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
Florida Council for Community Mental Health Annual Conference
Mission Possible: Changing the Status Quo through System Transformation
Clearwater Beach, FL
September 14, 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
“Your mission, should you choose to accept it...”
The original Mission Impossible television series went off the air more than a decade ago. But, these now-famous words, commissioning the agents of the elite Impossible Mission Force with another top-secret assignment, remain a symbol of the classic that captured America’s imagination for many years. Week after week, we looked on as the Force accepted a string of seemingly impossible assignments …and, succeeded against all odds. Even impossible missions were possible...when the leader chose the right team of experts to tackle a given task.
What a fitting theme for today’s conference! Transformation of Florida’s behavioral health care system is a mission possible. As I look around this room, I see that you have assembled the right team of experts to help you carry out your mission. My message for you today: Yes, the mission is possible. But to achieve the mission, we have to clearly articulate it and embrace it before we set out in pursuit of it.
You see, the final Report of the President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America, provided a clear vision of a transformed mental health care system...the idealized future we all seek. But the report did not fully define the mission—that is, how the vision will be realized. It is up to us to determine the vehicle that will actually get us there. It is up to us to give this mission “legs.” I am here today to help ensure that we are on one accord as we set out to realize the vision of a transformed mental health care system here in Florida...and across the nation.
A clear mission statement is the foundation for all fundamental change. In the book, Changing the Essence, authors Richard Beckard and Wendy Pritchard tell the story of the transformation of the Federal Express organization. When top management at Federal Express set out to transform the company, they had to first clarify their mission. They determined they were in the transportation business rather than the package delivery business. This change in the basic assumption that governed their business model led to fundamental changes in the organization.
Under the old assumption, for example, the Federal Express strategy was the same as its competitors: best results were achieved by a delivery system that moved packages from pickup point to delivery point by the shortest direct route. Under the new assumption, the company adopted the “hub” concept…a strategy used in the transportation business.
By clarifying its mission, the organization created a roadmap...a roadmap that, when followed, enabled it to reach its goal. By determining what business it was in, Federal Express set itself on course to realize its vision.
To achieve the promise in Florida...and across the Nation...we have to clarify our mission. We are on the brink of great change. We can change the status quo. We can realize the vision of a transformed system. But we must keep our eyes firmly fixed on the mission as we operationalize transformation...as we move from goals to action. To achieve the promise, we must decide : We are in the recovery business! Whether you are a provider...an administrator...a mental health authority...a policymaker...a consumer...or a family member…your mission, first and foremost, must be to deliver on the promise that recovery from mental illnesses is not only possible, it is the expectation!
Each of you is critical to this mission. You are the ultimate locus of accountability for the care that is available here in Florida. You can create a recovery-oriented system that will transform lives. Each of you must pursue this mission. Transformation will not happen without you.
And, you are off to an impressive start. Here in Florida, you have demonstrated a deep and true commitment to your mission: that is, transforming your system into one that is consumer- and family-driven...accountable to those you serve...and focused on the goal of recovery.
The wheels of transformation are turning well here in Florida. You have made considerable progress toward the transformed system described in Achieving the Promise. There will be bumps along the road. Change of this magnitude is inherently messy. But I want you to know that I deeply appreciate your willingness to take on this task. I know you will not be deterred by the challenges.
I am impressed with how heavily invested this provider community is in recovery-oriented care. I am impressed by the strong commitment to transformation your State officials have demonstrated. I am impressed with how your consumer movement is growing. Each and every consumer you reach with your message of hope and recovery is another success story...moving Florida closer to its goal.
I commend you for the steps you have already taken. Your State Action Plan for promoting a system of care aimed at recovery and resilience is a clear example of your commitment to transformation. I am looking forward to hearing more about this plan and the Task Force that will guide its implementation from Ken DeCerchio.
The statewide Recovery and Resiliency Conference you held in February—which promoted consumer, youth, family, and provider partnerships—is a model of the kinds of activity we would like to see catch on across the country. I was excited to learn that the February conference sparked so much interest among parents and advocacy groups that a Children’s Mental Health Summit is planned for next month.
I salute Florida’s providers for expanding your use of best practices and evidence-based treatment approaches. The work the Florida Council for Community Mental Health has done to identify and recommend evidence-based practices will be very valuable as you move forward with transformation.
