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
NAMI Annual Convention
Changing Minds, Changing Lives, Keeping the Promise
July 1, 2006
Washington, DC
PowerPoint version
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Slide 1/Cover
Thank you, Suzanne, for that most kind introduction.
It is always an honor and privilege to be part of your national gathering…and today, I am especially pleased to bring you an update on how we are moving forward with transformation in the States…nationally…and even internationally.
To start, I want to acknowledge the integral role NAMI continues to play in the transformation of our country’s mental health system. For over 25 years, your organization has been a beacon of information, education, and support for the mental health reform movement. Your organization represents one of the deepest pools of knowledge about mental illnesses available anywhere.
I particularly want to recognize NAMI’s Family to Family program and its dedicated volunteers—who work every day, week after week—volunteering countless hours to help consumers and families gain an understanding of mental illness…teaching individuals strategies to cope with their disorders…and leading them down the path of recovery. Your support is invaluable.
I want to commend NAMI for your work in producing this outstanding report—Grading the States – A Report on America’s Health Care System for Serious Mental Illness. This noteworthy report confirms the findings of the President’s New Freedom Commission on Mental Health in state-by-state detail. The report brings into focus the fact that too many State systems are failing to adequately serve individuals with mental disorders. Nationally, it gives our system a “D” average.
Alarming as that sounds, I am compelled to shift the focus away from the grade and toward the opportunity it presents. As a former elementary and high school teacher, I can say with certainty—that after the shock, after the disappointment, and even after the controversy that comes with any “grading process,” we often find renewed motivation when we focus on the solution and not the problem.
Slide 2 – Emerson Quote
Ralph Waldo Emerson has said, “Our greatest glory is not in never failing, but in rising up every time we fail.”
I see these report cards as the impetus for each State to rise up and meet the challenges of transformation…to take a closer look at the way they are serving the mental health needs of its citizens…to look around at the way other States are dealing with some of the tough issues and overcoming similar obstacles…to seek out opportunities to change the status quo…and to track many of the key elements that will accelerate mental health transformation. The NAMI report card presents a tremendous opportunity for States to keep building improvements in their transformational program.
As I travel the country, I see improvements taking place in all the States, regardless of the grade it may have received. All the States are trying very hard to move in the right direction and I am very encouraged by the developments I see and hear about every day. Despite the problems—fragmentation, the lack of access to care and the lack of funding—that exist in every State in the country, tremendous change is taking place.
Mental health is experiencing more attention than it has in a very long time. Positive, proactive attitudes and actions can be found in every State in the country. Smart, dedicated, innovative people are focusing their considerable talents on repairing what’s wrong with the mental health delivery system. All across the country, action is taking place that is changing both the face of mental health care and the lives of thousands of people. There is a lot being done right…as well as right now…in all of the States, even in those States whose grades were on the lower end of the scale.
Slide 3 – SIGs
One of the common themes across States is the lack of adequate funding. Funding is obviously of paramount importance in transformation. Last September, SAMHSA awarded more than 90 million dollars to seven States to help them develop the infrastructure needed to support the systemic changes that are called for…such as linking State mental health programs together with those conducted by the education and justice systems. We are also funding a new Transformation Action Initiative, which will broker technical assistance to help States meet the priority needs of their constituents. These seven States have an unprecedented opportunity to lead transformation and inform other States on which strategies work best in developing comprehensive service systems. But , in the meantime, I am pleased to see that many States are not waiting for additional Federal funding or support to promote their own State-level transformation further.
Slide 4 – California
Several States have demonstrated innovative ways to secure funds for mental health services. California recently enacted Proposition 63 to tax its wealthiest citizens as a stable source of revenue to fund mental health services. Regarded as one of the most creative approaches to financing, California expects a projected $750 million from this program to help its unserved and underserved population.
Slide 5 – New Mexico
New Mexico ’s Behavioral Health Purchasing Collaborative combines revenue from 18 State agencies into a single system to streamline care and decision making, implement evidence-based practices, and promote consumer and family choice. This program has the potential to become a national model.
