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
National Training Conference—Addressing Homelessness for People with Mental Illnesses and/or Substance Use Disorders
Preparing People for Change: Knowledge and Choice
Washington, D.C.
October 28, 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
Slide 2/Quotes
“Home is not where you live, but where they understand you.”
“Home is where the heart is.”
“There’s no place like home.”
“Home”...as each of these popular quotes attests...is far more than a building or a structure. “Home” conveys a state of mind, a sense of belonging, a close relationship...a connection. The men, women, and children who live and suffer on our streets don’t have that security…that connection…that sense of belonging. They feel cut off from their communities.
Our vision, at SAMHSA, is to provide a life in the community for everyone. Preventing and overcoming homelessness is crucial to realizing this vision because a life in the community begins with a home...a safe, stable, healing place to call one’s own.
I’d like to thank each of you for your dedication and determination in serving people with mental illnesses and substance use disorders who are homeless. You are making a difference all across this country…helping these very vulnerable Americans reach for and realize a higher quality of life.
We know that people with serious mental illnesses and/or co-occurring substance use disorders who are homeless can and do recover. That’s why we are all here today. Working together, we can help chronically homeless people overcome their complex and multiple challenges. We can help these men, women, and families move off the streets, into housing, and back into productive lives. We can take steps now to eradicate the root causes of chronic homelessness—lack of adequate income, a shortage of affordable housing, diminished social support—so that we can prevent the homelessness of tomorrow. We are prepared for change.
Slide 3/Achieving the Promise
Achieving the Promise: Transforming Mental Health Care in America —the groundbreaking final report of the President’s New Freedom Commission on Mental Health—has provided a mandate from the highest levels of the government to do just that. The Report declares, “The lack of decent, safe, affordable, and integrated housing is one of the most significant barriers to full participation in community life for people with severe mental illness.” Achieving the Promise challenges us to change the way this nation thinks about, delivers, and finances mental health care. The report calls on us to create a new, recovery-oriented national mental health system that meets the needs of every American living with mental illnesses.
Achieving the Promise presents a bold vision of a future when anyone with a mental illness will recover...when everyone will have access to the essentials for living, working, learning, and participating fully in the community. Achieving the Promise calls for a wholesale transformation of the mental health system...and urges everyone with a stake in mental health care to work together to realize this vision.
How will transformation impact our efforts to end chronic homelessness? What will services for individuals and families who are homeless look like in a transformed system? How can we prepare people for this fundamental change? I will address each of these issues in a moment. But I think it will be helpful to first take a look at exactly what we mean by transformation.
Slide 4/Transformation Is
Transformation is quantum change. Transformation compels a bold vision to change the very form and function of the mental health care service delivery system to better meet the needs of the individuals and families it is designed to serve. This kind of profound change in a system has many implications for policy, funding, and practice…as well as for attitudes and beliefs.
Transformation will require a different set of values…an entirely new way of thinking…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 is a deliberate, conscious process—not of forced change—but of an inherent shift in the individuals involved. It will require conversion, renovation, an entire makeover of the system we presently know. Transformation calls for a literal revolution in how we do things, in how we think, and in how we work together. Transformation has no destination. It is a never ending process.
Slide 5/Transformation Goals
In Achieving the Promise, transformation is defined as achieving these six goals—
- 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.
Transformation of this magnitude will require nothing short of a social movement. Transformation exudes a great deal of energy upon the people who are part of it. This energy must be guided by a strategy toward a goal. What is our strategy? To provide all of the services and supports required for persons with mental illnesses and their families to build resilience to face life’s challenges. What is our goal? To build a national system...State by State...community by community...that facilitates recovery and empowers every individual with mental illnesses...including those who are experiencing homelessness...to develop and reach their uniquely individual life goals.
Slide 6/Recovery
The core belief in recovery is embedded in transformation. Recovery is the journey of hope through which lives are transformed. It does not necessarily mean “cure”. Recovery, instead, is an individual process…a continuum of personal achievements as each person moves closer to a fulfilling and productive life in the community. It is a deeply personal and unique experience.
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.
The discussion shifts, then, to how we can facilitate every consumer’s 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.
A tall order? Absolutely. But I am convinced that we can leap into a better life...a better system...if, at this choice point, we say deliberatively that we will look at ourselves differently...change our expectations of what is possible...and then, act on these expectations.
I am equally convinced that, through transformation, we can end chronic homelessness…and offer those most in need renewed hope in recovery.
