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
Association of Community Mental Health Centers of Kansas, Inc. 27th Annual Conference
Achieving the Promise in Kansas…and Across the Nation
Wichita, KS
September 29, 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 America has been described as a nation of ideas transformed by events. Some events—like the discovery of the polio vaccine, man landing on the moon, and digital technologies—have propelled us forward with great speed. Others have tested our mettle…and challenged us to keep pushing forward, despite overwhelming obstacles.
One month ago, today…early on August 29,2005, Hurricane Katrina grazed New Orleans, Louisiana, and made landfall near the town of Buras, Louisiana. Katrina left behind a humanitarian crisis on a scale unseen in the U.S. since the Great Depression
In the wake of Katrina, thousands of men, women, and children are struggling to recover and rebuild their lives. We know that the disaster survivors…the rescue workers and emergency medical personnel…and Americans across the nation who have experienced the horror of the tragedy through media coverage…can suffer serious mental health effects. These effects can be deep…and can linger for weeks and months to come. The National Center for Post Traumatic Stress Disorder estimates that in the four most affected counties and parishes in New Orleans and Southern Mississippi, alone, up to 30% of the population—or as many as 242,000 individuals—will experience clinically significant mental health or substance abuse issues. The need is tremendous.
As I speak, the Department of Health and Human Services, SAMHSA, and CMHS are focused on deploying resources to aid in the recovery process for the survivors of Hurricane Katrina. In collaboration with our State, local, and Federal partners, we are working around-the-clock to ensure that mental health and substance abuse assessments and crisis counseling are readily available to those in need. We are taking steps to ensure that adults with mental illnesses and addictive disorders and children with serious emotional disturbances continue to receive ongoing treatment for their chronic conditions. And, we are committed to establishing a long term plan to assure Post Traumatic Stress Disorders are addressed with this population.
Slide 2/Katrina Response
Toward that end—
We have activated the SAMHSA Emergency Response Center (SERC)—the coordinating body for the overall federal response for mental health and substance abuse issues around Katrina.
We have awarded $600,000 in SAMHSA Emergency ResponseGrants for clinical services, including pharmaceuticals, to ensure continuity of care for those requiring ongoing treatment. These funds were the first urgent money to get out. I anticipate that the next phase will feature a five-to-fifteen-million-dollar response. Beyond that, we will be giving strong consideration to the types of services...and capacity…that will need to be in place...for the long term.
We are taking steps to ensure that there is adequate capacity where the evacuees are now…and where they're going to be. We have over 210 mental health professionals certified to be part of the deployment. SAMHSA has awarded $5 million to help send volunteer mental health and substance abuse professionals to Louisiana.
We have announced a National Crisis Lifeline to provide immediate assistance to individuals who are encountering emotional distress and in need of crisis counseling. That number is 1-800-273-TALK, and it is connected to a network of local crisis centers across the country. This resource is immediately available to the public, but we are putting additional capacity into place in the areas that have been impacted by the disaster and where evacuees are currently being housed.
We’re providing ongoing technical assistance and support in Louisiana, Mississippi, Alabama, and Texas.
And, we are assessing how to rebuild the mental health system in New Orleans and Louisianain the right way. Clearly, we know more today than ever before. As we invest dollars in rebuilding that system, we need to invest the dollars in evidence-based practices that we know are going to work, put the incentives in the right place as these systems are being rebuilt, and do it right.
(pause)
In the wake of Katrina, people on the Gulf Coast and across America will need the very best mental health care we can possibly provide. In the wake of Katrina, anything less than our bold commitment to mental health transformation is unacceptable.
Here in Kansas, your bold commitment to building the transformed system that will deliver the promise of hope and recovery to every man, woman, and child with or at risk for mental health issues makes you a leader among the States.
I commend Gary Daniels, Secretary of the Kansas Department of Social and Rehabilitation Services for his vision, along with Steve Erikson, Mental Health Director for the State of Kansas.
I would like to recognize Jane Adams, the New Freedom Commissioner from Kansas for her contributions to this historic initiative, as well as for the important work she does in her capacity as the Executive Director of Keys for Networking.
And my personal thanks to Mike Hammond, the Executive Director for the Association of Community Mental Health Centers of Kansas, Inc., for inviting me to this 27 th Annual Conference in Wichita.
It is clear that you understand what transformation is all about here in Kansas. You have demonstrated a deep and true commitment to transforming your system into one that is consumer- and family-driven...accountable to those you serve...and focused on the goal of recovery. You are using data-based decisionmaking to pinpoint where change is most needed and to achieve greater positive outcomes for consumers. You understand the need to replace unnecessary institutional care with healing relationships and effective and reliable community mental health services.
It is clear that you know a great deal about what it will take to transform the mental health care system here in Kansas. But I am here today to ensure that you also know how indispensable each of you is to this process.