Slide 6 – Oregon
Housing is another critical element in successful transformation. Housing is the most basic tie to a community and provides the gateway to local services. Oregon’s Affordable Housing program is an exemplary housing initiative providing integrated housing resources for people with serious mental illnesses. Its efforts are now being expanded by a new community mental health housing fund that was established by the sale of a former State hospital property. So far, Oregon has made more than 200 new community placements.
Slide 7 – Tennessee
Another example of a State that has made tremendous progress with its challenge to ensure adequate housing is available to its citizens is Tennessee. Tennessee’s housing level for individuals with mental illnesses now is among our Nation’s best.
Slide 8 – South Dakota
Ensuring employment opportunities for its mental health consumers is equally challenging to States. Jobs provide consumers with an important role in their communities. An individual’s work is a critical element for a successful life.
States can find strategic guidance in programs being conducted by South Dakota, which also has a large portion of its citizens living in rural areas. South Dakota has focused a lot of its transformation efforts on employment opportunities resulting in a 41 percent employment rate for consumers.
Slide 9 – Connecticut
Connecticut is providing a very focused recovery model of care, which includes excellent programs specific to supported employment and vocational rehabilitation.
Slide 10 – Nebraska
More and more States are reaping the benefits of jail diversion programs. Nebraska has a jail diversion program in Lancaster County that sets an example for similar programs throughout the nation. Clients, who are provided with help in finding jobs, treatment, housing, food and transportation, and navigating the court system show improvement in their attitudes and symptoms, and report a greater ability to control their lives, and to deal with crisis.
Slide 11 – Kentucky
Kentucky is successfully diverting people with serious mental Illnesses into treatment rather than jail through two highly effective, NAMI-supported Crisis Intervention Team programs and a federally funded mental Health court. It also passed a law mandating a statewide telephonic triage system to screen jail inmates for mental, cognitive, or substance abuse disorders, and provide linkages to treatment.
Most of these examples have come from States that scored C or less on their report cards. There are hundreds of other examples of innovative initiatives and programs that are working…and working well.
Slide 12 – All States
It is important to remember that every State is making a contribution to transformation and the time is ripe to build on these hard-earned, lessons learned.
So, we’re getting there. People are beginning to better understand the needs and the urgency of the challenges we’re facing and they are looking for creative ways to address those needs. That’s the good news. We know we still have a very long way to go, and there is enough work to keep all of us fully engaged in it for a long time to come.
Each step forward is a step toward success. Robert Collier, an American businessman and philosopher, believed that the greatest success is achieved by those who continuously strive to do better. He describes successful persons as those who “think ahead and create their mental picture in all its details, filling in here, adding a little there, altering this a bit and that a bit, but steadily building—steadily building.”
At the Federal level, we continue to make steady progress. On July 12, we will deliver a report to the Federal Executive Steering Committee on the progress we are making on the action items outlined in the Federal Action Agenda. Let me give you some background.
As some of you know, after the release of the President’s New Freedom Commission on Mental Health report, Achieving the Promise: Transforming Mental Health Care in America, SAMHSA was charged in leading transformation. It was obvious that transformation could not be the sole responsibility of one agency…nor one department…
transformation would take the combined efforts of many individuals, many organizations working together on many different levels.
Slide 13 – Federal Workgroup
SAMHSA brought together nine Federal departments, the Social Security Administration, and the Equal Employment Opportunity Commission to form the Federal Partners Workgroup for Transformation. There’s a reason for such a broad representation. Each of these Departments and agencies plays its own distinctive role in promoting and protecting the mental health of consumers. Each organization plays its part in making available the variety of services that will help people to achieve and sustain recovery…including a home, a job, transportation, and social support.
Our Federal Partners Workgroup reflects a genuine government-wide commitment to achieving real progress in mental health care service delivery. The workgroup is also a perfect example of the critical collaboration called for to develop and drive the systemic change needed for transformation.
We are modeling our approach, in part, on the lessons learned by our defense department. This department has successfully transformed itself into a 21st century fighting force, just as we have to transform those who are engaged in combating mental illnesses. Vice Admiral Arthur Cebrowski headed up the Pentagon's Office of Force Transformation until cancer led him to retire last year. This is the advice he handed out to those who would lead transformation.