I know that Florida providers are active proponents of a number of evidence-based practices…including supported housing and supported employment. I admire the way you are wrapping your arms around these practices. I applaud you for investing the time and resources to truly transform the way you value consumers and the way you utilize consumers’ strengths to promote recovery and hopefulness.
The Florida Self-Directed Care (SDC) program is a shining example of how focusing on recovery through consumer choice truly transforms the mental health system. Your plans to expand this innovative service delivery approach for adults into every county over the next three years…and to implement a new family-directed children’s mental health initiative…is proof positive that transformation is taking hold here in Florida. And the impact of your work is being felt far beyond your State borders. Your own Nancy Fudge said it well when she described the impact of the FloridaSDC program this way: “Every opportunity of choice is a seed that will grow into a healthy, empowered self-directed life.” Just think of how this kind of initiative can change the face and character of mental health care in this country!
Florida , you are on the cusp of something truly momentous. Through your efforts, you’ve started a positive chain reaction that will help every Floridian—children…adults…and older adults—cope with their mental illnesses. Your efforts are also moving the Nation closer to a tipping point…a monumental societal shift in the way we understand and approach mental health and mental illnesses in this country. You are helping to pave the way for a history-making transformation of our national mental health system that will benefit every American for generations to come.
I am happy to say momentum is building nationwide. Transformation is happening in States and communities from California to the Carolinas. Transformative projects, seeded by the recommendations in Achieving the Promise are being implemented. Strategies for securing the funding for change are being put into practice. Approaches for defining and measuring recovery are being developed. Real and steady progress is being made each day.
Before I update you on our progress, I think it is important, here, to review the goals of a transformed system...and to clarify what we mean by “recovery” and by “transformation.”
In fact, I believe one of my most important roles is to make sure that everyone has exposure to what transformation means. How will we know when we arrive at our destination if we don’t know where we’re headed?
Slide 2/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 calls for 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 a system…not on the margins. It leads to new behaviors and new competencies. Thus, in transformation, we are able to do things 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 transformation begins, a profoundly different system materializes—a system changed in structure, culture, policy, and programs.
Slide 3/Recovery
Embedded in transformation is the core belief in 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. 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.
Perhaps 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.
The discussion shifts, 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…foster responsibility for choosing services and handling the tasks of daily living…and provide opportunities for consumers to participate in decision-making about their care delivery systems.
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 efforts.
Slide 4/Goals
Achieving the Promise described an idealized end state…a transformed mental health care system…full of possibility… in which—
- Americans understand that mental health is essential to overall health.
- Mental health care is consumer and family driven.
- Disparities in mental health services are eliminated.
- Early mental health screening, assessment and referral to services are common practice.
- Excellent mental health care is delivered and research is accelerated.
- Technology is used to access mental health care and information.
Achieving the Promise gave enormous responsibility for this transformation to the States. And each of the States and Territories is answering the call...in its own way. Nearly every State has begun the work of transformation. Like Florida, some have already started to achieve great things.
The New Mexico Interagency Behavioral Health Purchasing Collaborative will replace this State’s fragmented system with a single behavioral health delivery system that will minimize confusion for providers, consumers, and families, and minimize ineffective or duplicative administrative costs. The result will be better, more efficient, more effective services and improved access to care for consumers. With the passage of the Mental Health Services Act, planning is underway in every county in California toward the development of comprehensive plans to address the needs of adults and children with or at risk for mental health problems. Georgia has launched an historic partnership between its Department of Human Resources and the Medical College of Georgia. This partnership will train psychiatrists in Georgia’s strengths-based peer supported recovery model. This collaboration has the potential to transform how future generations of psychiatrists and mental health professionals will serve those with mental illnesses.
Slide 5/Progress Toward Transformation
Almost every State Mental Health Agency has adopted a recovery mission statement and is working to develop recovery-oriented services. Nearly every State has initiatives to ensure that individualized, person-centered treatment plans are implemented to meet each consumer or family’s unique needs. More than half of the State Agencies are developing a Comprehensive State Mental Health Plan that spans multiple State agencies.