Slide 3/The Commission’s Vision
Achieving the Promise: Transforming Mental Health Care in America, the Final Report of the President’s New Freedom Commission on Mental Health, envisioned a future when “everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports—essentials for living, working, learning, and participating fully in the community.”
We simply cannot create this future without you. Each of you is critical to this mission. You are the ultimate locus of accountability for the care that is available here in Kansas. You can create a recovery-oriented system that will transform lives. Transformation will not happen without you.
It is a tall order. But, you have the power to help move this vision to reality.
Too often, I think, the discussion of transformation and its implementation takes place solely between Federal and State government authorities. But, transformation is not simply a matter of “authority.” Transformation is, in large part, about changing the way in which we provide care. Transformation involves a change in “practice”…in how we deliver services to consumers. You are the keystones of that change. Real and meaningful change will not take place in our mental health care system without community providers taking a leadership role in designing and implementing the changes we know are necessary.
That is certainly true here in Kansas. In fact, a number of the successful change initiatives that have taken hold here in this State have done so because community providers took the lead. I know that providers were instrumental in the effort to secure funding to sustain your statewide systems of care after the pilot ended. Thanks to the efforts of community providers, Kansas is one of only 3 States with an SED waiver that enables children to be served in their communities.
The progress that has been realized here, with the support of the provider community, is deserving of praise. You have moved your State system closer to the transformed system described in the Achieving the Promise.
I am impressed by many of the steps you have already taken to create such a system. One initiative that has taken shape here in Kansas stands out as a shining example of transformation in action: your regional transformation summits organized around the goals of the New Freedom Commission.
In these sessions, you have formulated strategies and recommendations related to suicide prevention, public awareness, reducing stigma, legislative communication, rural challenges, cultural competence, and the connection between physical and mental health.
You have confronted the challenges of moving research to practice to promote recovery and resilience and ultimately to cure and prevent mental illnesses. You have made the commitment to advance evidence-based practices using dissemination and demonstration projects…and to create a public-private partnership to guide their implementation.
Each of these topic-specific Summits has had its own agenda and plan—which is good. Even more importantly, the Summits demonstrate the effectiveness of a “system of systems” approach…a way to seamlessly consolidate these individual plans under one umbrella that powerfully demonstrates the value of the proposed recommendations and justifies the investment in mental health.
Kansas has a lot to be proud of. Your mental health programs exemplify many of the values that are the very foundation of transformation—including the importance of community to recovery…and the necessity of leadership by consumers. We want to see these kinds of programs take hold in States across the nation.
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 Kansas, some have already started to achieve great things.
The New Mexico Interagency Behavioral Health Purchasing Collaborative will replace its 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 4/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. Transformation is happening. And every step…large and small…brings us closer to realizing our goal.
Thousands of organizations in the private sector—from insurers to advocacy groups to corporations—are also joining in the effort. 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 fulfill the promise of transformation. Every day, I learn about others who are recognizing their stake in mental health and stepping forward to transform how mental health care is delivered in America.
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.
Before I update you on the real and steady progress we are making toward transformation at the Federal level, I think it is important here to review the goals of a transformed system...and to clarify what we mean by mental health recovery…and mental health 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 5/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 go about doing it. It has many implications for policy, funding, and practice, as well as 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. 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 the process of transformation begins, a profoundly different system materializes—a system changed in structure, culture, policy, and programs.
Slide 6/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. 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.
Albert Schweitzer once said, “Example is not the main thing influencing others. It is the only thing.”
In the nearly two years since Achieving the Promise was released, SAMHSA and its Federal Partners have made an unprecedented commitment to model the kind of collaborative activities that will be necessary to move from a vision of transformed mental health care to its reality.
Slide 7/Action Agenda
Recently, 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 move transformation forward.
Slide 8/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 the New Freedom Commission, cross walked with the goals of Achieving the Promise.
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 at the State level, where it will lead to even greater action…and transformation with a greater sense of urgency!
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.
Collaboration is the lifeblood of transformation. Why is this synergy—this mutually energizing collaboration—so important? People living with mental illnesses have complex and multiple issues that cut across every department, agency, and system. We need leaders and partners across government and the private sector to develop a comprehensive solution.
Slide 9/Transformation-Collaboration
As we move forward, SAMHSA/CMHS is fostering partnershipsacross the Federal government.Along withOur Federal Partners Workgroup, we have formed a Federal Executive Steering Committee that will bring together, for the first time, 22 Assistant Department Secretaries and Agency heads to eliminate barriers to effective mental health care… and make certain each agency commits necessary resources.
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. We will be awarding nearly $19 million in grant funding in FY 2005 to support State efforts to implement the systemic changes needed to meet the multiple needs of consumers and to foster recovery.
