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

SAMHSA/NGA Centerfor Best Practices/NASMHPD Regional Conference
"Transforming State Mental Health Systems"

June 15, 2006
New Orleans, LA

PowerPoint version

Slide 1/Cover

Good morning, and welcome. I am Kathryn Power, Director of SAMHSA’s Center for Mental Health Services. I am pleased to be here today to set the stage for the work that you will be doing over the next 2 days.

We are here today to create and move forward an action plan to change mental health care in America. Before we begin, I’d like to tell you about an unlikely change agent—John Woolman, an American Quaker who lived in the 1700s. Change management expert, Robert Quinn, tells Woolman’s story in the book, Deep Change: Discovering the Leader Within, to illustrate how each of us can harness our individual talents to bring about fundamental change in the systems around us.

In the 1700s, many Quakers were wealthy, conservative, slave owners. Woolman dedicated his adult life to eliminating the practice of slavery among his brethren. Woolman pursued this effort by using the art of gentle persuasion. He spent more than 20 years visiting Quakers along the east coast. He did not criticize people, nor did he make them angry. He merely asked questions such as, “What does it mean to be a moral person? What does it mean to own a slave?” Driven by his vision, he persisted, visiting farm after farm. By 1770, a century before the Civil War, not one Quaker owned a slave. The Quakers were the first religious group to renounce slavery.

In his book, Quinn ends the Woolman story with a question:

“…what would have been the result if there had been 50 John Woolmans or even five, traveling the length and breadth of the colonies in the 18 th century… persuading people, one by one…that a wrong should be righted by individual voluntary action? Perhaps we would not have had the war with its 600,000 casualties… We know now, in the perspective of history, that just a slight alleviation of the tension in the 1850s might have avoided the war. A few John Woolmans, just a few, might have made the difference.”

Slide 2/Quote

Quinn uses the Woolman story to make a simple, and yet profound, statement about how change happens: A single individual “has the ability to become a leader who induces change. The leader can transform separate individuals into cohesive teams. So linked, these individuals…can capture the imagination of larger communities, enticing them to dream new dreams. In the end,” Quinn declares, “excellence is infectious.”

One of those infected is transformation agent Tom Merrick from the Maryland Department of Disabilities. Tom shared with me his personal reflections on the book Deep Change. He observed,

“Transformative leaders are expected to experience and model deep personal change as they take necessary risks, putting vision attainment ahead of achieving political advantage, to create their desired results. This process is not reserved for the upper echelon alone, but is applicable and available to anyone at any level of an organization. Much of the rhetoric of two seemingly disparate lines of thinking—that is, self-direction for consumers and self-authorization for organizational players—is the same. There is dignity in risk; there is moral rightness in taking a stand; there is a recurring theme that change and learning come primarily from internal commitment. In many respects, recovery, as experienced by the mental health consumer, can be viewed as a kind of personal transformation, while a broadly brushed picture of system transformation can be viewed as a recovery, that is, the recovery of a system that is badly ‘out of alignment’ with currently changing realities….

“Leaders at all levels of the mental health system are charged to take the necessary political risks associated with allowing consumers to regain creative leadership roles in their own lives. The challenging reactions of those who would benefit from maintaining the status quo must be successfully negotiated. In this scenario, the stories of the lives of consumers fighting to achieve and maintain recovery become the truly heroic journeys at the heart of the system’s transformation. The leadership vision is focused on how we can get to the point that more of these stories are lived and more of these stories are told. That vision is a ‘deep change’ worth the fight and definitely worth the cost.”

As I look out into this audience, I see dozens of potential “John Woolmans.” As hand-picked leaders of your State’s key people-serving agencies, each of you has within you the power of one…the power of transformation.

This meeting is about the process of deep change…and the tremendous opportunities it presents for each of you to become agents of transformation. You can transform mental health care in your States…and across this country. We, at the Federal level, can facilitate, promote, and compel shared responsibility for the change that needs to happen. We can provide resources and use our convening power to raise issues to the national level. However, you are the ones who have the greatest, the most immediate, and the most personal opportunity to make a real difference in the mental health care provided to American adults and children.