The basic tenets of creating a recovery-oriented system apply as we think about how to best serve consumers who are homeless. Transformation of our mental health care system fully embraces the needs of these individuals and families. Transformation is about guaranteeing the essentials of a rich and productive life in the community…and you can’t have a life in the community without a home.
Of course, there are particular challenges in transforming services for individuals and families who are homeless. There are issues unique to this population that complicate recovery.
For example, homelessness adds another heavy layer of isolation and misunderstanding to the stigma and discrimination that many people with mental illnesses face. For people who are homeless, involvement with the criminal justice system creates additional hurdles. A criminal justice history makes it difficult, if not impossible, to access and maintain public housing, and creates even more bias in employment.
In transformation, we must create a new national mental health care service system that understands, anticipates, and fully meets the unique needs of people who are homeless.
What will these kinds of services look like in a transformed system?
In a transformed system, each of us will be called on to be more creative about what we do and how we do it…to do things in ways we may have never thought of before. In a transformed system, we will seek out private and public funds from unconventional sources...find innovative ways to surmount problems...and reframe the way we think about the world. In a transformed system, we will forge new relationships with organizations that may not believe they have an equal stake in the issue of homelessness. We will be bold and take risks!
Slide 7/Project Coming Home
In a transformed system, services to end homelessness will look a lot like the kind of care that is being provided today through Project Coming Home at Contra Costa County Health Services in Martinez, California. Contra Costa County Health Services is one of 11 grantees participating in the Collaborative Initiative to Help End Chronic Homelessness—t he 3-year SAMHSA/HUD/VA/HRSA partnership that is bringing an unprecedented comprehensive approach to bear on the problem. In this model of transformative, collaborative relationships, SAMHSA is funding mental health care, substance abuse treatment, and related support services. HUD is funding permanent housing. The VA is offering medical services to homeless veterans, and HRSA is funding primary health care.
When the project began in 2001, the price of a two-bedroom apartment in Contra Costa was $1,155 per month. The county unemployment rate was 2.5%, and on any given night 4,828 people were homeless. These three important developments shook this small community and propelled it to begin transforming its system.
In the Project Coming Home model, outreach teams of case managers, peer counselors, health care professionals, and others go out to camps and other places where homeless people congregate. Once a person is deemed eligible for the project, the goal is to get that person housed as quickly as possible. Individuals are first placed in interim housing… then in permanent housing throughout the county. Case managers ensure that the individuals in the program get the services they need to stay housed. To do so requires aggressive outreach. In contrast to the conspicuous homeless populations of large cities, in Contra Costa County, homeless individuals are spread out across an area about the size of Rhode Island…and they’re also well hidden.
In Contra Costa, they’re very good at what they do. Their “Housing First” approach works not only with people who are transitionally homeless, but also with the hardest-to-serve population—those who are chronically homeless and suffering from mental illnesses and addictions. In Contra Costa, 87% of the program’s tenants remained housed after 1 year; 79% remained housed after 5 years.
What is Contra Costa’s formula for success? An array of partners and very strong relationships. The local housing authority provides housing vouchers. The community health clinic and the VA provide health services. The county provides mental health and substance abuse treatment. Community-based organizations provide everything from peer counseling to training in money management. One organization handles all the leasing arrangements with landlords because homeless people frequently have credit problems that prevent them from signing their own leases.
In Contra Costa County, they’ve instituted a plan to end homelessness in ten years. And I believe they will succeed...because they understand that the costs of doing anything less are too great. What we see happening in Contra Costa Countyis transformation in action.
These kinds of transformative programs and activities are taking shape across this country. Transformation is happening! And, the timing is critical. Hurricane Katrina and her aftermath provide a dramatic example of why we must transform our thinking and action. Right now!
Slide 8/Hurricane Katrina
With Katrina, the sheer number of people affected by this lethal storm has directed a very powerful spotlight on the challenges that you in this room have been wrestling with for a long time. Now that the Nation’s response to Katrina is moving from crisis mode to long term mitigation and recovery…now that the emergency support is running out and literally hundreds of thousands of men, women, and children find themselves without homes...this disaster has elevated the “issue” of homelessness to dramatic new heights of awareness.
Overnight, the number of people who are homeless in this country…the number of Americans we are charged to serve…has at least doubled. Our responsibility has increased two-fold…but our funding and resources have not. A daunting challenge? Yes. But, I believe the Katrina crisis can serve as the “tipping point” for the wholesale system change that will be required to really deliver on the promise of a life in the community.
