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
Eliminating Mental Health Disparities
The Challenge and the Opportunities
Washington, DC
July 25, 2005
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]
[Slide 2/Gandhi Quote]
“You must be the change you want to see in the world.”
Almost 50 years after his death, Indian spiritual leader, political activist, and humanitarian Mahatma Gandhi still inspires many with the words of hope and spirit that made him one of the 20 th century’s most influential and respected people. These words still resound for us today.
What Gandhi says so eloquently with just a few words is this: for our world to be different, it is up to each of us to offer solutions…and to serve as an example to others that we can create the world we know is possible.
This idea is one I would like to speak with you about this morning…as current and former students…embarking on new challenges…entering the early stages of what are sure to be respected careers.
Because quite honestly, we need you to be the change we want to see in our mental health system of care. We need the drive…the focus…the care that you have demonstrated in your studies to implement the vision for a mental health system that effectively facilitates the recovery of every American living with mental illnesses…including members of our racial and ethnic minority communities who have for too long been undiagnosed…overlooked…and untreated.
I am happy to see the faces of so many people who in the last two years as Director of the Center for Mental Health Services have become familiar to me—the faces of accomplished mentors, speakers, and participants in the Minority Fellowship Program—who care deeply and are deeply committed to the challenges and goals facing the mental health profession. I know I speak for all of my colleagues at the Center for Mental Health Services (CMHS) …and across the Substance Abuse and Mental Health Services Administration (SAMHSA)…when I tell you how pleased we are to continue to support the SAMHSA Minority Fellowship Program, the American Psychological Association’s (APA) Psychology Summer Institute, and programs like it throughout the country. We are proud to have an opportunity to engage with you who will shape the future course of the behavioral health field.
I would like to take a moment to thank everyone at APA for developing the Summer Institute and its informative agenda. Special thanks to Drs. Kim Nickerson and James Jones—whose dedication leads the implementation of SAMHSA’s Minority Fellowship Program (MFP). Finally, I would like to recognize Dr. Henry Tomes, Director of the Public Interest Directorate here at the APA, a former state mental health commissioner in Washington and Massachusetts—who as many of you know—will join the ranks of retirement soon. Dr. Tomes, we thank you for being a wonderful model of what a career of service to others embodies.
[Slide 3/Diversity Stats]
The communities we serve are rich with diversity. Racial and ethnic minorities make up more than one quarter of the American population, and by 2025, will account for more than 40% of all Americans. Unfortunately, the number of trained minority mental health providers and services researchers is not increasing at the same rate—less than 10% of mental health providers are ethnic minorities—increasing the disparities currently found in the system.
[Slide 4/Psychiatric Disability Stats]
At the same time, psychiatric disability is on the rise. There are 450 million people worldwide that have a mental disorder. The top 3 leading causes of disability worldwide are behavioral disorders—mental illnesses, alcohol, and drug use disorders. By the year 2020, disability from mental illnesses will increase by 50 percent globally—a larger proportionate increase than that for cardiovascular disease. One in five Americans—44 million adults and 14 million children—live with mental disorders. Nearly 15 million people have a substance use disorder alone, while 4 million Americans have co-occurring mental and addictive disorders. Less than half of all Americans with severe mental illnesses seek treatment. Less than a quarter of them actually receive treatment from a mental health professional.
These are the national numbers, but we know that, on average, racial and ethnic minorities have less access to mental health services than White Americans. They are even less likely to receive needed mental health services. They tend to receive poorer quality of mental health care when they do get it; and they are underrepresented in mental health research.
The numbers are simply staggering…the challenges can seem insurmountable. There are huge issues to tackle and needs not being met. All of which place a burden on our communities. Children with serious emotional disorders find themselves in foster care in order to receive the services they need. People with mental illnesses are unjustly caught in the web of the justice system. Others are homeless and living on the streets.
[Slide 5/The Public Health Approach]
The prevalence and incidence of these disorders isa public health priority that requires a public health approach—a community approach to prevention and treatment. The premise of the public health approach is that caring for the health of an individual protects the community, while—in turn—caring for the health of a community protects the individual—with society at large reaping the overall rewards. The public health model is based on data…experiences… and best practice approaches.
The significance of this statement may not be immediately obvious. But, it is a critically important issue…because our knowledge base is sorely lackingdata…experiences…and best practice approaches related to the diagnosis and treatment of racial and ethnic minorities.
In 2001, the U.S. Surgeon General’s Report, Mental Health: Culture, Race, and Ethnicity, clearly defined the nature and pervasiveness of the many barriers and disparities facing African-, Hispanic-, and Asian-Americans, and American Indians and Alaska Natives. The Report called national attention to the fact that culture counts… that cultural differences must be accounted for to ensure that racial and ethnic minorities, like all Americans, receive mental health care that is responsive to their needs.
More recently, a June 2005 series in The Washington Post examined the role of cultural factors in the diagnosis, treatment, and outcome of mental disorders…spotlighting the ongoing prevalence of misdiagnosis for certain ethnic groups and the call for more “culturally competent” care. The series also recognized the importance of human technologies…or, as I like to say, the treatment of every person as a unique individual…a whole person—body, mind, and spirit—together.