“Be bold,” he said.“….Pick up the things that look really hard. Other people will have done everything else.” “Be fast, he added. “No transformational leader ever looks back and regrets moving too fast.”
SAMHSA’s agenda for mental health transformation is bold. Through the work we do together, we are literally changing the way we think about and go about providing care. In doing so we are embedding these new approaches...these new shared values...into the very fiber of how we work together. In doing so, we ensure that this work will continue...beyond the terms of the officials who are currently at these Departments and Agencies.
Slide 14 – Federal AA
You can get some idea of the depth and breadth of needed change by reviewing the document that outlines the steps being taken by the Federal Partners Workgroup. Copies of that document, entitled Transforming Mental Health Care in America: The Federal Action Agenda, are available to you at this event.
Our Federal Action Agenda identifies 70 different activities that we believe have the greatest potential to make an immediate impact. It is meant to be a “living agenda,” one that evolves as we make progress and as new priorities emerge.
To ensure that the needed resources will be available for transformation activities, we convened a Federal Executive Steering Committee comprised of twenty-one assistant secretaries and deputy commissioners representing the nine Federal departments and agencies. The committee is working to promote access to effective services by identifying and eliminating regulatory and funding barriers within their organizations.
Currently, the Committee is overseeing the creation of 15 cross-agency workgroups that will focus on mission critical issues…issues like suicide prevention, integration with primary care, financing, employment, disaster response, and others… issues that resonate with each of the partner agencies. SAMHSA is seeing unprecedented collaboration, accountability, and leadership from those involved. The Federal partners are taking action to make transformation happen… now!
The Department of Labor and the Social Security Administration are partnering to address one of the Federal Executive Steering Committee’s top priorities for 2006—employment and transition. Through the Joint Disability Program Navigator Initiative, DOL and SSA are collaborating to provide mental health consumers that receive Social Security disability benefits with a “one-stop” resource for the many programs and services that affect successful employment. Navigator program sites offer a “navigator”…a real, live, person who facilitates coordination of services and helps consumers move through the process. SAMHSA is ensuring that mental health information is incorporated into training for the program staff. This is a groundbreaking effort! Working together, these partners are providing a route to employability…and to recovery! This is transformation in action!
The Centers for Medicare and Medicaid Services, or CMS, is promoting transformative CMS programs such as Real Choice Systems Change and Independence Plus. Real Choice encourages State efforts to explore new ways of funding and delivering effective, community-based care. Independence Plus gives consumers greater choice, control, and responsibility in determining their own cost-effective care.
The Department of Veterans Affairs (VA) is also a leader in transformation. The VA is collaborating with the Department of Defense to aid in the mental health recovery and rehabilitation of troops returning from Iraq. It has launched a tele-mental health initiative to improve access and services for veterans who are experiencing homelessness.
Admiral Cebrowski, in his advice to transformational leaders, shared this strategy. “Be specific,” he charged. “If you lack specificity, your subordinates will be able to change your message to suit their own purposes.” At SAMHSA, we are displaying the behavior that we want others throughout the mental health system to adopt. Think of it as radiant leadership: changing ourselves first as a way to inspire others to make similar changes.
Slide 15 – Year of the Consumer
We are incorporating the concept of recovery in every aspect of our work. We have declared 2006 as the Year of the Consumer. We are surrounding ourselves with images of mental illnesses…and recovery. SAMHSA recently hosted a traveling exhibit by photographer Michael Nye. The exhibit, called Fine Line: Mental Health/Mental Illness, is a documentary of voices, stories, and portraits of individuals living with mental illnesses.
Slide 16 – Voice Awards
One of our most important activities has been to change the language of mental health. As Admiral Cebrowski noted, “Language conveys culture….You cannot expect old language to carry new ideas.”
Earlier this year, SAMSHA unveiled a consensus statement outlining the principle components of mental health recovery. The statement was developed through the deliberations of more than 110 expert panelists representing mental health consumers, families, providers, advocates, researchers, managed care organizations, State and local public officials, and others. We examined topics like recovery across the lifespan and recovery in different cultural contexts. We considered how recovery applied at individual, family and community, provider, organizational, and systems levels.