Katrina has challenged us to collaborate more effectively…to use active community outreach and other proven case management models…and to quickly increase capacity to respond to mounting demands for services. Katrina has prompted us to strategize about how to meet the need for immediate assistance while assessing how to rebuild the mental health system in New Orleans and Louisiana in the right way. Katrina has challenged us to carefully consider how to invest dollars in evidence-based practices that we know are going to work, and to put the incentives in the right place as these systems are being rebuilt. Many opportunities for transformative thinking and collaborative action have risen out of the tragedy of Hurricane Katrina.
Slide 9/Collaboration quote
Collaboration is the lifeblood of transformation. In its charge to us, Achieving the Promise plainly states “…No level or branch of government…no element of the private sector…can accomplish needed change on its own. To transform mental health care as proposed, collaborationbetween the private and public sectors and among levels of government is crucial.” Why is collaboration so important? People living with mental illnesses have complex and multiple issues that cut across every department, agency, and system. W e must break down the barriers...the silos that have existed for so long across government and the private sector...to develop comprehensive solutions that will enable us to better serve the whole consumer...mind and body.
W e, at the Federal level, are leading this change…by example. During the past year, SAMHSA/CMHS and our Federal partners have made an unprecedented commitment to work collaboratively on transformation . NineFederal Departments and the Social Security Administration, with SAMHSA at the lead, have joined in an unprecedented effort to change the status quo.
Slide 10/Action Agenda
Just a few weeks ago, we released the Federal Mental Health Action Agenda—the roadmap that will guide our 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.
The actions described in this report have the power to propel significant changes in mental health care. The Action Agenda 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 it, Congress, the nation and the people we serve can hold us accountable for achieving the goals we have set. I have made copies of the Agenda available to you (HOLD UP COPY) and I urge you to take them, read them, and share them with your colleagues.
Slide 11/Federal Partners
For the first time ever, key Federal agencies have recognized their stake in mental health care, and united behind a belief in recovery! This is how we will eliminate the fragmentation of services among Federal agencies! This is what we expect will become a model for an equally unprecedented level of collaboration here in the District of Columbia…in every State…and every Territory…where it will lead to even greater action…and transformation with an even greater sense of urgency!
One of the most exciting outcomes of this process has been the incredible synergy that has resulted...as so many of the Agencies that touch the lives of people with mental illnesses come together.
Nowhere is this synergy more relevant…or more critical… than in our efforts to prevent and overcome homelessness. Collaboration is essential to address the complex interplay of problems that perpetuate chronic homelessness.
To end chronic homelessness, we need leaders and partners in Housing. We have to work together to address the programmatic and regulatory barriers that stand between people in need and the mainstream housing programs that can open the door to a new life. HUD’s 2006 budget request includes $25 million to establish a reentry initiative for ex-prisoners, many of whom are struggling with serious mental illnesses. HUD will collaborate with DOL and DOJ in this effort.
We need leaders and partners in Criminal and Juvenile Justice. Studies conducted across the country have shown that up to half of all individuals leaving incarceration are homeless upon release. SAMHSA and the Department of Justice are partnering to expand our range of effective alternative interventions which will improve the possibility of recovery for individuals with mental illnesses who have become entangled with the criminal justice system.
We need leaders and partners in Labor. To end chronic homelessness for people with mental illnesses, we must increase and improve employment opportunities for these individuals. DOL and HUD will jointly fund five 5-year demonstration grants to promote employment of people with psychiatric disabilities who are chronically homeless.
We need leaders and partners in the Social Security Administration. The Social Security Administration Disability Programs (SSI and SSDI) are not only the gateway to Medicaid, but they are also a route to employability…to stable housing…and to recovery for homeless individuals and families. In one ground breaking new effort, SAMHSA/CMHS is working in partnership with HUD and the Social Security Administration to develop training materials designed to equip local providers to assist persons who are experiencing homelessness gain eligibility for SSI and SSDI—and to succeed in the very first decision. With these activities, we will give case managers across this country the tools they need to help thousands of people who are homeless and living with mental illnesses secure the resources that are deservedly theirs.
Slide 12/Stepping Stones to Recovery
We have developed a manual for case managers who assist homeless SSI/SSDI applicants. The manual has just been published and is available at this conference at the PATH booth. Or, you can call SAMHSA’s National Mental Health Information Center at 1-800-789-2647 and ask for Stepping Stones to Recovery, A Case Manager’s Manual for Assisting Adults Who are Homeless with Social Security Disability And Supplemental Security Income Applications.
In collaboration with HUD and HRSA, we are also providing a Technical Assistance package on this issue. The TA package—which will be awarded to States and localities on a competitive basis—will include an initial 2-day meeting for stakeholders planning a local or State strategy to assist homeless SSI/SSDI applicants. It will also feature training for two persons from each State or site who will be equipped to conduct training workshops for case managers in their State or site. These activities represent the beginning of our collaborative efforts in this area. More activities are in the planning stages.
