 10,000 more than were murdered! My intent is to grab my audience’s attention and to inspire them to take action. But, because you are mental health professionals, advocates, and consumers, you already are aware that mental illness is a public health crisis in this country. You know what the problems are, and you know the barriers that impede their resolution. So I thank you sincerely for coming here to share your ideas about how we can merge planning and statistics to solve the problems and smash the barriers. With mental health transformation as our ultimate goal, we have an urgent need to move forward and to do it together.
My message today is to emphasize how this is our time to forge ahead with transformation, to move from its goals to action, . . . with shared leadership and knowledge and with extraordinary hope in our ability to make a profound difference in the lives of millions of Americans with or at risk of serious mental illnesses. This is the direction in which we are moving. We already can chart progress at the national, State, local, and private levels. We’ll be sharing some of the highlights with you. However, before I describe our progress, I’d like to spend a few minutes discussing our motivation.
[SLIDE 2. Achieving the Promise cover scan]
It’s been nearly 2 years since the President’s New Freedom Commission on Mental Health released its final report, which it called Achieving the Promise: Transforming Mental Health Care in America. [Copies of this report are available in the back of the room.] The “promise” is a full life in the community for people with disabilities, including those with mental disabilities. This is a life that will include a job or an education, a home, and meaningful relationships with others. This is a promise that has been made to Americans by laws such as the Individuals with Disabilities Education Act and by Supreme Court rulings such as the Olmstead decision. It is a promise founded on the moral, ethical, and humane principles of a caring and compassionate society.
Achieving the Promise declares that millions of Americans with mental illnesses are being denied this promise. Stigma and discrimination, fragmented and inadequate services, poor opportunities for consumer involvement and self-determination—these are the barriers to their hope in recovery and a life in the community. The report concludes that the only way to keep our promise to all Americans is to transform our mental health system.
Achieving the Promise lays out six broad goals for a transformed system. The report, however, left it to us to determine what actions we would take to achieve them. These are the goals.
[SLIDE 3. Six goals—PAUSE for reading]
The ultimate goal of transformation is to create a system that is consumer and family driven, with a focus on recovery and on building resilience. These concepts—consumer and family driven, recovery and resilience—are the basic values of transformation. Think of transformation in terms of building a better future for mental health care in America. These values are the mortar that will hold together all the pieces that must come together.
[SLIDE 4. Terms defined]
Consumer- and family-driven means each adult or child will have access to the full spectrum of services needed to support recovery. It means they will have real and meaningful choices among providers, services, and treatment options. Recovery is a process, sometimes lifelong, through which a consumer achieves independence, self-esteem, and a meaningful life in the community. Resilience is a person’s ability to face life’s challenges. This last value—resilience—implies major shifts in services provided. Resilience takes a lifespan approach to promotion of mental health and the prevention of mental illnesses.
During the past year, SAMHSA has been working with providers, consumers, and national mental health advocacy groups to refine the meaning and real-life application of these values. How, for example, can we make care more consumer-driven? What about real and meaningful opportunities for consumers to make meaningful decisions about the services and supports provided—not just for themselves but for others? How can we increase these opportunities?
This brings me to the subject of leadership. A system that reflects the values of transformation will have these values embedded in every policy, practice, and decision that is made, from the national to the individual level. Consumers will be involved—continuously, substantively, and respectfully—in decisionmaking at every level. Their lived experiences give insight and authority to their opinions. Who is more qualified than the individuals we serve to say what does and doesn’t work in the delivery of mental health care?
A shift of this magnitude demands leaders—individuals who can create an organizational culture that identifies and operates consistently with the values of transformation. Such a culture will demonstrate a readiness for change, a willingness to risk, and an openness to new ideas. . . . unlike the organization in this cartoon.
[SLIDE 5. Cartoon] [PAUSE for reading] .
Each of you can be a leader. Leadership is not the sole province of people in positions of authority. A title does not make a leader. Instead, leadership is demonstrated in attitude and actions, by those whose words and behavior inspire others to act similarly. When you apply new values and new strategies to old problems, you’re exercising leadership. Think about the changes in acute care; it used to mean in-patient beds only. Recently, however, we have expanded acute care to include mobile crisis intervention units. These units provide assessment and intervention to a consumer in the community—in the home, or in a jail, or on the street. They provide a continuum of care that involves the community. This is consumer-driven care—care when and where the consumer needs it! It took a transformational leader to ask the questions and propose the solution to change how and where our system provides acute care.
