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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
Sharing Values, Changing Lives:
Forging Strategic Partnerships on Behalf of Returning Veterans and Their Families
August 11, 2008
Washington, DC
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Good morning. I want to thank Ira and Loree not only for their ongoing leadership around the needs of our returning service members and their families, but also for their deep and abiding commitment to the partnership that brings us together today. We each represent very different types of organizations with distinct constituents—from active duty military to veterans to States, communities, and individuals with mental health and substance abuse problems.
Yet, together, we recognize our collective responsibility to seize this moment to make a difference in the lives of our men and women in the Armed Forces and their families. This is an historic opportunity for us to speak with a single voice on behalf of the men and women who are returning from Iraq and Afghanistan bearing what are often called the "invisible wounds" of war.
Chinese philosopher Lao Tzu said, "A journey of a thousand miles begins with a single step." Each of us on this panel, and every one of you here today, are taking the first step toward understanding what all of us have to offer in caring for the physical and mental wellbeing of our returning soldiers and their families.
At SAMHSA—though our partnerships with State mental health authorities, State substance abuse agencies, and community mental health centers—we can provide access to a full range of community-based services for returning soldiers who choose to seek our help. We are also committed to expanding the level of community and provider awareness, education, and capacity that will allow us to connect veterans to the DOD and DVA services for which they are eligible. Between the health and mental health care services offered by TRICARE, DVA, and the community agencies SAMHSA supports, our returning soldiers should have access to a comprehensive and continuous set of services that will support their transition from active military service to an engaged and healthy life in the community.
The fact that we can join forces despite our different orientations speaks volumes about a set of shared beliefs that drives our individual and collective action.
The first is our shared belief that mental health is essential to overall health. Last year DOD released an action plan that called for the Department to put psychological health and fitness on an equal footing with physical health and fitness. This echoes the recommendation of the New Freedom Commission on Mental Health to "address mental health with the same urgency as physical health" and was amplified by the DOD Task Force on Mental Health when it said:
We fully believe that psychological health means much more than just the delivery of traditional mental health care. It is a broad concept that covers the entire spectrum of wellbeing, prevention, treatment, and health maintenance.
Wellbeing, prevention, and treatment are the cornerstones of a public health approach to health care. Our second shared belief is in the underlying premise of the public health model, which is that notion that it is inherently better to promote health and prevent illness before an illness begins.
The public health model is well suited to help promote an individual's recovery from mental and substance use disorders and the traumas that may result from combat exposure. It recognizes that mental health does not reside solely in the individual but also within the web of interactions among the individual, the family, the military unit, the neighborhood, and the community in which he or she lives. In particular:
- Recognizing that mental health and substance use problems can lead to other health and social problems, a public health approach is holistic, taking into consideration all aspects of the individual's wellbeing.
- Public health seeks long-term solutions that are best achieved by high-quality care before symptoms and co-occurring conditions become severe. Accordingly, prevention is as important as treatment.
- Public health employs evidence-based practices and always measures outcomes.
- Finally, a public health model focuses treatment and care on the needs of the individual, but also develops interventions for the entire population. A public health approach to the care of returning veterans recognizes the need to involve not only the individual's family but also the broader community that will welcome the soldier home.
If we are to implement successfully a public health approach to the behavioral and physical health care needs of our returning soldiers, we must recognize the universality of trauma and be prepared to address it. I'll speak more about this at lunch.
For now, I want to note that across DOD, DVA, and SAMHSA, this issue is front and center on our radar screen. We are addressing it with research, dissemination of effective practices, and education of the broader public about the many faces of trauma—from the child whose parent has had multiple deployments...to the female solider who was sexually assaulted...to the veteran who begins experiencing flashbacks months, and even years, after a battlefield incident.
Unfortunately, those of us in the mental health field may unintentionally recreate the trauma an individual has experienced by the use of forced medication, seclusion, or restraints. We are perpetrating violence ourselves when, as in the words of a woman subjected to forced treatment, we "lock them up, shock them up, tie them up, or drug them up." Seclusion and restraint are not treatment options—they are treatment failures. Safe, respectful, and nonviolent treatment options must be the norm for mental health treatment offered in the community and by DOD and DVA practitioners.
