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
The National Alliance on Mental Illness of Vermont
System Transformation: Strategies for
Achieving Our Goals for Change
Montpelier, VT
November 4, 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
Good morning. It is good to be here in the Blue Mountain State. I am excited to take part in NAMI Vermont’s 10 th Annual Provider In-Service Training at this pivotal moment in the history of mental health care.
“Great moments are born from great opportunities.”
Actor Kurt Russell uttered these now famous words when he portrayed Coach Herb Brooks—the leader of the 1980 U.S. Olympic Hockey Team—in one of my favorite movies, Miracle. For those of you who haven’t seen it, Miracle retells the powerful true story of Team USA—the ragtag squad of college kids who beat the ice hockey champions of the world from the Soviet Union…against near-impossible odds…at the Olympic Games in Lake Placid, New York. After this stunning victory, dubbed the Miracle on Ice, Team USA went on to capture the gold medal.
The Miracle on Ice match has been described as one of America’s greatest sports achievements of the 20 th century. But, what struck me…as I watched the inspiring story of Team USA’s triumph…were the good, solid lessons we can learn from it about advancing fundamental systems change.
Team USA was a long shot in the 1980 games. But Coach Herb Brooks succeeded in his improbable gold medal run… and, in the process, built a team that transcended its sport and united a nation with a new feeling of hope. How did he do it? How did he pull together a team of rival college hockey players to represent their country and do better than a U.S. team had ever done at the Olympics? How did he create the opportunity that led to that great moment in American sports history?
Coach Brooks transformed the way American hockey is played. R ather than looking for superstars, Brooks selected amateur players that could and would adapt to new roles, and learn to polish those new skills quickly. He put his players through a tough team-building regime unlike any they had ever known before. And he advocated a hard-line approach. For Coach Brooks, winning in hockey required staying focused on techniques and strategies.
We can learn much from Coach Brooks as we continue on our mission to transform America’s mental health care delivery system.
Transformation of the mental health care system here in Vermont and across the nation will require a willingness to risk and a readiness for change…a commitment to teamwork and collaboration at every level…anda steadfast pledge to set clear goals and execute a bold strategy to pursue these goals.
Providers, consumers and their families, community organizations, insurers, advocacy groups, State and Federal governments…each of us must be willing to take on new positions…to play new roles. We must build new partnerships across mental health and among all of the agencies and organizations that touch the consumers and families we are charged to serve. We must be guided by a clear strategy.
Each of us must embrace and practice recovery values…and share in the vision of hope if we are to realize our goal: the transformed mental health care system envisioned in Achieving the Promise: Transforming Mental Health Care in America, the final Report of the President’s New Freedom Commission on Mental Health.
Slide 2/Transformation Goals
Achieving the Promise outlined six goals describing an idealized end state…a recovery focused, consumer- and family-centered, mental health care system…a system full of possibility. Let’s take a closer look at those goals.
- Americans understand that mental health is essential to overall health.
- Mental health care is consumer and family driven.
- Disparities in mental health care 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.
The commission 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.”
Now this is certainly a tall order! To achieve our goals and realize the fundamental transformation of our mental health system, it will require nothing less than a concerted and well-orchestrated team effort.
I am here today to ensure that you know how indispensable each of you is to this work. We simply cannot create the transformed system we envision without you. Each of you is critical to this mission. As community providers, you are the ultimate locus of accountability for the care that is available in your communities. You can create a recovery-oriented system that will transform lives. 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 being willing to change…without community providers taking a leadership role in designing and implementing the changes we know are necessary.
I commend each of you for being here today…for recognizing and embracing the need to transform the way you value consumers and the way you utilize consumers’ strengths to promote recovery and hopefulness. I deeply appreciate the fact that you are stepping forward to attend this kind of training…during this season of transformation.
Your very presence here today shows your readiness for the change that is required to move us to a new level of care—one that is consumer- and family driven…accountable to those you serve…and focused on the goal of recovery. We will need everyone to be willing to adapt…to play new positions—if necessary—to move toward our goal…to achieve transformation
By being here today, you are literally forging a path…a pathway toward a more consumer- and family-focused vision of mental health care here in Vermont. As you take what you learn here back to your communities…and this vision spreads, provider by provider, community by community, State by State…and the promise of recovery is embraced and espoused and articulated over and over again…we will realize the fundamentally transformed system that we all seek.
As we move forward, it is imperative that we all understand the meaning of our shared goal—a transformed national mental health care system where recovery will be the expectation…not the exception. In fact, I believe one of my most important roles is to make sure that everyone with a stake in system transformation has exposure to what transformation means.