Thousands of organizations in the private sector are also sharing in the work of transformation. Mental health associations, guilds, and advocacy groups are moving transformation to the forefront of their agendas. Every day, I learn about insurers, corporations, and others who are recognizing their stake in mental health and stepping forward to transform how mental health care is delivered in America.
Last month, the Campaign for Mental Health Reform—a partnership of 16 national organizations representing millions of people with mental illnesses, their families, providers, administrators, and others—announced its Roadmap for Federal Action…another urgent call to action to fulfill the promise of transformation.
Slide 6/Voice Awards
These are exciting times in mental health. Times marked by high national visibility. For example, on July 20, SAMHSA hosted the first-ever Voice Awards to publicly honor writers and producers of television, radio, and film, as well as State mental health professionals who are raising awareness and understanding of mental health issues.
Kudos to Florida’s EBI—Elimination of Barriers Initiative—project for earning the Voice of Determination award. As many of you may know, the EBI is a SAMHSA-sponsored demonstration project designed to counter the discrimination associated with mental illnesses. Despite experiencing its worst hurricane-related devastation in over a generation in 2004, Florida’s EBI effort did far more than survive the storms…it thrived! When the EBI’s partner, the Florida Department of Children and Families, was pressed into action to provide emergency trauma counseling, it seized this opportunity to disseminate EBI messages across the State. Undaunted by the obstacles, advocates persevered…fanning out across Florida to promote the EBI through a number of high-visibility events.
This is the exactly the kind of perseverance and determination we will all have to marshal as we rally to assist the hundreds of Hurricane Katrina victims who are struggling to recover and rebuild their lives. You, here in Florida, know all too well that those affected by the storm—including the thousands of rescue workers and emergency medical personnel—can experience serious mental health effects…effects that can be deep and can linger for weeks and months to come.
Over the past year, CMHS, in conjunction with the Federal Emergency Management Agency (FEMA), has awarded 4 Crisis Counseling program grants to the State of Florida to assist victims of each of the hurricanes that hit this State over the last year. SAMHSA also awarded an $11 million grant to support Florida’s efforts to respond to disaster mental health needs related to these hurricanes. Through these grants, we have worked closely with Florida’s State Disaster Mental Health Coordinators to set up interdisciplinary teams, including mobile response teams. We have assisted in the purchase of traditional treatment services as needed. We have also brought in consultants to train staff in the use of short term cognitive behavioral approaches with people who had difficulty coping in the aftermath of the storms.
As I speak, SAMHSA/CMHS is focused on providing resources to aid in the recovery process for your gulf coast neighbors…the survivors of Hurricane Katrina. It will take unwavering effort…from all of us…to restore hope to these courageous Americans.
Slide 7/Transformation Will Require
Likewise, transformation of our mental health system will require consistent and simultaneous work across many areas of performance…at the individual, community, State, and Federal levels. This is exactly what we are seeing…from our vantage point in Washington…as we work to lead this national movement.
At the national level, SAMHSA/CMHS has taken deliberate and concerted action to move these goals from vision to reality. As many of you know, SAMHSA/CMHS was charged to lead the transformation effort at the Federal level. I’m proud to say: we are on the threshold of achieving the promise of transforming mental health care in America.
In the nearly two years since Achieving the Promise was released, SAMHSA and its Federal Partners have made an unprecedented commitment to model collaborative activities and to support the efforts of participants in the public and private sectors.
Slide 8/Action Agenda
Just a few weeks ago, we released the Federal Mental Health Action Agenda—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. 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 this Action Agenda, Congress, the nation, and the people we serve can hold us accountable for achieving the goals we have set. I urge each of you to read this document and determine how you, too, can be involved.
Slide 9/Federal Partners
In developing this first Federal Action Agenda, the U.S. Department of Health and Human Services, along with five other Departments and the Social Security Administration, created an inventory of current mental health activities, along with proposals for new transforming programs and practices. We built our Action Agenda on the five principles that guided the work and vision of Achieving the Promise, cross walked with the Commission’s goals.
For the first time ever, key Federal agencies have recognized their stake in mental health, and united behind a belief in recovery! This is transformation! This is how we will eliminate fragmentation of services among Federal agencies! This is what we expect will become a model for an equally unprecedented level of collaboration here in Florida, and in every State, where it will lead to even greater action…and transformation with a greater sense of urgency!