In many ways, the mental health field has lacked the knowledge base to fully appreciate and respond to the individual differences of members of racial and ethnic minorities. Differences in cultural and social norms, and even preconceived notions on the part of mental health professionals have played a large role in this gap. We can’t change the past, but we can learn from it…and do something about today…and tomorrow.
I am pleased to say that CMHS is leading a vision for the future of behavioral health—a future that calls you to become part of the changes that are underway…a future that calls on you to invest inmental health transformation and the promise it holds to reduce disparities in care for racial and ethnic minorities. A vision that your voices must amplify and your hands must help mold.
[Slide 6/Achieving the Promise]
It is the Final Report of the New Freedom Commission on Mental Health that provides the impetus for…and presents extraordinary new opportunities to create…the seamless system of behavioral health care necessary for our work to affect the lives of those among us who most need these services.
As most of you know, and others may have learned during Dr. Larke Huang’s presentation yesterday, in 2002, the landmark final report of the President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America reaffirmed the urgent need to eliminate disparities for minority populations and moved the issue to the forefront of the national agenda. Achieving the Promise also observed that racial and ethnic minorities remain seriously under-represented in the core mental health professions…and that many mainstream providers are inadequately prepared to serve culturally diverse populations.
Achieving the Promise reached a bold conclusion: we must fundamentally transform our Nation’s approach to mental health care. The assignment of transforming mental health across the entire United States is no less than monumental. But the challenges we face require this scale of change.
[Slide 7/Transformation Is]
Transformation is revolutionary. It implies profound change—not at the margins of a system, but at its very core. Transformation assumes the need for a fundamental shift to another level of thought and action. In transformation, new sources of power emerge. New competencies develop. Fortunately, Achieving the Promise provides us a vision of transformed mental health care with goals and specific recommendations for achieving this vision.
What will it look like when these goals are realized? Our transformed national system will be focused on recovery and self-determination. It will uphold the dignity of every individual. All Americans will share equally in the best available services and outcomes— regardless of race, gender, ethnicity, or geographic location. The hope for and the promise of recovery is the fuel that is driving this transformation.
[Slide 8/Recovery Is]
What do we mean by mental health recovery? Recovery is the journey of hope through which lives will be transformed. It does not necessarily mean “cure.” Recovery is a process...a continuum of personal achievements as each person moves toward his or her greatest potential. Perhaps the most compelling element of a recovery-focused system is the belief that people with mental illnesses can take charge of their own lives, their own wellness, and their own care.
This single belief has extraordinary implications for transforming mental health care. It demands change—from Federal and State agencies, from providers, from the people we serve and their families. Each of us must have the capacity, as well as the willingness, to become equal partners in a systemic change in our approach to determining and delivering care.
[Slide 9/NFC Executive Order Principles]
In developing its vision for a transformed system, the Commission framed its work around five principles… principles that seek to:
- Improve the outcomes of mental health consumers;
- Promote collaborative community level models of care;
- Maximize existing resources and reduce regulatory barriers;
[Slide 10/NFC Executive Order Principles, cont.]
- Use mental health research findings to influence service delivery; and
- Promote innovation, flexibility, and accountability at the Federal, State, and local levels.
These principles are the priorities…they are directing our efforts to advance transformation across the behavioral health field.
[Slide 11/Action Agenda]
These principles are the driving force behind the new Federal Mental Health Action Agenda that was just released on Friday…the roadmap that will guide our next steps as a Nation toward this wholesale transformation. This first Action Agenda identifies time-limited, realistic steps that we, at the Federal level, can take during the next year to respond to the principles that guided the Commission’s work and move transformation forward.
[Slide 12/Federal Partners]
The Action Agenda is the result of an unprecedented collaborative effort among a coalition of senior level staff from 9 Federal Departments and the Social Security Administration. The Action Agenda features an extensive inventory of recovery-focused mental health-related activities and resources at the Federal level, as well as proposals for new initiatives to support transformation or to better align existing ones. These are time-limited, realistic priorities for year one of what we see as the first 5-year arc for transformation. We will develop new agendas, addressing new issues, as we make progress.
The most important outcome of the cross-agency collaboration we have achieved at the Federal level is the model it provides for what can happen at every level of the system—especially in the States…the real center of gravity for transformation.
I am happy to say that momentum is building and transformation is happening in States and communities across this country. Progress is being made each day. Almost every State Mental Health Agency has adopted a recovery mission statement and is working to develop recovery-oriented services. 93% have initiatives to assure every consumer receives an individualized, person-centered treatment plan that meets consumers’ unique needs. Over half of the State Agencies are developing a Comprehensive State Mental Health Plan that spans multiple State agencies. This is transformation in action. And every success…large and small…brings us closer to realizing our goal.
[PAUSE]
Today, you stand at a moment in time when need meets opportunity—a far too fleeting chance to truly make a difference.
