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
Third National Policy Academy on Co-Occurring Substance Abuse and Mental Disorders
Planning for the future of Behavioral Health Care
Philadelphia, PA
September 13, 2005
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Before I begin my remarks, I want to acknowledge the organizations and individuals who helped to plan this academy. My sincerest thanks go to Lewis Gallant and the National Association of State Alcohol and Drug Abuse Directors, Bob Glover and the National Association of State Mental Health Program Directors, Linda Rosenberg and the National Council for Community Behavioral Healthcare, and Howard Shapiro and the State Associations of Addiction Services. I also want to recognize the hard work of Larry Rickards, who has been the CMHS point person for planning. On behalf of SAMHSA and its three Centers, I extend our sincerest appreciation for your commitment to the task. Your level of involvement in planning the policy academies for co-occurring disorders speaks volumes about the importance of this issue. Thank you.
I’m also want to recognize someone else who has contributed greatly to this and to other academies. After 40-plus years of government service, George Kanuck is retiring to a leisurely life of reading books and eating cheesecake. This is his last policy academy. George has told his colleagues that his job goal has always been to be where he is supposed to be, on time, and prepared. He certainly has achieved this goal whenever we at CMHS have had the pleasure of working with him. We are grateful that George chose to remain on the job long enough to participate one last academy. George, thank you and best wishes on your retirement.
This academy really is a collaborative effort. As you know, it is supported by all three of SAMHSA’s centers. All three center directors have arranged to be here to underscore its importance and our joint commitment to addressing the needs of those with co-occurring disorders.
All of us within SAMHSA share its vision—a life in the community for everyone. We are working to fulfill this vision by building resilience and facilitating recovery among adults and children with or at risk of developing mental or substance use disorders. Integrated treatment for individuals with co-occurring disorders is critical to achieving our vision as well as to building a stronger, safer, and healthier America.
Whenever I attend an academy, I’m filled with optimism about the future of behavioral health care in this country. I’m proud of our ability to present real-life examples of what works in preventing and treating co-occurring disorders. I’m excited about the potential of these academies to help the States transform services to individuals with co-occurring disorders.
I’m delighted that your States are seizing this opportunity to learn how to best meet the needs of all of your constituents. You have an opportunity here…an opportunity to change the status quo of mental health service delivery and to offer greater opportunities for recovery to those you serve.
Think about our academies as a banquet of opportunities. First and foremost, an academy is an incredible starting point for you to set and achieve high goals for service delivery that surpass your original expectations.
Our two previous academies have been huge successes. Those States that attended have reported great progress in carrying out the State action plans they developed. They are well on their way to creating greater access to integrated care for individuals with co-occurring disorders.
I’ll give you two examples of progress being made by States that sent teams to previous academies.
Oklahoma views integrated treatment as a major component of its vision for mental health system transformation. This year, Oklahoma is implementing two major strategies for system change: the provision of trauma-informed services and the provision of integrated treatment.
Oklahoma’s collaborative engagement with providers has resulted in new contract language with its community mental health centers. The centers have committed to developing the capacity to provide integrated assessment and treatment for persons who also have a substance abuse disorder. By next July, all individuals served by Oklahoma's community mental health centers will receive integrated services.
Oklahoma reports a tremendous willingness among providers to embrace this new direction. Organizational self-assessments are being conducted, change agents are being trained to facilitate implementation, providers are being cross-trained, and policies are being developed to ensure that individuals with co-occurring disorders are welcomed into treatment.
These efforts will ensure that anyone entering the Oklahoma system will receive a thorough assessment for both mental health and substance abuse needs and will be linked with appropriate services.
The second State I will highlight is Washington. The action plan developed by the Washington State team now is the driving force behind co-occurring disorder efforts statewide.
Washington’s amazing progress began with its inclusion of a Senate council member as an advisor to its team. This legislative lawyer became so engrossed in the spectrum of need presented by co-occurring disorders that she was transformed! She went back to her office and crafted a new piece of legislation. In April, Washington State passed a bill that provides $65 million to expand mental health treatment capacity, with more than $20 million dedicated to co-occurring disorders.
The Senate Omnibus Treatment of Mental Health and Substance Abuse Act of 2005 is a major policy victory. The act recognizes the extent and impact of co-occurring disorders across systems. It acknowledges that individuals with co-occurring disorders need unique services, and it provides resources and training to ensure that they are available.
Provisions of the act emphasize diagnosis of multiple disorders at the earliest opportunity. By this January, Washington State is to adopt a statewide comprehensive screening and assessment process for co-occurring disorders.
