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
Vermont Association for Mental Health 67th Annual Meeting
Montpelier, VT
November 3, 2005
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Good morning. It’s great to be here with you at this exciting time in the history of mental health care. Ken opened today’s meeting with a bold admonition: “The end is near”. I echo Ken’s declaration…with one caveat. I believe the end is, indeed, near. But I see “the end” as former U.S. Treasurer Ivy Baker Priest has seen it. She explains, “The place which may seem like the end may be only the beginning”.
I believe we are witnessing the end of bureaucratic, system-directed care in favor of consumer-centered, community-based care. I believe we are seeing the end of a one-size-fits-all approach to mental health services in favor of an individualized approach…the end of symptom management in favor of addressing the comprehensive needs of each person living to achieve recovery. Yes, the end of mental health care as we have known it is near. And, this ending foresees a tremendous new beginning…the birth of a new and far more effective system of care…here in Vermont and across the Nation.
I know that many of you here in Vermont are all too aware of the need for fundamental, wholesale change in the way the Nation thinks about, delivers, and finances mental health care. Two years ago, Achieving the Promise: Transforming Mental Health Care in America, the landmark final report of the President’s New Freedom Commission on Mental Health, moved that need to the forefront of the national agenda.
The report envisioned a future when “everyone with a mental illness will recover, a future when mental illnesses will 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”. The Report describes 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 are eliminated.
- Early mental health screening, assessment and referral to services are common practice.
- Excellent mental health care is delivered and research is accelerated; and
- Technology is used to access mental health care and information.
Transformation is defined as achieving these six goals.
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 calls for fundamental change at the very core of the system…not on the margins. It 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.
In fact, transformation of this magnitude will require nothing short of a social movement. And, 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 persons with mental illnesses to develop and reach their uniquely individual life goals.
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 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 and families 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.
This fundamental transformation of our mental health system will require constant and simultaneous work across many areas of performance…at the individual, community, State, and Federal levels. It will take each of us.
At the national level, SAMHSA/CMHS has taken concerted action over the past two years 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 that we are on the threshold of achieving the promise of transforming mental health care in America.
Nine Federal Departments and the Social Security Administration, with SAMHSA at the lead, have joined in an unprecedented effort to change the status quo. We recently 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. 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 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). I urge you to take them, read them, and share them with your colleagues.
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 Vermont, and in every State…where it will lead to even greater action…and transformation with an even greater sense of urgency!
Each of us has a part to play in this mission. As advocates, your role is critical. The word “advocate” comes from the Latin advocare…to call…to speak in favor of…to give voice to. This is what you do best. You excel at transmitting ideas and information with power and impact based on your personal experience and insight. You elevate expectations and conversations to a new level.
The Vermont Association for Mental Health is a shining example of the power inherent in committed and impassioned people sharing a common goal. Your organization has worked long and hard to spread the message that mental illnesses are real illnesses. You know and demonstrate that recovery is not only possible…but the expectation. Your efforts are striking at the heart of stigma and discrimination – two of the most formidable barriers that stand between consumers, families, and the services and supports they deserve. I was heartened by your campaign to educate the Vermont Teddy Bear Company to the insensitivity of their “Crazy for You” bear. When you stood up and publicly opposed a product that trivialized the pain of people with severe mental illness and reinforced long-held stereotypes, you demonstrated transformation in action.
As a citizen group, you are raising the voices of your communities. Communities can create the expectation of recovery and place that expectation on the mental health service system. Public demand determines programs. When communities demand responsible, evidence-based services such as jail diversion and re-entry programs, school-based mental health programs, supported housing, vocational rehabilitation, and other supports that are necessary to lead a full and productive life in the community, the result is the healthiest communities possible.
Communities are vital conduits in sending a message to the service system: “We expect transformed systems and we will accept no less”. In the ongoing discussion of transformation, the central element is changing expectations. Large systems can have the tendency to cater to the lowest common denominator. In dealing with the health and lives of human beings, we cannot allow that tendency to prevail. Communities must dictate what they will and will not accept…what they need and how they want their needs met. It has been said that “all politics are local”. The same can be said of nearly all human endeavors. At the core of societies, the most important changes take place on the community level, led by the individuals who live and work in those communities. Transformation of the mental health care system will be no exception.
Over the last two years, I have visited scores of communities across this country. I am finding a readiness and willingness to change in each and every one of them. States, communities, and individuals are ready to take this on! We are truly in the midst of a social, cultural, organizational, and attitudinal change! The wheels of transformation are turning in nearly every State in the country. Some, like Vermont, have already started to achieve great things.