Transformation really is a matter of personal action—of believing in a vision so deeply, so intensely, that a person is driven to make that vision a reality.

As leaders, each of you possess the potential to induce change…to capture the imagination of your larger communities…and to inspire them to dream new dreams about the way we deliver mental health care. You can fundamentally change your State systems. As this wave of transformative change spreads State by State, community by community, we can create the transformed national mental health system envisioned in Achieving the Promise: Transforming Mental Health Care in America, the final report by the President’s New Freedom Commission on Mental Health.

Your presence here demonstrates a strong commitment by your Governors to transforming your States’ mental health systems. Likewise, your presence here demonstrates the high level of confidence that has been entrusted in you by your States.

Each of you is here because you are the standard bearers. You have the authority to bring together the partners and resources needed to collaborate on a strong plan of action to achieve transformation. Your leadership in planning, financing, service delivery, policy reform, and evaluation of consumer- and family-driven services will be critical to our ability to advance the transformation agenda across this country. I deeply appreciate the fact that you are stepping forward to do this important work.

Now that we have assembled this group of leaders, what do we hope to accomplish? As Robert Quinn attests, the right tools, placed in the right hands, can make magical things happen! We have come together today to make transformation happen!

Slide 3/Achieving the Promise

The New Freedom Initiative has articulated a national mental health policy…for the first time since the Carter Administration. We have a vision. We have a direction. Now, we have to take action to realize the vision. We must give it “legs.”

The time to transform is now. We are in the midst of a public health crisis. The demands for mental health services and resources are growing every day. Our population is rapidly growing older and more diverse. We face emerging threats to our mental well-being, such as the fear and trauma associated with terrorist attacks.

The relationship between the fundamental nature of mental health and a person’s overall life is resoundingly clear. That point was driven home to all of us when Hurricanes Katrina and Rita struck this region last summer. These storms left in their wake thousands of men, women, and children struggling to recover and rebuild their lives. Their struggle is ongoing. The survivors, who include the rescue workers and emergency medical personnel who where on the scene, remain vulnerable to the long-term mental health effects of their traumatic experiences.

The U.S. Department of Health and Human Services, SAMHSA, and CMHS continue in their efforts to provide resources to support recovery by the survivors of the storms. Our efforts focus on helping individuals cope with trauma and on recovery. Depression is a significant problem, as are co-occurring disorders.

Our temporary crisis counseling program, which is really a prevention program, remains in place. This program takes a triage approach to ensure that the local public and private behavioral health systems are not completely overwhelmed. We also are doing a lot of education around helping individuals and organizations understand that most individuals seen in our crisis counseling program are responding normally to extreme trauma. Individuals affected by the hurricanes experienced a tragic, life-altering event. They have a right to grief…to emotional pain…to sadness. With care and understanding, they will regain a sense of well-being.

New Orleans , just like its people, is being transformed in the wake of the storms. Its behavioral health infrastructure needs to be recreated. What an amazing opportunity lies with the enormity of what must be rebuilt! The issue now is: How can New Orleans, or the rest of us, take what we’ve learned here and apply it elsewhere? What are the lessons for transformation?

One of the lessons we’ve learned is how individuals actually use behavioral health services. We often talk about the stigma that prevents individuals from seeking care. The reality of New Orleans and other cities is that we took services to people in need, and they took them gratefully…and asked for more. We located a clinic in a trailer park for individuals who couldn’t get anywhere else. We helped communities establish support groups within their populations. Emergency services were well received. How can New Orleans, or your communities, provide similar services long term? There are real opportunities to reduce behavioral health problems by making services more accessible.

The next 2 days will provide an important opportunity for you to focus on transformation…to work in really meaningful ways with your critical partners on the issues and challenges that must be addressed to make transformation happen in your States.