Slide 17 – Recovery Consensus
Our meeting led to this consensus definition of recovery for adults.
“Mental health recovery is a journey of healing and transformation for a person with a mental health problem to be able to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential.”
The process of recovery builds on the strengths of each individual. It is nonlinear and self-directed. It is holistic and person-centered, and it involves personal and community respect, responsibility and hope. It empowers consumers to make decisions that impact their lives. It recognizes the valued role of consumers in supporting and encouraging others as they continue on their own journey toward recovery.
Recovery is not an end point. Our definition implies a continuum of support...and a breadth of services that acknowledge the whole person and not just the disorder. The scope of this definition changes our entire perspective on how we should provide care.
To educate Americans about mental illnesses and recovery and to encourage those who need help to seek it, we have launched a national anti-stigma campaign. We have created the Voice Awards program to recognize writers and producers of television, radio, and film whose words portray individuals with mental illnesses with dignity and respect. The new language we recognize speaks of hope…and recovery.
I’m proud to say that SAMHSA’s own voice is being heard. We received the only Community Service Emmy that the National Academy of Television Arts and Sciences awards each year. Our “15+ Make Time to Listen―Take Time to Talk…About Bullying” multimedia campaign was selected from among hundreds of entries as the best example of outstanding messages and services for our communities.
To spread the word of transformation across America, we are continuing to partner with the National Governors Association in hosting regional meetings for States to learn from each other. Last year, we began to meet with teams of senior State officials to help them assess their mental health systems and to adjust their policy and funding priorities accordingly. We are doing more than calling for change by the States: we also are ensuring that they have the strategic tools and leadership that will make change possible.
Our goal at SAMHSA is to realign our national expectations of mental health care. We are transforming our mental health system so that its reality matches the reality of about 20 million Americans who currently have a diagnosable mental illness. Recovery is a real possibility, but it hinges on the ability of these consumers to obtain the necessary services when and where they need them.
SAMHSA and its Federal, State, and private-sector partners have made tremendous progress in transforming mental health care across America. The programs and policies that SAMHSA has been promoting are those meant to embed transformation across and within our national mental health system. And yet, many issues remain unresolved, many collaborations have yet to be formed, and much work lies ahead.
As a country, we are not lone travelers on the transformation highway. More and more nations throughout the western hemisphere are embracing the vision of transformation where care is holistic, culturally competent, and respectful of the individual. We are learning lessons from our international counterparts as they challenge their own systems of care. High on their agendas is the concept of social inclusion, which goes beyond “a life in the community for everyone.”
Social inclusion is about finding ways to make sure everyone has the opportunity to access all that society offers; it is a sense of shared responsibility for others that drives the actions that make our community stronger; through working together better we deliver a better future for all. We hope to see this vision extend to every country in the world…even the developing world. The language of recovery must become universal.
Slide 18 – Transformation Equation
The nation…the world…will not realize this ideal of a transformed mental health system overnight. It is not an “event”…but a continuing process. Some of you have heard me say it before but it so vitally important to remember that I will say it again. Transformation equals vision plus belief plus action times continuous quality improvement, squared. Our pursuit of excellence in behavioral health care will require ongoing and continuous effort.
And, throughout our journey…as we travel the road of transformation, we must remember to celebrate our progress along the way. Winston Churchill observed that there is a particular joy in the endless pursuit of excellence.
Slide 19 – Churchill Quote
Churchill remarked, “Every day you may make progress. Every step may be fruitful. Yet there will stretch out before you an ever-lengthening, ever-ascending, ever-improving path. You know you will never get to the end of the journey. But this, so far from discouraging, only adds to the joy and glory of the climb.”
Ultimately, we will see every State in our Nation…every country around the globe…make the perfect grade…achieve a level of excellence to fulfill the promise…and deliver the services and supports that really help a person with mental illness live a full life in the community. And, when we have achieved that glorious goal, we will have transformed the lives and future of millions of men, women and children.
Thank you.
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