Vermont has demonstrated a deep commitment to transforming its system into one that is more consumer- and family-driven…accountable to those you serve…and focused on the goal of recovery. With the help and efforts of advocacy groups such as the VAMH, remarkable changes are taking place.
In many ways, Vermont is a national model of revolutionary and transformative activities. One initiative that has taken shape here in Vermont stands out as a perfect model of what transformation is all about – your parity legislation. The comprehensive legislation that VAMH’s parity campaign promoted…and helped to pass 8 years ago…carries with it significance far beyond matters of access to insurance. And its influence reaches far beyond the borders of the Green Mountain State. This legislation mandates equal treatment for the mind and body. Thanks to your efforts, parity – in the broadest sense – has become a key directive for all social policy issues in Vermont. Likewise, what you have accomplished here will provide valuable insights and useful ideas for parity efforts and similar legislative campaigns through the country. I applaud the Association’s role in the development and passage of what is now recognized as the most comprehensive parity behavioral health care legislation in the country. I am certain that your continuing role in its implementation will be no less meaningful.
I know that the issue of parity has played an important role in a variety of debates here in Vermont…including the location of a new psychiatric facility on the main campus of Fletcher-Allen Health Care in Burlington…and in the process of trying to resolve how you will replace the Vermont State Hospital in Waterbury. I urge you to see these issues as once-in-a-lifetime opportunities to shape the future of Vermont. The State Hospital project provides a singular opportunity to design the delivery system that will service Vermonters for the next 30 or 40 years…a chance to create a good, solid model of the best of what we know now, shaped by Vermont values.
I also applaud the Association’s recent efforts to end the practice of physically restraining children who are being transported for psychiatric exams. Ending the use of unnecessarily coercive treatment is a transformation imperative! The use of these kinds of controlling or coercive interventions is counterintuitive to transformation! The Federal Action Agenda includes support of State training efforts to implement alternatives to seclusion and restraint. SAMHSA has launched a national action plan to accomplish this goal. I commend you for your willingness to put a spotlight on this issue…and to take action to focus on specific and tangible solutions.
And I salute the Association for taking the first steps to develop a system to immediately restore housing, health care, Social Security, and other Federal benefits to consumers who leave Vermont’s prisons. Your commitment to ensuring that these very vulnerable individuals have the supports they need in place to facilitate their recovery…and to reduce the chance that they will reoffend…is admirable.
The VAMH is asking the right questions…and demanding the appropriate solutions. You are helping to build a readiness for change in this State. You are truly agents of transformation. You are transforming your mental health delivery system. And you are doing so in the face of enormous obstacles. Funds are limited. There are ever-increasing demands for mental health services and resources…demands that are often greater than your ability to meet them…demands that are growing still.
That point was driven home to all of us when Hurricane Katrina struck America’s Gulf Coast and left in its wake thousands of men, women and children struggling to recover and rebuild their lives. As I speak, the Department of Health and Human Services, SAMHSA, and CMHS are focused on deploying resources to mitigate the damage and 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.
In the wake of Katrina, people on the Gulf Coast and those who have relocated 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 care transformation is unacceptable.
Here, in Vermont, 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. It is up to States like Vermont to continue to lead…to keep the pressure on…to do what you know must be done. You have the power to move the critical issues we have talked about today to action…to shape Vermont’s transformation…to become part of the system we have envisioned…the system Vermonters living with mental illnesses deserve. But, you must first be willing to embrace this profound change if the profound results you seek are to be achieved.
I have every confidence that you are up to the task. You will achieve the promise of a full and rewarding life in the community for all Vermonters. Strong advocacy…in partnership with progressive State government…guided by the real and meaningful involvement of consumers…is a formula for success. Certainly challenges abound. This will not be easy work. But, these challenges also provide a wealth of opportunities to expand, change, grow, and create a system that better serves people.
The Chinese character for “crisis” is a combination of the characters for “danger” and “opportunity”. This is a fitting symbol for our transformation efforts. While there is some degree of danger in taking on a task as immense as the one before us, the opportunity exists to accomplish more than we may have previously thought was possible.
Transformation is possible. I have witnessed it…here in Vermont…and across the Nation. Momentum is building. We are approaching the end of mental health care as we have known it…the end of disparity, stigma, hopelessness, fragmentation, and bureaucratic silos.
Author and entrepreneur Barbara J. Winter has said, “When you come to the end of everything you know and are faced with the darkness of the unknown, faith is knowing one of two things will happen. Either there will be something solid for you to stand on…or you will be taught to fly!” We are embarking on a new beginning…a new day when persons with mental illnesses and their families will have access to all of the supports and services they need to successfully live a rich, full life. Although transformation challenges us to step out into the darkness of the unknown, I am convinced that working together, we will fly! Thank you.
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