SAMHSA’s nearly $55-million-per year formula grant program, PATH—or the Projects for Assistance in Transition from Homelessness program—provides another example of the power of collaboration. PATH has been around a long time. Many of you may be familiar with the critical bridge it provides...supplying some of the only funding many communities have to support the range of services needed to effectively reach and engage individuals with serious mental illnesses and/or co-occurring substance use disorders.
SAMHSA is also collaborating with HUD and the VA to develop the Samaritan initiative. Through this initiative, States and localities will be able to access the full range of services that chronically homeless people need including housing, outreach, and support services such as mental health services, substance abuse treatment and primary health care. Based on experience with the Collaborative Initiative to Help End Chronic Homelessness project, the President has proposed the Samaritan Initiative at $200 million in his Fiscal Year 2005 budget. Priority will be given to grantees who seek to expand access to mainstream Federal programs for those who experience chronic homelessness.
Slide 13/Blueprint for Change
I would like to mention one other key resource from our portfolio to end chronic homelessness—SAMHSA’s Blueprint for Change. This is a comprehensive resource that States and local communities can use to design their own initiatives.
It's a nuts-and-bolts, how-to guide. It includes information about the current state of community-based care, typical characteristics of the homeless population, the concept and practice of recovery-based treatment, sources of funding, evidence-based practices, and ways to measure results. With this guide, local communities and organizations can use a systems approach to better address all of the key domains of care for these very vulnerable Americans. We think it will be an invaluable tool in helping to achieve transformation at the community level.
I cannot discuss the need for transformation at the community level without addressing an emerging priority in America’s communities: family homelessness.
The typical homeless person of the 70s, 80s and 90s was a single male. Today, we’re serving women and children who are living on the street…as well as single fathers with their children. Children in these families without homes suffer from hunger and illness, are troubled by emotional problems, and often have no opportunity to succeed in school. Many homeless families have been victims of violence and abuse, and have become completely isolated and disconnected from our communities.
According to the National Center on Family Homelessness, at least 1.3 million children are homeless in a given year. Families with children are among the fastest growing segment of the homeless population.
Slide 14/Homeless Families Project
Homeless families are increasingly becoming an area of concern. But this is not a new issue for SAMHSA. CMHS, in partnership with CSAT, began the Homeless Families Project in 1999. In this multi-year development initiative, we documented and evaluated the effectiveness of time-limited, intensive intervention strategies for providing treatment, housing, support, and family preservation services to homeless mothers with psychiatric and/or substance use disorders that are caring for their dependent children. The program has just concluded, and we are currently synthesizing the results. Early findings suggest that women participating in the two phases of the program regained connections with the community.
The immediate and first order evaluation results of the family homelessness study will be published in a special issue of the American Journal of Community Psychology—probably in 2006. As the analysis of the study results are completed, we will use these findings to inform our next steps, including the design of dissemination products and the appropriate target audiences. Importantly, the final report will also examine the policy implications of the findings for addressing family homelessness over the long run.
(pause)
Women...men...children...families...every person needs a home…a beginning place.
Through our long history of work in this area, we have learned much about confronting homelessness…about how to best provide this new beginning. We now know that the answer to solving the problems of homelessness is about housing first…but it is not just a housing issue. We know that persons who are homeless need a whole continuum of care including treatment for mental illnesses and substance abuse, trauma care, supportive employment, and supportive education. All of these issues must be addressed if these persons are to achieve a life in the community.
These are not new issues…we have been dealing with them for a long time. But, in the face of mounting need, we need new answers. Transformation is not about mobilizing to solve problems we already know how to solve. Transformation is about confronting problems that have never yet successfully been addressed. Even in the face of limited funds. Even in the face of ever-increasing demands. Transformation is about creating a new expectation of what is possible!
What can you do to continue to transform your systems in spite of the challenges? What can you do to prepare for this change? As the theme of this conference suggests, knowledge and action are key. I offer you these ideas as a start:
Slide 15/What You Can Do
- Read and discuss the Federal Action Agenda and consider how you can incorporate these action steps into your organization’s agenda.
- Keep working to help your communities understand what is involved in developing a system that is consumer driven and focused on recovery.
- Continue involving consumers. Make sure that, as you engage in the business of transformation, you continue to keep the needs of consumers and families central to the process.
- Continue to work with and find new partners to assist in the transformation of your system.