When we take a public health approach to health care that recognizes the importance of mental health to overall health and the need to address trauma in the lives of our returning soldiers, we are well on our way to building resilience and facilitating recovery. As the DOD Task Force on Mental Health noted, "Maintaining the psychological health, enhancing the resilience, and ensuring the recovery of service members and their families are essential to maintaining a ready and fully capable military force."
Indeed, our third shared belief—in the concept and practice of recovery—is central to our ability to create not only healthy soldiers, but also healthy individuals, healthy families, healthy communities, and a healthy Nation.
It wasn't all that long ago that most mental illnesses were believed to be debilitating, lifelong conditions that required long-term, custodial care. Today we understand that, given the right combination of treatment and support and a voice in decisions concerning their care, people with mental illnesses can and do recover.
We also recognize that recovery is an individual process that is aided by treatment professionals but led and defined by the individual him or herself. Finally, we know that offering the hope of recovery is essential to help an individual heal from trauma and mental health and substance abuse problems. "Hope is to the soul what oxygen is to the body," says Larry Fricks, an Army veteran and consumer leader who was instrumental in developing certification for Peer Support Specialists.
Believing in recovery and designing services to promote it are at the heart of a transformed system of care. Each of us at this table has a vested interest and a shared belief in the importance of transforming our respective systems and, ultimately, in transforming the nature of the work we do together.
We owe a debt of gratitude to the late Vice Admiral Arthur Cebrowski, who headed up the Pentagon's Office of Force Transformation and who laid out many of the tenets of transformation we follow today, whether at SAMHSA, DOD, and DVA or in the private sector.
Cebrowski studied the concept in depth by looking at corporations and systems that had been able to recreate themselves successfully and identified several common characteristics that define transformation.
- Transformation is a continuous process, without end. It is meant to create or anticipate the future.
- Transformation is accomplished through changes at the core of a system and not at its margins. These fundamental changes result in new behaviors and new competencies. Thus, in transformation, we look at what we are able to do now that we were unable to do before.
- Transformation is meant to identify, leverage, and even create new underlying principles for the way things are done. New sources of power emerge.
- Once the process of transformation begins, a profoundly different organization materializes—changed in structure, culture, policy, and programs.
Transformation ultimately is about newness—about new values, new attitudes, and new beliefs that are expressed in new behaviors of people and institutions. Transformation is about creating the future rather than perfecting the past.
When the New Freedom Commission called for "fundamental transformation" of the Nation's mental health system, DVA was among the first to respond with a Mental Health Strategic Plan that was designed to drive the implementation of the Commission's principles and goals through more than 200 discrete recommendations.
This is a significant undertaking for DVA, but also for the broader mental health system, as well. Because DVA is the largest integrated health care system in the Nation, it is able to pioneer health care policies that could not be implemented in other settings. The Department's experience in implementing evidence-based treatment and services—such as the integration of mental health services into primary care—will serve as a template for developing policies to support the adoption of these practices in other settings.
When he was working for the Department of Defense, Vice Admiral Cebrowski once defined his work as taking place at the "intersection of unarticulated needs and nonconsensual change." By this, he meant it was his group's responsibility to envision the future and to act on these beliefs rather than waiting for either market pressure or broad consensus to forge ahead.
So, too, must each of us in the room—no matter the agency or sector we represent—be prepared to, in the words of Gene Roddenberry, "boldly go where no man has gone before." We must envision the future in which all of our returning soldiers and their families receive help for mental health problems when they recognize a need for it and at whatever door they present.
We must forge strategic partnerships built on the foundation of our shared beliefs in the primacy of mental health, the importance of the public health approach, the need to address trauma, the goal of facilitating recovery, and the vision of transformation.
We must never lose sight of our ultimate goal, which is to support the right of every individual who has served in our Armed Forces and his or her family members to live, work, learn, and participate fully in their communities.
The poet Carl Sandburg once said, "Sometime, they'll give a war and nobody will come." In the meantime, SAMSHA and its partners at DOD and DVA stand ready to help. Individually and together, we offer resources, technical assistance, and expertise to help States, communities, and frontline providers meet the mental health needs of our returning soldiers and their families.
We are paving the road home for our brave men and women with our hope, our hearts, and our hard work. Thank you for joining in this effort, whether you are taking what you have learned back to your communities tomorrow or staying on to develop your State plans as part of the Policy Academy that follows. Each of you goes forth with my gratitude and my full support.
Thank you. If we have time, I'd be happy to take your questions.
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