Leadership is about people, about working with, guiding, learning from, and encouraging people in the context of our values. It’s about bringing emergent leaders to the table to share their perspective on problem-solving. Our profession, as well as our daily life, constantly tests us for our level of commitment to what we believe in. If we truly believe in consumer- driven care focused on recovery, then we’re going to take action. We’re going to leave our offices at the end of the work day and engage in mental health transformation in our communities. The greater success will come to those who demonstrate a never-ending commitment to act on their beliefs until they achieve their goals.
[SLIDE 6. FY 2005 Proposed Activities]
We at SAMHSA have responded to the need for shared leadership with vision, goals, and actions. Our vision is that effective behavioral health care leadership will be developed at all levels of our mental health system. This slide shows the goals we have proposed for achieving our vision. Our progress toward our goals can be seen in the actions we are taking at the national and State levels.
[SLIDE 7. Federal Partners Workgroup]
We continue to expand shared leadership for transformation at the Federal level. Since I met with you last June, the U.S. Departments of Agriculture, Defense, and Transportation have joined our Federal Partners Workgroup. The workgroup meets regularly to identify benchmarks for progress and to ensure that we continue to make progress toward the goals and recommendations of Achieving the Promise. I’m proud to say that we now have eight Federal departments participating in our workgroup.
The involvement of some agencies may seem like a stretch—at first. Why, for example, should the Department of Transportation be involved? What is its stake in mental health care?
Transportation can be critical to a consumer’s hope in recovery and to a life in the community. It represents his or her ability to get to a treatment facility or to a job. In addition, mental health care is a public health issue. There isn’t a person in this room who isn’t somehow affected by the costly social burdens of untreated or inadequately treated mental illnesses in his or her community. The willingness of the Department of Transportation to learn about recovery and build a responsive collaboration with us is in itself transformative.
Every organization has a stake in transforming mental health care in America. You can see it in the collaboration and shared leadership that is expanding across Federal agencies. For transformation to occur, however, this same broad-based collaboration and shared leadership needs to occur at the State and community levels. Not only will these actions be required, they should be both expected and demanded.
SAMHSA is working to develop, encourage, facilitate, and compel leadership at the State level. States are at the very center of mental health transformation, so leadership at this level is crucial. We at the Federal level may establish general policies and programs, but the States are responsible for determining what services they will provide and who will have access to them. It falls to the States to decide how to allocate available funds and to link service delivery systems. Ultimately, it is the States that must evaluate the wisdom of their decisions and answer to the people they serve.
[SLIDE 8. Regional Meetings]
In 2 weeks, we will be working with the National Governors Association to hold the first of four regional meetings. We have designed these meetings, called Transforming State Mental Health Systems, to develop shared leadership among State representatives who are most accountable for service delivery. I personally have been calling your State mental health commissioners to encourage their attendance and the attendance of State teams at the first meeting.
Our agenda will focus on team development of a transformation vision and strategies for creating comprehensive mental health services in their State. We’ve specified two of the persons who must be members of the team. One is the health policy advisor or another member of the policy staff in the Office of the Governor. The second is the commissioner or director of the State mental health authority. The other two team members can be the State Medicaid director; the Cabinet-level official responsible for mental health and disability services; the director of agencies providing services, such as housing and welfare, to people with mental illnesses in your State; and consumers. Shared leadership among this group has amazing potential. Just think of the progress that can be made when they combine their knowledge and resources!
[SLIDE 9. Transformation SIGs]
In April, we announced the availability of nearly 19 million dollars for State Incentive Grants for Mental Health Transformation, or Transformation SIGs. A higher funding level is proposed for the next fiscal year. These discretionary grants are a truly unique opportunity for the States to advance their own vision of comprehensive mental health care. They are a block grant accelerator, not a block grant add-on. Consider some of the differences.
[SLIDE 10. Block grant/Transformation SIG comparison]
Block grants provide flexible funding for direct and support services. Transformation SIG funding can be used only for planning and developing infrastructure. This focus on infrastructure enables a State to concentrate on systemic changes needed to meet the multiple needs of consumers. Block grant funds are to be used for adults with serious mental illnesses and children with serious emotional disturbances. Transformation SIG funding, by contract, expands the population to include those at risk for mental disorders.
[SLIDE 11. SIG plan requirements]
Transformation SIGs demand a far more comprehensive plan than the one called for in block grants. Interagency collaboration is an expectation of the block grant: It is a requirement of a Transformation SIG. The comprehensive mental health plan required for Transformation SIGs must include mechanisms to accomplish these two tasks:
- Improve collaboration
- Address the overlap between systems, such as child welfare, education, and corrections.