- Keep building public support for transformation. Continue advocating for expanded services and funding. Help shape State and local priorities by generating the community feedback that can influence policies.
And, continue to spread the word that recovery is possible throughout your communities.
Perhaps the single most important thing you can do: you must 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. As individuals, w e must have the capacity, as well as the willingness , to become partners in a systemic change in our approach to determining and delivering care.
The men, women, and children in communities across America who are homeless and living with mental illnesses and substance use disorders are depending on you to accept this challenge. They are depending on you to ignite the flame of transformation and carry it back to your communities. You have the power to move the critical issues we have talked about today to action …to become part of the system we have envisioned…the system every American living with mental illnesses deserve.
Each of you…doing the best you are capable of doing, day by day…can make monumental change happen. You will be the deliverers of recovery and of hope in the transformed system. You will be the innovators…and the torchbearers.
This work will not be easy. I know that all of this change can seem overwhelming. But it can, and must, be done. It is too vital, too essential, for anything other than success to be an option.
Slide 16/Quote
Joan Holmes, the Executive Director of the Hunger Project—the worldwide movement to end hunger—has said, “We often think of heroes as extraordinary people with powers and abilities far beyond those of ordinary human beings. But when we really look, we discover that heroes are ordinary men and women who dare to see and meet the call of a possibility greater than themselves—people who despite their doubts and fears commit themselves to action; people who go beyond their limits in what they think is possible. Ordinary people—daring to be heroes—are the greatest expression of human potential.”
As I look around this room, I see literally hundreds of ordinary heroes. Please join with SAMHSA and the Federal Partners as agents of change…as agents of transformation. I urge you to press on...to continue the work you have been doing. And, dare to do more! Dare to go beyond the limits of what you think is possible. Renew your commitment...and take transformative action to end chronic homelessness in your communities.
Together we can make a profound difference. We can build a recovery-focused system that serves all persons... a transformed system that offers everyone a rewarding life in the community…and a place to call “home.” Thank you.
CONSUMER VOICES INTRO
Now, it gives me great pleasure to introduce these voices of recovery...a distinguished group of panelists who have graciously agreed to join us this morning to speak about recovery…from their unique and profoundly personal perspectives. It is by listening to these lived experiences that we will truly create a recovery focused system that can transform lives.
After all three participants have spoken, we’ll have time for questions from the audience.
Moe Armstrong , M.B.A., M.A., is the Director of Consumer and Family Affairs for the Vinfen Corporation, a provider of mental health services in Cambridge, Massachusetts. With his wife, he established the Peer Educators Project, which believes that people with mental illnesses and their families are an educational resource.
He has earned:
- the Ruth M. Batson Award in 1999 for conviction, devotion, and tenacity in fighting for necessary resources for the mentally ill;
- the National Alliance on Mental Illness (NAMI) National Lionel Aldridge Award for promoting the education, recovery, and empowerment of mental health consumers in 1998; and
- the NAMI Massachusetts Member of the Year Award for 1997.
Janice Grady is a Training Specialist with the Office of Organizational Development, Department of Mental Health (DMH) Training Institute, in Washington, D.C. Previously, she was employed at Community Connections in Gaithersburg, Maryland, as a Consumer/Survivor/ Recovery/Advocate Researcher and Director of the Women’s Support and Empowerment Center. She pioneered the development of a peer survivor’s program in DC, combining experience and education into a program that has empowered many women. Ms. Grady has also conducted over 30 training sessions during the past two years for the various Core Service Agency consumers on the topic of “Consumer Choice and Problem Solving.” She was also elected as a Board Member to the N Street Village, an organization whose mission is to empower homeless and low-income women. She has worked as a consultant with NRTC and other national and local organizations.
Ana Lazu is the founder of Latinos Unidos Siempre (LUS), a non-profit organization that has become highly successful in providing culturally sensitive and appropriate care to the Latino population of eastern Connecticut. For her work through LUS, Ms. Lazu was one of six individuals honored at the 7th Annual Welcome Back Awards ceremony earlier this year. Sponsored by Lilly, the Welcome Back Awards is a national program that recognizes outstanding individuals who make a difference in the depression community. Ms. Lazu's proudest achievement is LUS's PRIMOS Training Program. In this program, students learn how to overcome cultural and language barriers so that they can secure quality care for themselves. She prepares her students for employment and continuing education, and gives them a comfortable place to learn interpersonal skills and practice English.
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( Kathryn: After all three have spoken, the organizers have asked that you thank the panelists for their participation…then, an NRTC staffer will field Q&As and release the attendees to the workshops.)
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