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

Delaware Health and Social Services 35th Summer Institute on Substance Abuse and Mental Health:
Transforming Services...Transforming Lives

July 24, 2006
Newark, DE

PowerPoint version

Slide 1/Cover

Thank you, Renata ( Henry ). Good morning and welcome everyone.

I am pleased to be here this morning to set the stage for the work that you will be doing over the next few days to transform services…and transform lives…here in the “ Diamond State.”

Ironically, the “diamond” is a perfect symbol for the work of transformation.

Diamonds , General George S. Patton reminds us, are made under pressure. Diamonds are not merely found in polished stones. They are formed when carbon atoms are squeezed under pressure almost too extreme to comprehend—imagine the weight of the Eiffel Tower resting on a dinner plate.

These same bits of carbon are exposed to temperatures over 2000 degrees Fahrenheit. Even once they form, diamonds take thousands of years to make their way to the surface. A diamond is a legend in the making.

Mental health system transformation...here in the “ Diamond State”...and across this nation is a similar legend in the making. And, each of you has a critical role to play in this narrative of human actions...this history-making mission we call transformation.

Much like the odyssey of the carbon-atom-turned-precious-gem, the road to transformation of Delaware’s behavioral health care system will not be an easy one. As you work to change the status quo in your systems of care, there will certainly be pressure. I imagine you’ll even feel the heat once in a while. But I am here this morning to ensure you that despite the heat...despite the pressures...you can…you must…you are making transformation happen here in Delaware. The more than 15,000 Delawarians who turn to you for help with their mental and substance use disorders are counting on you to see this mission through. You are true agents of mental health system transformation.

I’d like to tell you a story about a powerful...if 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 18th 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/How Deep Change Happens

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 by Woolman’s story is a transformation agent who hails from a State close to SAMHSA’s headquarters just outside of Washington...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.” 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. 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.” In your roles as behavioral health care providers and others working in this State’s system of care, you are out there everyday fighting the fight…and paying the cost. I am here this morning to salute you and to encourage you to stay the course…to continue to focus your individual talents on this collective endeavor. Each of you has within you the power of one…the power of deep change...the power of transformation.

This Summer Institute is about the process of deep change…and the tremendous opportunities it presents for each of you to advance the transformation vision across Delaware…and the nation.

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.

You are critical to this mission. We simply cannot create the transformed system we envision without you. You are the ultimate locus of accountability for the care that is available in your communities. You can create a recovery-oriented system that will transform lives. You have the power to help move this vision to reality.

Too often, I think, the discussion of transformation and its implementation takes place solely between Federal and State government authorities. But, transformation is not simply a matter of “authority.” Transformation is, in large part, about changing the way in which we provide care. Transformation involves a change in “practice”…in how we deliver services to consumers. You are the keystones of that change. Real and meaningful change will not take place in our mental health care system without providers being willing to change…without providers taking a leadership role in designing and implementing the changes we know are necessary.

I commend each of you for being here today…for recognizing and embracing the need to transform the way you value consumers and the way you utilize consumers’ strengths to promote recovery and hopefulness. I deeply appreciate the fact that you are stepping forward to do this work.

Your very presence shows your readiness for the change that is required to move us to a new level of care—one that is consumer- and family driven…accountable to those you serve…and focused on the goal of recovery. You are literally forging a path…a pathway toward a more consumer- and family-focused vision of mental health care here in Delaware. Going forward, you have 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. 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 that Renata so artfully described.

Now that we have assembled this group of transformation 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 next few days will provide an important opportunity to focus on how to operationalize transformation…to work in really meaningful ways on the issues and challenges that must be addressed to make transformation happen here in Delaware.

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 next few 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 morning, I would like to share a few of these lessons...concepts that I believe will be essential to your success as you develop your own 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 here in Delaware 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. I applaud DSAMH for including recovery goals in its community contracts and for making the commitment to incorporate these goals in all clinical services this year.

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…and foster responsibility for choosing services and handling the tasks of daily living. Housing is one critical aspect of daily living. I know that housing is a real area of strength here in Delaware. DSAMH supports a variety of group homes, supervised apartments, and rental subsidy programs. This is transformation in action!

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. I commend you— Delaware’s behavioral health care provider community—for working closely with primary care providers to increase the treatment of physical health needs for persons with mental illnesses in this State.

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.

DSAMH’s Cultural Competence Committee serves as an active guide in the ongoing process of creating a truly culturally competent service delivery system here in Delaware. The Strategic Plan lays out an organized, system-wide approach for creating a vision for the future that truly serves every citizen of Delaware. I also applaud the initiatives being taken to eliminate disparities caused by geography...and to ensure services are accessible to and by consumers in this State’s rural areas.

