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
Seizing Opportunity: Using the Block Grant as a Platform for Health Care Reform
June 18, 2009
Washington, DC
PowerPoint Version (2MB)
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]
Thank you, Joyce, for your kind introduction and for the invitation to join you today. I recently came across an English proverb that said, “A smooth sea never made a skillful mariner.” Individually and together, those of us in this room are sailing through turbulent waters. We only have to pick up a morning newspaper or turn on cable news to know that these are difficult times for States, for providers, and for individuals of all ages with mental health conditions.
We know that nearly every State in the country is facing budget gaps this year and next, and that together, States are projecting 105 billion dollars in shortfalls for 2010. As many as 32 States are enacting mental health funding cuts. State Mental Health Authorities are responding to required budget cuts creatively and conscientiously, but sadly many have to lay off staff, cut services, and reduce the number of individuals being served.
At the same time in which States and providers struggle to do more with less, an increasing number of individuals are in need of services. A front page story in a recent Mental Health Weekly pointed this out when it noted, “From the psychotherapy patient seeking to cut back on sessions to the chronically mentally ill client bombarded with messages of economic gloom, most everyone receiving mental health services is bound to be touched in some way by the Nation’s ongoing financial crisis.”
[Slide 2—Mental health is essential]
In fact, according to the American Psychological Association’s recent Stress in America survey, almost half of Americans say they are increasingly stressed about their ability to provide for their family’s basic needs. They are turning to food, alcohol, and cigarettes to cope.
The National Suicide Prevention Lifeline has experienced a 30 percent increase in calls over the last year. Crisis centers are reporting a significant increase in the number of people who are calling because they have lost their job or their home or are afraid they will.
But far from this being a bad time to make major changes in health care in this country, this is precisely the time when we must prevail. The health of our families and friends, our communities, and our Nation depends on it.
I know that each and every one of you here today has the skills and the commitment to be a skillful mariner, steering your States and your organizations through the current economic storm. More than any other time since I have been working in mental health, I believe we have not only a golden opportunity but also an ethical, moral, and financial imperative to transform the delivery of health care in this country. As President Obama has said, “Change will not come if we wait for some other person or some other time.” We are the ones we’ve been waiting for.”
We are the ones because we know what needs to be done to transform not just mental health care, but all of health care, with mental health as the basis for all health and wellbeing.
Indeed, there is a groundswell of understanding and support for the belief that mental health is essential for overall health.
It’s evident in the Administration’s call to invest in prevention and wellness.
It’s clear in recent passage of the Mental Health Parity and Addiction Equity Act.
And it’s behind the reemergence of the Hippocratic notion that the mind and the body are inseparable. We know that healthy individuals, healthy communities, and a healthy Nation depend on us to get it right.
[Slide 3—CMHS priorities]
This morning, I’d like to suggest that success in health care reform demands attention to the five critical priorities that drive the work we do at CMHS. They are:
- The public health model;Whole health, person-centered health care;
- Attention to the broad determinants of health;
- A customer-focused workforce; and
- Continuous quality improvement.
These five priorities are the centerpiece of a new strategic forecast that CMHS prepared to chart its course in the coming years. As the single largest initiative CMHS funds, the Mental Health Block Grant and the programs it supports are the center of gravity for transformation of health and mental health care in States and communities. We know that transformation is a process that evolves over time, which means we must be nimble, proactive, and well-positioned to address any emerging issues that arise. Clearly, we don’t have a moment to lose.
[Slide 4—Mental health continuum]
The Public Health Model
As behavioral health providers, the foundation of our work must be a public health model of care because it encompasses everything else that follows. Public health is a community approach to preventing and treating illnesses. Its premise is that caring for the health of an individual protects the community, while, in turn, caring for the health of the community protects the individual. As such, health promotion and disease prevention are the cornerstones of a public health approach.
We have not always thought of mental health as a public health discipline, but the World Health Organization has noted, “The goals and traditions of public health and health promotion can be applied just as usefully in the field of mental health as they have been in the prevention of infectious or cardiovascular diseases.”
Science bears this out. In March, the Institute of Medicine released a much anticipated report, Preventing Mental, Emotional, and Behavioral Disorders among Young People: Progress and Possibilities. CMHS was pleased to support this update to the seminal 1994 report, Reducing Risks for Mental Disorders.