Some of you have been working on transformative activities for some time, and need a platform for looking at things differently. Others are starting out fresh. These 2 days will provide the opportunity to develop and communicate a vision for your transformed systems that will inspire others to “own” the vision…and perform in extraordinary ways to make that vision a reality.

Slide 4/Lessons Learned

In our efforts to advance transformation at the Federal level, we have learned many valuable lessons about creating an action plan for transformation. We have learned…

• about fostering communication and collaboration across diverse agencies...
• about how to align programs related to mental health such that the whole becomes greater than the sum of its parts…
• about how to maximize the value that each partner brings to the transformation process.

This meeting is about sharing these lessons. It is about providing the tools that will be essential to your success as you create your own action competencies, skill sets, and strategies for transformation.

I think it is important, here, to take a moment to clarify what we mean by “transformation.”

Slide 5/Transformation is…

Transformation is an extremely powerful concept. Transformation is a vision, a process, and an outcome.

It suggests an upheaval and reorganization of what we know, what we do, and how we do it. It has implications for policy, funding, and practice…and for attitudes and beliefs.

Transformation is not simply a fancy word for reform. It is far more encompassing than that. Transformation is not merely a synonym for modernization; it is much more than the process of improving current capabilities. Transformation certainly involves change. But change, alone, speaks to the predictable and possible. Transformation calls for a fundamental shift to another level of thought and actions. Transformation assumes a different set of values…an entirely new way of thinking…and a better way of providing services to consumers and families by educating, empowering, and encouraging them to be equal partners in their own care.

Transformation calls for fundamental change at the very core of the system, and not on the margin. Transformation is meant to identify, leverage, and even create new underlying principles for the way things are done. New sources of power emerge. Once transformation begins, a profoundly different system materializes—a system changed in structure, culture, policy, and programs.

Yes, transformation will require radical shifts in attitudes and actions. But, the end state…the transformed mental health care system…will be well worth our deliberate and courageous action.

What will a transformed mental health system look like? Of course, it will vary from one State to the next. The needs of Louisiana may be very different from those of Wyoming, for example. But, there are a number of common characteristics that all transformed systems will share. For instance—

Slide 6/In a Transformed System…

In a transformed system, recovery will be the guiding principle of everything we do. Recovery is the journey of hope through which lives will be transformed. Recovery does not necessarily mean “cure.” Recovery is a process...a continuum of personal achievements as each person moves toward his or her greatest potential. For some individuals, recovery is the ability to live a fulfilling and productive life despite a disability. For others, recovery implies the reduction or complete remission of symptoms.

The most compelling element of a recovery-focused system is the belief that adults with mental illnesses can take charge of their own lives, their own wellness, and their own care. It is the belief that systems should help children and their families build on existing strengths, foster resilience, and create promising futures.

These beliefs have extraordinary implications for transforming mental health care. When we change the focus from system-directed to self-directed, we begin to look at what is required to empower persons with mental illnesses to build meaningful lives with real opportunities to develop and reach their uniquely individual life goals.

Consumers and families are at the very center of a transformed system. In a transformed system, consumers…working in partnership with their care providers…will direct their own care. It is a very powerful idea. Our roles will change. The discussion will shift, then, to how can we facilitate consumers’ freedom to live in the community …enable authority over the funds needed for one’s own care…offer support for choices that are best for them…foster responsibility for choosing services and handling the tasks of daily living…and provide opportunities for consumers to participate in decision-making about their care delivery systems.

A transformed system will encompass both prevention and treatment to remove barriers in lives, and begin a chain reaction for future success. In a transformed system, we will work to prevent the onset of disorders. We will also provide prevention-minded treatment— treatment that goes beyond symptom management to consider what else a person needs to achieve and to sustain recovery.

In a transformed system, all Americans will share equally in the hope for recovery from mental illnesses, regardless of their race, gender, ethnicity, or geographic location. We will eliminate the disparities that currently exist in the system. We will collect accurate data about mental health needs of ethnic and cultural minorities. We will build a workforce of trained, bilingual personnel who can provide culturally competent services. And we will identify, design, and implement culture-specific treatments and supports.