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. The DSAMH/University of Pennsylvania evaluation project that examines issues pertaining to quality, outcomes, and resources demonstrates a real commitment to the widespread adoption of effective 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.

Delaware ’s commitment to implement an evidence-based, integrated treatment model for co-occurring mental illness and substance abuse is a shining example. With 22 programs across the State, staff in Delaware’s mental health, substance abuse, homelessness, criminal justice, and health care systems are better equipped to provide the treatment people need no matter what treatment door they enter.

The growing partnership between the Delaware State Troopers and New Castle County mental health advocates is another significant transformation success story. Equipped with better training about mental illnesses, the Troopers have developed a Crisis Intervention Team...and I understand that the County recently passed a resolution encouraging the police departments to explore further implementation of CIT.

As these examples demonstrate, there are countless ways to accomplish transformation in Delaware...and across all of the 50 states and Territories. There is no one blueprint. 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
• The widespread availability and use of effective practices, and
• Workforce development, including the use of consumers as staff. I would like to underscore this point.

Workforce issues are at the center of our change strategy. SAMHSA has commissioned the Annapolis Coalition to develop a national strategic plan on workforce development that is designed to transform our approach to recruiting, retaining, training, and educating the behavioral health care workforce. We see this plan as a starting point for an on-going series of strategies to strengthen the workforce...and, as a result, dramatically improve the care that consumers and their families receive. We know that this call for transformation is happening at a time when providers are already adjusting to a revolution of possibilities—new medications, new treatments, new expectations. But we are committed to supporting the workforce in making the real and meaningful changes necessary to advance transformation.

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 few 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. I urge you to 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!

Just recently, we convened a Federal Executive Steering Committee to guide and monitor the Federal Government’s process of transforming mental health care. Who’s on this committee? Twenty-one assistant secretaries representing the nine departments and agencies that make up the Federal partnership. We have charged these senior-level individuals with promoting consumer access to effective services by identifying and eliminating regulatory and funding barriers within their organizations.

SAMHSA also is proceeding rapidly to facilitate and compel transformation by the States. The greatest opportunities for change lie here at the State level...where the decisions about funding and service availability are made. We have been urging every State to take bold action…and we’re backing up our efforts with funding and technical assistance.

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 supporting State efforts through our new Transformation Action Initiative, which will broker technical assistance to help them meet the priority needs of their constituents.

We will not stop with these seven States nor will we wait for additional funding to promote State-level transformation further. We will use the experiences of the seven grant States to inform other States on which strategies work best in developing comprehensive service systems. Together with the National Governors Association, we will continue to host regional meetings. 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.

One of our most important activities both internally and externally has been to change the language of mental health. We have launched a national anti-stigma campaign to educate Americans about mental illnesses and recovery and to encourage those who need help to seek it. 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.

SAMHSA also convened a national panel to develop a consensus statement outlining the principles of consumer-driven recovery…what it means and how it can become real in practice. We recently released a draft statement. The language of this statement will be just as important to changing the attitudes, values, and beliefs of consumers as it will be to changing those of program administrators and providers. Consumers are the reason for the difficult but necessary work of transformation. They, too, must be ready to change and willing to risk because it is their needs, their expectations, and their potential that should shape the new reality of mental health care.

SAMHSA and its Federal, State, and private-sector partners have made tremendous progress in transforming mental health care. The programs and policies that SAMHSA has been promoting are those meant to embed transformation across and within the mental health system. And yet, many issues remain unresolved, many collaborations have yet to be formed, and much work lies ahead.

We must seize the many opportunities for progress that exist. The New Freedom Commission gave us a vision. Now it is up to the rest of us to maintain the current momentum for change. SAMHSA will continue to advance change across the mental health system. But we need your support. Transformation requires unprecedented collaboration, accountability, and leadership from everyone involved.

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

As you attend workshops and sessions over the next few days, I urge you to be open to doing things differently…to being innovative and creative about change…and, ultimately, to focusing 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 / Leadership Wheel

Importantly, effective leadership is imperative to initiate and sustain change of this magnitude. This Transformation Leadership Competencies wheel, developed by Dr. Noel Mazade of the NASMHPD Research Institute, is a starting point for a discussion about the many attributes that are needed to lead change. I’d like to highlight continuous personal development as a core competency of a transformational leader.

Slide 11/Continous Personal Development

Dr. Mazade’s assessment of desired traits includes this one: the ability to demonstrate personal values, vision, and goals. Leadership is character. It’s not a superficial role that we can take on and off. It has to do with who we are and the forces that have shaped us. Our actions as well as our words send daily messages about our personal commitment to visions, goals, and priorities. Transformation leaders must be courageous enough to take risks and be resilient and resolute in pursuing their vision. Transformation management implies that we as leaders inspire and develop these same traits in others.

Slide 12/MHST Graphic