In addition, the Transformation SIG plan must prepare the State to sustain these mechanisms.
Eligibility to apply for a Transformation SIG is limited to the Office of the Governor. We limited eligibility for a reason: The depth and breadth of change that will be required across multiple systems can be accomplished only by the person ultimately responsible for these systems and their operations. Transformation SIGs are a wonderful opportunity for the Governors to exercise leadership in getting their departments to work together.
I’m extremely gratified to report that many States already demonstrate progress toward the goals of Achieving the Promise. The NASMHPD Research Institute (NRI) of the National Association of State Mental Health Program Directors is tracking State progress toward implementing the report’s six goals. My thanks to the Institute for allowing me to preview the major findings of its survey of State mental health agencies.
[SLIDE 12. NRI Survey]
According to NRI’s ongoing survey, the majority of States are:
- Collaborating with Medicaid and State health departments to better integrate mental and primary health care;
- Working to reduce fragmentation of services across agencies;
- Adopting recovery mission statements and developing recovery-oriented services;
- Providing prevention and early intervention services;
- Implementing at least one evidence-based practice service; and
- Investing heavily in technology to enhance quality and accountability.
These States are leaders in transformation! What is most exciting? —the initiative being taken by the States to make care more consumer-centered. Nearly every State is working to ensure that consumers receive individualized treatment plans that respond to their unique goals for recovery.
The States have an excellent framework for moving from the goals of transformation to action. This framework is their mental health block grant. Oklahoma, for example, is using its block grant to achieve the first two recommendations under Goal 4 of Achieving the Promise. The first is to “promote the mental health of young children” and the second is to “improve and expand school mental health programs.” Oklahoma deserves special recognition for developing a creative partnership with its Department of Education to provide expanded services to schoolchildren.
Other States are using their block grants to increase access to care by racial and ethnic minorities. You may recall that eliminating disparities of care is Goal 3 of Achieving the Promise. Minnesota dedicates 25 percent of its block grant funds to meeting the mental health needs of the Native American nations in the State. Washington State has developed a best-practices guide for treating vulnerable populations, such as Alaska Natives and Native American children. Colorado has formed a Latino Mental Health Roundtable to promote greater accountability in meeting the needs of the Latino community.
So how can a State best use its block grant to move from goals to action? The answer is data-based decisionmaking. Lord Kelvin, a Scottish mathematician of the late 1800s, made this astute observation: “ When you can measure what you are speaking about, and express it in numbers, then you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meager and unsatisfactory kind.”
Data enable us t o identify the gaps between service needs and service delivery; planning enables us to set outcome goals and to identify priorities for action. This is a process focused on recovery. It pinpoints where change is most needed to ensure that consumers have access to the treatments and supports they need to achieve and sustain recovery. If I can add to my building analogy, data-based decisionmaking is the foundation on which we can build transformation.
[SLIDE 13. Three NOMs]
The national outcome measures, or NOMs, are a required element of block grant planning and evaluation. The NOMs reflect a transformed view of effective mental health care because they focus on positive outcome measures for consumers. I’ve listed just three on the slide. Note how they reflect the promise of a life in the community, which is defined as a job or an education, a home, and meaningful relationships with others.
Just as mental health transformation is an evolving process, the NOMs are evolving measures of performance. The States currently are pilot-testing two of the measures— decreased symptomatology/improved functioning and social connectedness. The NOMs and other Uniform Reporting System measures are, in fact, a test bed for measuring our basic concepts of what recovery means to a consumer.
[SLIDE 14. Scan of publication cover]
A month ago, SAMHSA Administrator Charles Curie appeared before the Congressional House Appropriations Committee. During his testimony, he publicly released NOMs data gathered by the States thus far. What was the focus of his remarks?—shared leadership and knowledge. Administrator Curie emphasized to Congress that SAMHSA and the States are working together closely and effectively to develop a data system that will improve substance abuse and mental health service delivery. This is shared leadership. He pledged that the NOMs system, fully implemented, will provide a much clearer reporting mechanism for Congress and the taxpayers to use in judging the effectiveness of their investments in our programs. This is shared knowledge.
Administrator Curie’s testimony assigns a tremendous responsibility to us. It is up to us to continue transforming our mental health system until it can meet everyone’s expectations. What are these expectations?—better data, better data-based decisionmaking, and—most important—greater positive outcomes for consumers.
With all there is to be done, we have to do it together. But it can be done—step by step and State by State—as we go from goals to action.
