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
Presidential Program at the APA’s 113th annual convention
Washington, DC
August 20, 2005
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Thank you, Mary. I am honored to be included on this panel as part of Dr. Ron Levant’s/Ron’s Presidential Program. My congratulations to Dr. Fred Frese and Dr. Ron Bassman on their receipt of a Presidential Citation Award. Their work exemplifies what one dedicated person can accomplish.
Today, we stand on the threshold of achieving the promise of a transformed mental health system in America. Federal, State, and local governments, as well as thousands of private organizations and individuals, have united in this effort. Together, we are creating a system that is consumer driven and focused on recovery. This is the system envisioned by the President’s New Freedom Commission on Mental Health. It is a vision of hope, of health, and of the promise and potential that lies within every adult and child.
During the past 2 years, the Substance Abuse and Mental Health Services Administration, or SAMHSA, has been leading efforts by the Federal government to transform the mental health system. Nine U.S. departments and the Social Security Administration have joined us in an unprecedented effort to change the status quo.
Last month, SAMHSA released the Federal Action Agenda for Mental Health. This document summarizes the actions being taken across the Federal government to transform mental health services. Michael Leavitt, the Secretary of the U.S. Department of Health and Human Services, and Charles Curie, the administrator of SAMHSA, have provided leadership and support in fostering this incredible effort.
I have made copies of the report available to you at this meeting. Take one, read it, and share it with your colleagues. Our agenda represents a broad Federal commitment to achieving the transformation vision. It is a record of our planned activities and a measure of our accountability. It is proof positive that an exciting series of events has occurred and will continue to occur. The actions described in this report have the power to propel significant changes in mental health care.
But, as Administrator Curie has noted, our action agenda “is not a ‘quick fix’ for the problems that have ailed the mental health care system for decades.” In reality, transforming the form and function of our mental health system will be a long-term process. It will involve numerous stakeholders on multiple levels. It will require synergy, or the mutually energizing force that comes from cooperative action. This broad-based commitment to a common cause is vital to achieving the promise of transformation.
But so is the power of one.
Here is a question for you—What is the most difficult problem that you can imagine solving with your skills and training? I’m not asking you as a group, but as individuals. What is the most difficult problem that you can imagine solving?
Keep that question in your mind while I tell you about one man’s answer.
John Woolman was an American Quaker who lived in the 1700s. At that time, 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.
Robert Greenleaf recounted Woolman’s story in a book called Deep Change: Discovering the Leader Within. As background, Robert Greenleaf developed the philosophy of servant leadership, which asserts that true leaders are those who lead by serving others. Greenleaf remarked—
“One wonders what would have been the result if there had been 50 John Woolmans or even 5, traveling the length and breadth of the colonies in the 18 th century… persuading people, one by one, with gentle non-judgmental argument 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.”
Right now, as I look out into this audience, I see hundreds of potential John Woolmans. Each one of you has within you the power of transformation.
Your power of one can transform mental health care in our country. At the Federal level, we can facilitate, we can promote, and we can 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.
Transformation really is a matter of personal action—of believing in a vision so deeply, so intensely, that a person is driven to make that vision a reality. This is how I describe the transformation equation. “Transformation equals vision, plus belief, plus action…multiplied by continuous quality improvement squared.” In transformation, each one of us continuously must ask if the resources we provide are effective and meeting the mark. We continuously must seek to improve.
Transformation of the mental health system is possible! And we will achieve transformation more rapidly when each of us begins to take personal responsibility for the changes that must occur—both within ourselves and in our practices.
The power of one is reflected in a recovery-focused system. The fundamental belief on which the recovery vision rests is that people with mental illnesses can take charge of their own lives. In this system, the individual will be at the center…and in control…of his or her recovery journey…because recovery occurs from within. Recovery results from the personal courage of an individual in confronting his or her life’s challenges.
The recovery vision moves the role of consumers and families far beyond their simple participation in the system. In a transformed system, consumers direct their own futures. The consumer as decisionmaker is a powerful idea and very different from the status quo. This concept requires us to change the way we think about the delivery of mental health services.
Never in the history of America have we known so much about mental health or how to enable people with mental illnesses to live, work, learn, and participate fully in the community. Recovery from mental illness is now a real possibility. Our challenge now is to take what we know to be effective and place it into the hands of treatment professionals—into your hands—to share with consumers.
The Institute of Medicine reports a lag of 15 to 20 years before cutting-edge research becomes standard practice. Furthermore, a recent study cited by the National Implementation Research Network found that we devote 99 percent of the medical research budget to understanding disease biology and to developing effective therapies. We spend only 1 percent to learning how to implement those therapies safely with patients.
SAMHSA is working hard to move science into service faster and more effectively. For example, we are funding the development of a series of Implementation Resource Kits. Each kit focuses on a different evidence-based practice, such as supported employment or medication management. Six of these kits already are available for implementation and evaluation. You and your colleagues can obtain copies of the kits without charge from SAMHSA. We welcome your valuable feedback about how they work in real practice, with different populations and in different settings.
Of course, information dissemination at the Federal level is not enough to transform services. To truly bridge the science-to-service gap, we need you. We need the power of one at the local level to expand into the power of many.
In offices, universities, clinics, and research facilities across the country, one practitioner and one scientist can start an essential two-way dialog. That dialog must begin by asking consumers about their goals for recovery and about how we can help them achieve their goals.
This is the question that practitioners and researchers must ask of the men, women, children, young people, and older adults with a mental disorder—What does recovery mean to you and what services do you need to lead a full life? Recovery is different for those who have experienced trauma, or who are at different stages of life, or who are of varied cultural backgrounds. To truly be consumer driven, we have to step out of our own perceptions of recovery and into the experiences and expectations of each unique individual whom we serve.
Once we have tapped into the knowledge and experiences of consumers, we can begin to empower consumers to direct their own recovery. Practitioners and researchers can work together to conduct the kind of research that will help consumers to reach their goals.
One researcher and one practitioner also can begin to focus research and practice on prevention. The New Freedom Commission report does not address prevention in as much detail as it addresses treatment. However, prevention is “embedded” in every one of the report’s goals and recommendations. Prevention is a critical element of recovery.
At SAMHSA, we heartily endorse the Institute of Medicine’s classifications of preventive interventions as universal, selective, and indicated. But we also embrace the broader definition used by the National Institute of Mental Health (NIMH). NIMH defines prevention as preventing the onset of a disorder as well as preventing co-morbidity, relapse , and disability. Prevention-minded treatment takes a holistic approach to recovery. It goes beyond symptom management and considers what else a person needs to achieve and to sustain recovery.
Likewise, one administrator in every organization across this country can begin to instill the concept of recovery into policy and program administration. Program administrators also are on the front line of transformation. Transformation implies changes in reimbursement mechanisms for evidence-based practices. It means recognizing and rewarding practitioners who are transforming how they deliver services. It means creating an infrastructure that supports the hiring of culturally competent practitioners and that offers multiple channels to share information and continuous skill-based training, coaching, and mentoring. Remember, we are out to change the very form and function of our current mental health system!
It’s 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.
I urge each one of you to be open to changing the status quo…to do things differently…to be innovative and creative about change…and, ultimately, to focus on the meaning of recovery for the people you serve.
Continuously ask—and answer—Is my work helping consumers achieve their goals? Are they feeling more capable? Do they feel empowered? Are they leading the fullest life possible in their community?
Change minds and you can change the world. John Woolman did it more than 200 years ago. You can do it today. You have the opportunity to change the world for the better by transforming mental health care in America. Use your power of one to help achieve the promise of transformation for many. Thank you.
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