With change, comes the exciting window of opportunity to embrace new ways of thinking…of collaborating…of implementing. Later this afternoon, Dr. Paul Wohlford will speak more in depth about opportunities within SAMHSA. However, I want to take a few moments to share with you just some of the emerging opportunities connected to the priorities of a transformed mental health system… opportunities for you to invest your time and talent in ways that can make all the difference.
At SAMHSA, we intend to expand and educate the workforce so that it can respond adequately to the mental health needs of underserved populations. We have proposed an entire portfolio of activities to address issues such as cultural competence, public education, and the adaptation and evaluation of innovative, evidence-based practices that reflect and embrace cultural diversity.
Our objective is to develop a workforce that has been trained and is supported through a competency-based approach to eliminate disparities in mental health care. We also want the workforce to respond to and shape an environment that supports recovery. This means facing the barriers to care for underserved populations in the current mental health system head-on and providing consumers from all populations with the culturally competent services they need.
[Slide 13/SAMHSA Activities]
With the addition of $1.2 million in FY 2005, the SAMHSA Minority Fellowship Program will invest $3.6 million in training fellowships…through the American Psychological Association, the American Psychiatric Association, the Council on Social Work Education, and the American Nurses Association…to facilitate the entry of minority students into careers in mental health and substance abuse services.
The recently announced HBCU National Resource Center (HBCU-NRC) outreach is part of SAMHSA's Infrastructure Grants program, which provides funds to increase the capacity of mental health and substance abuse service systems to support effective programs and services. The National Resource Center will be dedicated to 3 goals:
- establishing a national network of HBCUs to facilitate collaboration among the 104 HBCU institutions, and increase communication and access beyond campuses;
- supporting culturally appropriate prevention and treatment services for persons with substance use disorders and mental illnesses on HBCU campuses; and
- facilitating the design of accredited courses, minors/majors and undergraduate and graduate degree programs that adapt State requirements and encourage student interest in substance abuse and mental health.
I encourage you to visit our Web site—www.samhsa.gov—for more information on these and other programs.
Our long-term goal is to develop a National Strategic Plan to eliminate disparities entirely. As I look around this room, I am optimistic about the outlook for developing a workforce that helps achieve this goal. With each of you…with your input…we can build a workforce that is also diverse in the types of issues it addresses. We need you to tell us the unmet needs you see…the gaps that must be filled to ensure we can effectively meet the needs of underserved consumers.
One of the underlying principles of Achieving the Promise is that the mental health system must identify programs, services, and models that work…and apply these practices on the front lines of service delivery. However, right now, minorities are severely underrepresented in research.
[Slide 14/Chart]
A case in point: According to a special analysis performed for the 2001 U.S. Surgeon General’s Report on Mental Health: Culture, Race, and Ethnicity, since 1986, some nearly 10,000 participants have been included in randomized clinical trials evaluating the efficacy of treatments for bipolar disorder, major depression, schizophrenia, and attention-deficit/hyperactivity disorders. As you can see here, for half of the participants, no information on race or ethnicity is available…for another 7 percent of participants, studies only reported the designation, “non-white,”…and not a single study analyzed the efficacy of the treatment by ethnicity or race.
This is unacceptable. This is but one example of why transformation of our system will be incomplete without you. You can help bring science to bear in the services world. There are many questions that you can explore in your work…questions that have impact on ethnic minority communities….and all Americans…questions that you can help to answer. For example, what is the role of culture in psychiatric epidemiology?How can we help our colleagues become sensitive to issues of cultural competence, even during 15-minute office visits? How well will individual evidence-based practices translate in different cultural groups?
As part of our Science to Services Initiative, for example, we are funding development of a series of Implementation Resource Kits, each one focusing on a different evidence-based practice like Supported Employment or Medication Management. Six of these kits are already available to the public for implementation and evaluation. It is important that you and your colleagues provide SAMHSA with the feedback we need to make the toolkits and practices successful. You can help us identify and adopt evidence-based practices that are effective and relevant to the behavioral health needs of all communities. You can help us to apply what we know now.
By definition, transformation involves collaboration across systems...across populations. For transformation to take shape, every sector of the behavioral health care community must be represented—and behavioral health care must represent all of the communities it serves. Transformation presents a tremendous opportunity for you to look at these big public health issues and to help lead us in bringing about the changes that are so needed.
We want to see the same change. We share a common vision for the world. And we can build on this vision…we can build together to work towards the goals we share—in 2005 and beyond.
Your perspective is invaluable. As part of a rich network of rising and promising professionals, you can help us create a picture of what a transformed system should look like from your lived experiences…and from your desire to help change the world for the better. Your voices are crucial to the transformation process, because recovery is not one size fits all.
It is the deeply personal nature of the recovery journey that makes your leadership so critical to SAMHSA. In order to create a recovery focused mental health system that will serve all Americans, we need to better understand how to serve the needs of racial and ethnic minority consumers.
[Slide 15/Mental Health System Transformation]
Share with us your vision of the change you would like to see…and then be that change. Thank you.
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