I’m happy to be able to share with you two key findings from the new report. First, the 2009 update reveals concrete evidence that an increasing number of mental, emotional, and behavioral disorders are, in fact, preventable. Second, and equally important, this groundbreaking report goes beyond the 1994 report by recommending the inclusion of mental health promotion in the full spectrum of mental health interventions.
The authors conclude, “The nation is now well positioned to equip young people with the skills, interests, assets, and health habits needed to live healthy, happy, and productive lives in caring relationships that strengthen the social fabric.” What a wonderful vision for health care reform.
Whole Health, Person-Centered Health Care
To promote health and prevent disease, we must embrace a whole health, person-centered approach to health care. A whole health approach is grounded in the knowledge that health is a function of the complex interplay between body, mind, and spirit. Person-centered care is respectful and responsive to the needs and values of individuals and honors and supports recovery and wellness.
In practice, this means that all of the factors that influence a person’s health status must be acknowledged and addressed across the continuum of health care services…with the full participation of the individual at all stages of care.
One important way to do this is to integrate and coordinate mental health with primary care. Statistics on morbidity and mortality among individuals with mental health conditions make clear that we can’t treat the mind and not the body.
In fact, there is substantial evidence to demonstrate that providing adequate levels of mental health and addictions prevention and treatment, as well as integrating these services with those of general health care, can:
- Improve health outcomes;
- Lessen the rate, duration, and intensity of disability of many illnesses;
- Cut and/or control the growth of overall health care costs;
- Improve individuals’ productivity;
- And control the size and growth of other social costs.
This is transformation made real!
To support the development of integrated systems, SAMHSA announced the Primary and Behavioral Health Care Integration program. We sought applications from community-based behavioral health agencies to improve the physical health status of people with serious mental illnesses. We will help them do so by supporting coordination and integration of primary care services into publicly funded community mental health agencies.
The services we fund will incorporate a prevention and wellness approach and show cooperation and collaboration across community mental health and primary care. Clearly, we can’t improve the health of individuals, communities, and the Nation unless we transform the way we provide treatment and services.
The Broad Determinants of Health
Embracing a whole health, person-centered approach fosters the active engagement of individuals in their own recovery and helps build resilience to support their ongoing health and productivity. But individuals exist in the broader social context. Any attempts to improve the overall health of individuals and the communities in which they live must address the personal, social, economic, and environmental determinants of health. As our colleagues at the Mental Health Commission of Canada have so eloquently stated, “The context of people’s lives matters.”
Unfortunately, we have excluded people with mental illnesses from the social fabric of our lives for far too long. We know that social exclusion increases the likelihood of significant psychological distress and psychiatric illness, including substance abuse.
On the other hand, social inclusion means that we adopt policies and activities that are not necessarily planned as mental health interventions, but—because they improve access to a wide variety of resources—have important mental health effects. We include all members of a community when we have safe schools, stores that sell healthy foods, and places to gather for recreation and relaxation.
Ultimately, without access to housing, health care, meaningful activities, social support, and community relationships, individuals are excluded from all that it means to be healthy in today’s society.
[Slide 5—Workforce screenshot]
A Customer-Focused Workforce
Providing integrated, holistic care that supports healthy individuals and healthy communities requires that we train, educate, and support the workforce that delivers care—not only in behavioral health care, but across the health care professions. “The people who deliver care are the health system’s most important resource,” noted the Institute of Medicine in its report, A New Health System for the 21st Century.
This summer, SAMHSA will launch a Behavioral Health Workforce Development Resource Center to serve as a comprehensive Web portal for mental health and substance abuse treatment providers and the programs that employ them. The site will contain a wealth of information on such cutting-edge issues as licensing, credentialing, education, and employment, as well as recruitment, retention, supervision, and leadership training.
Behavioral health providers will be able to search for a job and build a resume. They will also have access to state-of-the-art education and training resources. Employers will find information on how to recruit qualified, well-trained staff. Information on the site will be updated daily.
As part of this project, we are also developing core competencies for behavioral health care providers who work with a full range of clients—from adults and older adults to women, children and families, and various ethnic and cultural minority groups.
In addition, SAMHSA recently released a Request for Proposals to create a standardized training manual on recovery-oriented care. We recognize the urgent need to transform the concepts of recovery from a set of beliefs into action at the service provider level. This project will support the expansion and integration of recovery-oriented care delivered by mental health providers. This is transformation made real!
Continuous Quality Improvement
Finally, to be successful in creating innovative, sustainable health care reform, we must focus on continuous quality improvement. This involves the collection and use of data that show not just who we serve, but how we can serve them best.