The act formally charges the State team who put together the action plan with oversight authority. The team will work with another group who is responsible for program implementation. This method merges policy and program, creating a wonderful synergy for action and accountability.
The changes taking place in Oklahoma and Washington are transformation in action! These States are changing their programs, their policies, and the people involved. Change is taking place at the core of their system and not around its margins.
Emilio Vela, who was the Washington State team leader, has joined us at this academy. We also are fortunate to have Andy Homer, the State team leader from Missouri. Both men are here as resources for you. One objective of our policy academy is to create a “learning community” through which States help each other move forward.
Other States have used our academies as the foundation for their applications for State Incentive Grants for Co-occurring Disorders, or COSIGs.
Arizona and Connecticut are examples. They took what they learned about effective, collaborative efforts, they used this knowledge to engage other stakeholders, and they put together a winning application for a COSIG.
Our academies also are opportunities to enhance co-occurring efforts that may already be ongoing in your State, such as a State Incentive Grant for Co-occurring Disorders. Two States here are recipients of COSIG grants. They are Arkansas and Pennsylvania.
Any opportunity to improve 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.” An academy is a tremendous opportunity for you to keep building in program improvements.
States that already have COSIGs also benefit from their attendance at an academy. The knowledge they acquire at an academy helps them to clarify planning and operation of grant components. They find that they can allocate resources in much stronger ways than they had previously identified.
Co-occurring disorders are the most complex diseases that confront our behavioral health system. There is no end to what we can learn and do to improve the services we offer. Throughout this academy, fantastic speakers will be sharing examples of evidence-based practices for treating co-occurring disorders. You also will have the opportunity to learn from each other. Talk with teams from other States. Some of the most innovative strategies to be revealed may be theirs—or yours.
I mentioned a minute ago about how this policy academy is an opportunity to form a learn community. By sharing experiences—both good and bad—we can accelerate the progress we can make. Bad experiences can generate just as many lessons learned as good experiences.
Adversity is never pleasant, but sometimes it teaches us lessons that we could not learn in any other way. Tomorrow evening, we will be hosting a town hall meeting focused on the impact of Hurricane Katrina. Our meeting will be facilitated, and it will have two goals. First, we want to give you an opportunity to discuss your experiences and reactions to the storm. Everyone here is involved in some way. You might know affected individuals, or you simply might have experienced the shock, commiseration, and determination to help that swept across our country.
Your State may be taking in evacuees. Your organizations may be dealing firsthand with the human aftershock of a storm that robbed individuals of families, friends, and communities—of everything that represented their home and security. We are a Nation that wept for the victims and then waded in to console the survivors.
Our second goal for the meeting is to give you an opportunity to share your experiences in terms of their relationship to planning. There are predictable outcomes of disasters that can guide planning. Adults and children traumatized by events such as Hurricane Katrina are at heightened risk of developing mental illnesses or substance abuse disorders. Individuals in recovery are at heightened risk of relapse. First responders and providers require specialized training in trauma-informed care.
Thomas Insel, the director of the National Institute of Mental Health, reports that an estimated 6 percent of those affected by Hurricane Katrina had pre-existing mental health disorders requiring medication or ongoing treatment. Are their needs now being met? What happens to individuals who don’t have access to methadone or to Haldol, a drug for treating schizophrenia? Being able to meet the behavioral health care needs of disaster survivors is as urgent a planning issue as being able to meet their basic needs for food and shelter.
Hurricane Katrina only underscores the importance of looking at all the issues that come together around behavioral health care. Consider the challenges faced by the Gulf States. Their citizens may be experiencing homelessness, unemployment, loss of social and community connectedness, the threat of violence, and the potential of widespread communicable diseases. These all are high-risk factors for mental and substance use disorders.
Affected States, which include those States absorbing large numbers of evacuees, face an expanding public health crisis. The behavioral health care needs of the individuals and communities devastated by the storm will be long term. They can expect more substance abuse and challenges to individuals already working to achieve or maintain recovery. To confront these challenges successfully, multiple State systems will need to work together—not just now but during the long haul. These systems include justice; housing; labor; welfare; education; and primary, mental health, and substance abuse care. This is why we stress collaboration so strongly in planning efforts. Every system is affected by the problem of co-occurring disorders—every system has to be part of the solution.
The action plans that you develop for your State will revolve around the needs and priorities of your individual constituencies. New York, for example, is among the top 10 States in the percentage of Hispanic residents. New York also has absorbed the second largest number of refugees entering our country during the past two decades. A priority planning strategy for New York might be to increase the linguistic and cultural competence of providers and services. New York also might focus on making services more trauma-informed. Refugees may be fleeing civil war, ethnic persecution, or extreme poverty.