As we move forward with transformation, we must maintain our steadfast commitment to its goals. People, like organizations, are less effective when they lose their focus.
[SLIDE 15. Steps, jumps, ]
Mental health transformation is a long-term process. Progress will consist of many small steps, some medium jumps, and a few big leaps forward. But every move forward should be a cause for celebration. Just as it takes hundreds of bricks to create a new structure, it will take hundreds of actions to build a new system. Each brick helps to build a larger, stronger structure. When it comes to transformation of our mental health system, we must remain patiently impatient for a better future.
This meeting is where we can begin drafting blueprints that guide us in moving from the goals of transformation to action. We’ve structured our meeting in a way that presents transformation in concrete terms. State representatives will be meeting as regional groups this afternoon and tomorrow morning. During these sessions, presenters will rotate among groups to describe ongoing transformational activities at the national, State, local, and private levels.
The programs you will hear about during the regional sessions, talks, and poster sessions are transformation in action—tangible progress toward the goals of a transformed mental health system. Not all of these ideas will be right for your State. After all, the most basic value of a transformed system is that the services provided are driven by the needs of the individuals being served. The priorities of the people you serve in your State and communities may be far different than in others.
Please make this a highly interactive—not static—conference. Listen, ask questions, express your opinions. Shared information is essential to moving from goals to action, so share your ideas. In turn, we will share your ideas during a town hall meeting on Friday. Each regional group will have its own facilitator and recorder, who will remain with their group throughout the conference.
It’s vitally important that you share your own experiences, both positive and negative. Yes, we want to know what works for your State or organization and if can be replicated elsewhere. But we also need to know what hasn’t worked. Let others avoid similar pitfalls! Every time we eliminate a policy, program, or practice that doesn’t work, we open up an opportunity to try something else—something that is new and different and may hold greater promise. We have to get transformation started before we can get it right.
You’ll notice that this conference has another special feature: each day starts with an opportunity to network around specific transformation challenges, such as planning and data management. We want you to get to know others in your area, to build working relationships, to know whom you can call with questions or answers. Keep working together for transformation, both here at this meeting and after you return to your home States.
Transformation, as described in Achieving the Promise, is both an outcome and a process. It is not just a fancy word for change. Transformation implies a structural, procedural, and even cultural makeover of an entire system, with far-reaching and long-term consequences. It is ultimately about newness—about new values, new attitudes, and new beliefs that are expressed in the changed behavior of people. The “people” aspect of transformation is crucial because people just like you are its architects.
[SLIDE 16. Richardson quote]
Look around you. The greatest resource we have to invest in transformation is ourselves. As individuals and as mental health professionals and advocates, we have made a commitment to mental health transformation. Now is the time to share leadership and knowledge in bringing it about. To paraphrase Governor Bill Richardson of New Mexico, “We [as mental health professionals and advocates] have too much promise, too much potential, and too much at stake to go any other way than forward. We are too strong in our hearts, too innovative in our minds, and too firm in our beliefs to retreat from our goals.” Our goals reflect the future health and well-being of America. For us, there is no other alternative than action. Thank you.
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I’ll now open up the floor to questions. . . .
Potential questions:
Why are the Transformation SIGs so important?
- Progress made through Transformation SIGs will be the evidence that we can create and sustain comprehensive mental health service plans.
- First cadre of grantees will form a quality circle for developing implementation strategies that other States can replicate.
- If we do it right, other States will not need to wait for a Transformation SIG to begin implementing broad-based change.
How will the new Institute of Medicine (IOM) report on mental health care relate to transformation?
- New IOM report is to be a blueprint for implementing mental health transformation.
- The IOM report is not supposed to be a book that goes on the shelf. Because it should propose real and tangible strategies for change, it should be a living document for moving change forward.
- Report will help us move us from demonstration to scalability; that is, from test sites for transformation to national action.
What is happening with SAMHSA’s budget?
(See slide at end of presentation)
- This is a time of fiscal constraint. Funding available for mental health is declining, even as demand for services is increasing.
- This situation highlights our absolutely critical need to move toward a transformed mental health system, where we can prevent as well as treat serious mental illnesses.
- Mental health care that moves along a continuum of services and across the lifespan demands greater collaboration among agencies. If we can accomplish this—if we can combine resources, braid funding streams, and cross-train our workforce—we can reduce the costs of mental health care.
- This Administration supports mental health transformation. President Bush’s proposed budget for fiscal year 2006 proposes increases in only two of SAMHSA’s programs. One is “Access to Recovery,” a voucher initiative for substance abuse treatment. The second is our Transformation SIG program.
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