Indeed, the mental health community has been at the forefront of efforts to develop, adopt, and adapt evidence-based practices. A decade ago, then Surgeon General David Satcher pointed out that most mental health conditions are as treatable as most general health conditions.
In the intervening years, with your help and support, we have shown the comparative effectiveness of a number of practices, including supportive housing, supported employment, and integrated treatment for co-occurring disorders. We should rightly be proud of our contribution to the science and practice of evidence-based medicine. Comparative effectiveness, according to Jean Slutsky—director of the Center for Outcomes and Evidence of the Agency for Healthcare Research and Quality—“is a natural evolution in making sure we provide the most effective health care to the right [individual] at the right time.”
This is why the data you collect are critically important both at the State and Federal level. When you gather information on the individuals you serve, the types of services they receive, and whether the care you provide meets their needs, you are helping us define a transformed health care system.
In fact, the data you collect were vital in helping us confirm—as part of a recent evaluation of the Mental Health Block Grant program—that the Block Grant has been and continues to be implemented according to congressional intent.
But you are doing so much more than meeting the letter of the law. You are a living embodiment of the spirit of the Block Grant legislation.
You are providing services to some of our most disenfranchised citizens, helping them reclaim their rightful places in their communities.
You are collecting, analyzing, and sharing the data that reveal not only whether we are headed in the direction we want to go, but whether that direction is the right one for the adults, children, and families we serve.
And you are helping us operationalize what it means for individuals to recover from mental health and substance use conditions and be resilient in the face of life’s adversities.
This truly is transformation made real!
[Slide 6—Helen Keller quote]
Moving Forward
I began my remarks this morning by talking about the difficult economic circumstances we face. You might wonder how we can implement some of the strategies I’ve outlined when resources are scarce. But how can we not when the need is so great? The individuals we serve are counting on us more than ever.
Helen Keller once said, “When one door closes, another opens. But we often look so long and so regretfully upon the closed door that we do not see the one which has opened for us.”
We must not look back at what has been; we must seize this opportunity to transform the health of individuals, of communities, and of the Nation as a whole.
Clearly, we can’t wish away the current fiscal crisis. Many of you have told us you will have difficulty with the Block Grant’s Maintenance of Effort or MOE requirements. The SAMHSA Administrator is authorized to approve MOE waivers if a State can demonstrate that it has met the definition of “extraordinary economic circumstances.” I encourage you to speak with your Project Officers to learn the details of this program.
We also must do all that we can to help build resilience in the individuals we serve. Many of them are at increased risk for mental health and general health problems, family tensions, and social isolation as a result of severe economic hardship.
The providers and programs you support are the heart of our safety net, and we stand with you during this difficult time. SAMHSA’s Disaster Technical Assistance Center is developing a toolkit that will focus on providing guidance for individuals, families, communities, and organizations in developing and maintaining psychological resilience. We have already posted an online guide, Getting through Tough Economic Times. You can use these materials as the basis for starting a conversation with those who may need your help.
But as bleak as things may look, we have seen a wonderful phenomenon play out in cities and towns across America—individuals who have lost their jobs have swelled the ranks of volunteers working with children, feeding individuals who are hungry, and reaching out to men and women living on the streets, many of whom have mental health conditions. The have turned challenge into opportunity. This is the face of resilience.
Resilient individuals are those that bend rather than break during stressful conditions. They are most likely to have a positive outlook and a sense of personal mastery and to find meaning even in difficult circumstances. We must nurture a resilient spirit not only in the individuals we serve but also in ourselves.
We also must be certain we are not trying to sustain programs and services simply because they exist. Instead, we must invest in those programs and services that produce the desired outcomes of healthy individuals, healthy communities, and a healthy Nation. We must pay for what works and discard outmoded treatment and outdated science.
Finally, and perhaps most important, we must be ambassadors for the role that mental health plays in overall health and wellbeing.
We must demonstrate with data and show with results that we not only understand the importance of mental health to overall health but we know how to put words and ideas into action.
We must not only have a seat at the table when health reform is being discussed, we must lead the discussions and help pave the way for a truly equitable health care system that honors the strength and wisdom of each individual it serves.
We must not miss this opportunity to have a significant and positive impact on health reform discussions and, in so doing, on the health of the men, women, and children we serve. They deserve nothing less.
Thank you.
|