When Texas attended an earlier policy academy, its team created an action plan focused on services for children. Children also represent an underserved population. I seldom think about children without also thinking about the words of John F. Kennedy. Kennedy spoke of children as our greatest natural resource and our best hope for our future. In describing how we must protect our natural resources, he observed that “actions deferred are all too often opportunities lost.”
Preventing co-occurring disorders among children is one of our greatest opportunities to reduce the prevalence and burden of co-occurring disorders in the future. Of all of the States here, Kansas—at 27 percent of its population—has the highest percentage of children under the age of 18. Prevention and treatment of co-occurring disorders among youth might be a planning priority for Kansas.
But remember—the progress you make in delivering comprehensive services has implications that extend far beyond your State boundaries.
SAMHSA’s mission is to build resilience and facilitate recovery among children and adults with or at risk of mental and substance use disorders. Better prevention and treatment of co-occurring disorders is essential to achieving this mission, which is why addressing the needs of adults and youth with co-occurring disorders is one of SAMHSA’s four redwood, or priority, programs.
SAMHSA’s commitment to its co-occurring disorder program is demonstrated by the resources and services we dedicate to this task.
Our national policy academies are evidence of our commitment. We also fund the State Incentive Grants for Co-occurring Disorders. As of this date, we have awarded COSIGs to 15 States.
CMHS and the Center for Substance Abuse Treatment co-fund the National Co-occurring Center for Excellence, or COCE. The Co-Occurring Center for Excellence provides information about evidence- and consensus-based practices for preventing and treating co-occurring disorders. It also offers technical assistance and training for implementing these practices. COCE will be an invaluable resource for States dealing with the behavioral health care aftermath of Hurricane Katrina.
The progress you make in your States also will contribute to our ability to transform the public mental health system. Many of you will be familiar with the concept of mental health transformation, which is another of SAMHSA’s four redwoods. For the past 2 years, SAMHSA, through CMHS, has been leading the Federal effort to transform the national mental health system.
Nine U.S. Departments and the Social Security Administration now are members of our Federal Partners Workgroup. Our newest members are the departments of Agriculture, Transportation, and Defense. Any organization that serves children, families, and adults has a role to play in promoting the mental health of Americans.
Together, we are responding to the final report by the President’s New Freedom Commission on Mental Health, which called for a system that is consumer and family driven and focused on recovery. “Consumer driven” means that each adult and each child and family will be partners in determining which services and supports they need to build resilience and to facilitate recovery.
Last month, SAMHSA released a document entitled Transforming Mental Health Care in America: The Federal Action Agenda. This document summarizes the first steps we are taking to change the form and function of our mental health system. You will have received a copy of both the New Freedom Commission report and our action agenda as part of your registration information.
Our report, similar to the report by the New Freedom Commission, addresses co-occurring disorders in the broader context of transformed mental health services. There is a reason for this. Transforming services for individuals with co-occurring disorders is as basic to mental health transformation as equal opportunity is to civil rights.
Prevention and treatment of co-occurring disorders define what is meant by consumer-driven recovery. We will achieve the promise of transformation when we fully develop our capacity to provide the full spectrum of services and supports that offer the greatest opportunity for recovery to anyone with or at risk of multiple disorders.
- Consumer-driven recovery becomes possible when individuals are able to seek treatment willingly, openly, and with hope.
- Consumer-driven recovery becomes possible when we offer evidence-based treatments that work for different populations and in different settings.
- Consumer-driven recovery becomes possible when we screen for disorders across the lifespan and across systems, such as child welfare, homeless services, and criminal justice. It becomes possible when any door is the right door for treatment.
- Consumer-driven recovery becomes possible when multiple systems, such as mental and substance abuse treatment, housing, juvenile justice, primary care, and education, take advantage of shared opportunities to help prevent and treat multiple disorders.
Your progress in addressing the needs of individuals with co-occurring disorders also has implications for our Nation. What will happen when you take the lead—when you demonstrate that integrated care is achievable and that recovery is possible? The answer is that other States will follow. Your success will inspire, guide, and enhance efforts made by other States. You will raise the level of care provided to anyone who seeks treatment for mental illnesses or substance use disorders.
Ultimately, every State in our Nation will come to understand, embrace, and begin acting on the essential need to provide integrated services for those who need them. When we have achieved that glorious goal, we will have transformed the lives and future of millions of Americans.
The opportunities for change begin here, now, and with you. Thank you.
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