Transformation demands that we be on an urgent mission to overcome the divide between the laboratory and the field...between science and service. In a transformed system, we will move science to service faster and more effectively . The use of evidence-based, state-of-the-art treatments and supports will be standard practice. These practices will be widely available and supported. Transformation also implies changes in financial incentives and accountability practices to promote the use of evidence-based practices.

Finally, in a transformed system, services and supports will be available…and accessible…and coordinated across multiple systems. Children, adults, and older adults with mental disorders are seen in multiple systems and sectors—from hospitals and homeless shelters to the judicial, education, and social welfare systems. In a transformed system, everyone in each of these systems will work together to provide a seamless mental health care delivery system that serves the whole consumer…mind and body.

What will it take to transform mental health? You have a lot of flexibility in how you will accomplish transformation in your State. However, our knowledge of systems change research and our review of the current literature indicates the following are essential to transformation—

Slide 7/Essentials of Transformation

• Strategic and comprehensive planning developed under the leadership of the Governor with full participation by a broad range of relevant State agencies, community representatives, consumers and family members
• Cross-agency collaboration
• A commitment to institutional change through strong leadership
• The real and meaningful involvement of consumers/family members in the process of strategic decision making
• Workforce development, including the use of consumers as staff, and
• The widespread availability and use of effective practices.

SAMHSA/CMHS is committed to working with you on each of these critical system needs. We are in this together. Our success depends on your success. It will take all of us. In fact, collaboration is the lifeblood of mental health transformation. Why is this synergy—this mutually energizing collaboration—so important? People living with mental illnesses have complex and multiple issues that cut across every department, agency, and system. It will require cooperative action…from numerous stakeholders on multiple levels … to develop the comprehensive and broad-based solutions we require.

Slide 8/Federal Partners

Over the past 3 years since Achieving the Promise was released, we have experienced the transformative power of collaboration, firsthand. Today, nine Federal Departments, the Equal Employment Opportunity Commission, and the Social Security Administration, with SAMHSA at the lead, have united behind a belief in recovery and joined in an unprecedented collaborative effort to change the status quo!

Slide 9/Federal Action Agenda

Together, we have developed a Federal Mental Health Action Agenda—the roadmap that will guide our steps as a Nation toward this wholesale transformation. In developing this document, each participating Federal Department and agency created an inventory of its current mental health activities…and made suggestions for new, transforming programs and practices. This Action Agenda identifies the first time-limited, realistic steps that we, at the Federal level, can take during the next year to move transformation forward.

The actions described in this report have the power to propel significant changes in mental health care. It is tangible evidence of how we will move from a vision of transformed mental health care to its reality. This document is our pledge to take action. With it, Congress, the Nation, and the people we serve can hold us accountable for achieving the goals we have set. I have made copies of the Agenda available to you at this meeting. I urge you to take a copy, read it, and share our plans with your colleagues.

The Action Agenda is transformation in action! This is how we will eliminate the fragmentation of services among Federal agencies! And, the action steps proposed in the Agenda will create tremendous opportunities for transformative collaborations that will cascade to the State and local levels. We expect our Federal Action Agenda to become a model for an equally unprecedented level of collaboration in every State…where it will lead to even greater action…and transformation with an even greater sense of urgency!

Yes, collaboration is the life blood of transformation. But, so is the power of one.

As you work on your action plans over the next 2 days, be open to changing the status quo…to do things differently…to be innovative and creative about change…and, ultimately, to focus on the meaning of recovery for the people you serve.

It has been said: When you change the way you look at things, the things you look at change. A change in perspective is the essence of transformation. Transformation requires people to change…one person at a time…before changes in the system can follow.

Slide 10/MHST Graphic

John Woolman did it more than 200 years ago. You can do it today. You have the opportunity…right here, right now…to change the world for the better. You can begin by taking these important first steps toward transforming mental health care in your State. Use your power of one to help achieve the promise of transformation for many. Thank you.