We have completed the review of applications for the first round of grants. We expect to award 6 to 8 Mental Health Transformation SIGs in the next few days. This investment in transformation is a strategic one. The idea is to create a learning community with the knowledge that we gain from the first group to leverage even greater success for the next round of awards.
(Pause)
Transformation requires vision, action, and accountability. Achieving the Promise gave us the vision. I have described a number of actions that are taking place across every level of government and the private sector. Now, I’d like to focus on a very critical feature of transformation...accountability.
Congress sees CMHS as a business...and our work is being evaluated as a business. The White House Office of Management and Budget is looking to us for strong data measures and measurable outcomes.
When Charles Curie became SAMHSA Administrator, he made a pledge to Congress to improve outcomes for people with mental illnesses and substance use disorders. We are making steady progress toward creating a data-driven system that will enable us to measure, manage, and ultimately, improve performance.
Mr. Curie’s testimony assigns a tremendous responsibility to us. It is up to us to continue transforming our mental health system until it can meet the expectations of all of our stakeholders…policymakers and consumers, alike. What are these expectations? Better data; better databased decision-making, and, most important, greater positive outcomes for consumers and their families.
Throughout SAMHSA/CMHS, we are looking at “what is” and asking, “what should be” to promote innovative approaches and effective performance. Activities that move us toward “what should be” will be our priority for consideration as we move forward with efforts to transform the mental health system. With that goal in mind—
Slide 10/SAMHSA Priorities
- We are investing in transformational leadership to mobilize others around a shared vision of recovery.
- We are working with NASMHPD to develop templates for model Comprehensive State Mental Health Plans. These plans will assist every State in addressing the full range of treatment and support services consumers need to live in their communities.
- We are developing prototype Individualized Plans of Care that consider the specific needs and concerns of every adult, child, or family coping with a mental illness.
- We are developing a national Strategic Plan that will guide our progress toward eliminating racial and ethnic disparities in mental health services.
- We are pursuing an aggressive science to services initiative, which includes expanding 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.
On August 29, SAMHSA announced the proposed expansion of the Registry, which will create a national resource for the latest information on science-based interventions to prevent and treat mental illnesses and substance use disorders. Revised review and screening criteria will be posted on the new NREPP Web site by the fall of this year. You can access this information at: www.nationalregistry.samhsa.gov.
Slide 11/NREPP Federal Register
Please take time to review the Federal Register notice on NREPP. You can visit the SAMHSA home page, www.samhsa.gov, and click on “National Registry of Evidence-based Programs and Practices FRN” under the “Quick Picks” section. We would like your input and perspective on this endeavor. We are accepting public comment until October 25. You can send your comments to the addresses you see here. (Refer to slide)
Additionally, we have released six EBP 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.
(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 the profound change required to build a behavioral health care system that holds the rich promise of hope for all Americans.
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. You, in Kansas…along with each of the States and territories…will be the true agents of change. You will be the true agents of transformation.
I understand the obstacles that States face today. Funds are limited. You have ever-increasing demands for mental health services and resources…demands that are often greater than your ability to meet them…and growing still. But despite these barriers, transformation is possible.
How do we transform systems in spite of the obstacles? How do we start changing the minds and hearts of all Americans? I believe that ordinary people doing a professional level of work can make change…even change of this magnitude…happen.
You and others whose decisions and actions “touch” consumers can make this change happen. You will be the deliverers of recovery and hope in the transformed mental health care delivery system. But 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. We have to transform people before we can transform systems.
It is not our institutions that make this country great…it is our people. We’ve seen this throughout our history as a nation. We saw it in the response to 9/11. We’re seeing it now in response to the enormous devastation caused by Katrina.Here in Kansas, you are doing what needs to be done. But I’m here today to ask each and every one of you to do it even better.
Slide 12/Winston Churchill Quote
To paraphrase Winston Churchill, there comes a time in every person’s lifetime…that special moment when you are figuratively tapped on the shoulder and offered that special chance to do a very special thing, unique to you and fitted to your talents. What a tragedy if that moment finds you unprepared or unqualified to do the work which could have been your finest hour.
These are unparalleled times in mental health. Times of tremendous change. You are prepared. You are qualified. And achieving the promise of a transformed mental health care system here in Kansas will be the work of your finest hour. Thank you.
To paraphrase Winston Churchill, there comes a time in every person’s lifetime…that special moment when you are figuratively tapped on the shoulder and offered that special chance to do a very special thing, unique to you and fitted to your talents. What a tragedy if that moment finds you unprepared or unqualified to do the work which could have been your finest hour.
These are unparalleled times in mental health. Times of tremendous change. You are prepared. You are qualified. And achieving the promise of a transformed mental health care system here in Kansas will be the work of your finest hour. Thank you.
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