Collaboration is the lifeblood of transformation. Why is this synergy—this mutually energizing collaboration—so important? Transformation requires deep…and profound…and continuous change. It will take our collective wisdom to formulate the revolutionary, transformative solutions that this kind of change requires. Working together, we magnify the impact of our efforts… exponentially.
Slide 10/ Transformation-Collaboration
As we move forward, we are fostering partnershipsacross the Federal government.Along withOur Federal Partners Workgroup, we have formed an Executive Steering Committee that will bring together, for the first time ever, the most senior representatives from nine Federal Departments who will steward the transformation process.
We are fostering partnershipsacross SAMHSA. Our internal matrix workgroup for transformation includes representatives from all 3 SAMHSA Centers.
We are fostering partnershipsacross and between all levels of government. Our Mental Health Transformation State Incentive Grant Program is a shining example. This investment in transformation is a strategic one. What we learn from this first group of grantees will help all boats to rise. Transformation cannot rely on these federal dollars alone. It will take all of us to realize this goal!
Throughout SAMHSA/CMHS, we are looking at “what is” and asking “what should be.” Activities that move us toward “what should be” will be our priority for consideration as we move forward. These priorities include—
Slide 11/SAMHSA-CMHS Priorities
- Transformational leadership to mobilize others around a shared vision of recovery.
- Templates for model Comprehensive State Mental Health Plans that will assist every State inaddressing the full range of treatment and support services consumers need to live in their communities.
- Prototype Individualized Plans of Care that consider the specific needs and concerns of every adult, child, or family coping with a mental illness.
- A national Strategic Plan that will provide a roadmap for how we, as a nation, can make meaningful progress toward eliminating racial and ethnic disparities in mental health services.
- An aggressive science to servicesinitiative, which expands the number and distribution of evidence-based practices available through SAMHSA’s national registry, NREPP…and ensures that States and providers can implement these practices. We have already released six Implementation Resource Kits…each one focusing on a different evidence-based practice. We intend to produce four more toolkits this year, focused on practices related to aging, children, consumer-operated services, and supportive housing.
I urge you to consider how you can incorporate these critical system needs into your State priorities.
(Pause)
SAMHSA/CMHS is committed to system transformation. But, we cannot—indeed, should not—attempt this work alone. We will provide the resources and the leadership to facilitate this profound change. We have already harnessed the power of collaboration with our Federal partners. We are on a mission, now, to forge collaborations with the States to fuel transformation across this country . It is you, Florida…and each of the States and territories…that will be the true agents of change. You will be the true agents of transformation.
You and others in this State whose decisions and actions “touch” consumers can make this change happen. Transformation simply cannot happen without the real and meaningful involvement of community providers in designing and implementing the change. Transformation is about changing the way we provide care. Transformation involves a “practice” change…and you are the locus…the focal point…for this kind of change.
I know the challenges of transformation can be daunting. I have “walked in your shoes.” As the former Director for Mental Health, Retardation and Hospitals for 10 years in Rhode Island, I know that my success in transforming Rhode Island’s system was, in large part, because I was fortunate enough to have a core of community mental health organizations and professionals that were unafraid to take risks.
They were unafraid to try new services. They were unafraid to engage with consumers and families in creative ways. They were unafraid to reframe problems to surmount challenges. They were unafraid to practice recovery values and principles, and to share the vision of hope.
How can you transform systems here in Florida, in spite of the obstacles you face…in spite of limited funds, and demands that are often greater than your ability to meet them? I offer you these ideas as a start.
To be an effective change agent, you must first be willing to change…in fundamental ways. You must be willing to embrace this profound change if the profound results we seek are to be achieved. You 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. Your role must change.
Your mission, should you choose to accept, is to become an honorable traveling companion, facilitating consumers’ personal journeys to recovery with all of the resources at your disposal.
Slide 12/Mission Possible
The thousands of men, women, and children of this State who are living with mental illnesses are depending on you to accept this mission. They are depending on you to ignite the flame of transformation across Florida. You have the power to move the critical issues we have talked about today to action…to shape Florida’s transformation…to become part of the system we want…the system Floridians living with mental illnesses deserve. Don’t leave their futures to chance. Choose to be an agent of transformation. Put your power to work to realize this mission possible. Thank you.
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