Slide 3/Transformation is…
Transformation is an extremely powerful concept. 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. 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. And once the process of transformation begins, a profoundly different system materializes…a system changed in structure, culture, policy, and programs.
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.
Slide 4/Recovery Consensus Statement
Last December, SAMHSA and the Interagency Committee on Disability Research held a conference to work out a consensus definition of mental health recovery. A National group of over 110 expert panelists—including consumers, family members, providers, advocates, local public officials, and eight Federal agencies—were invited to participate. The result of their efforts is a National Consensus Statement on Mental Health Recovery that is scheduled to be released later this year. This Statement will be a key tool in formulating policy, developing programs, and in achieving the promise of recovery as the common expected outcome.
Certainly recovery is not a new concept. Recovery has had several lives, but we are at a different level now. We’ve talked about it on the community level…and on the State level. But here’s what is unique about right now: recognizing that consumers need a voice and choice in mental health care, we are, for the first time, working to reorient the Nation’s entire mental health system toward recovery. This is a first!
The recovery vision rests on the fundamental belief that people with mental illnesses can and should take charge of their own lives! Recovery occurs from within and is directed from the personal power of the individual.
This vision puts consumers at the center of a transformed system of care. It is a vision that moves the role of consumers and families far beyond simply participating in the system. In a transformed system, consumers will direct their own futures. It is a powerful idea. And, a critical one. Because I believe the greatest source of transformation will come from the potential of the individual…of the self.
An esteemed colleague, Larry Fricks, the Director of Georgia’s State Office of Consumer Relations, has said so eloquently: “Our greatest potential for improvement does not lie in mental health systems, it lies within the individual who has faith that she or he can recover, does recover, and then shares that good news with others.”
I wholeheartedly agree. When we change the focus from system-directed to self-directed care, we begin to look at what is required to help persons with mental illnesses build meaningful lives with real opportunities to develop and reach their uniquely individual life goals. Our roles change. We become honorable traveling companions, facilitating consumers’ personal journeys to recovery with all of the resources at our disposal.
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 to participate in decision-making about their care delivery systems.
Transforming the focus of behavioral health care to self-directed recovery is essential to the system transformation called for in Achieving the Promise. It is a primary value within the entire Department of Health and Human Services…and a top priority for us at SAMHSA/CMHS and across the Federal government.
In the nearly two years since Achieving the Promise was released, SAMHSA/CMHS and its Federal partners have made an unprecedented commitment to model the kind of transformative activities that will be necessary to move from a vision of a consumer- and family-driven mental health care system to its reality. I’m proud to say: we are on the threshold of achieving the promise of transforming mental health care in America.
Slide 5/The Federal Partners
NineFederal Departments and the Social Security Administration, with SAMHSA at the lead, have joined in an unprecedented effort to change the status quo.
Just a few months 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.
Slide 6/The Action Agenda
The Action Agenda was built on the five principles that guided the work and vision of the New Freedom Commission, cross walked with the goals of Achieving the Promise. The Agenda represents a broad Federal commitment to achieving the transformation vision.
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) and I urge you to take them, read them, and share them with your colleagues. This Action Agenda is transformation in action!
With the Action Agenda as our roadmap, SAMHSA and the Federal Partners are moving forward to create the consumer- and family-focused system we all seek.
With that goal in mind—
Slide 7/Transformation SIGs
We are making a strategic investment in transformation! Last month, we awarded the first Mental Health Transformation State Incentive Grants to seven States ─ Connecticut, Ohio, Oklahoma, Washington, Maryland, New Mexico and Texas. With this $92.5 million investment, over the next five years, these States will begin to make the systemic changes needed to meet multiple consumer needs and foster recovery. We are asking these States to do something truly revolutionary—to unite all of their State agencies involved with adults and children behind a common vision of mental health care as it should be! These States have an unprecedented opportunity to be leaders in collaborative transformation . What they learn can help speed the pace and extent of transformation by others.
As part of the Transformation SIG program, we are piloting a new initiative we call our “Transformation Action Initiative” or TAI. Through the TAI, technical assistance brokers will tailor a technical assistance plan in response to a given State’s specific priorities for transformation.
Slide 8/SAMHSA Transformation Activities
- We are also 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.nationalregistery.samhsa.gov.
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.
Slide 9/SAMHSA Consumer-Directed Activities
In 2004, SAMHSA/CMHS committed to explore consumer-driven and consumer operated approaches to achieving recovery and community integration. Today, we are doing it! We are applying the principles of self-directed care in our programs.
SAMHSA has sponsored the first Consumer Direction Initiative Summit. 79 consumers and family members, policymakers, providers, and State and Federal representatives came together to examine the issues and develop recommendations for SAMHSA’s next steps toward a more consumer directed approach in behavioral health care. Workgroups at the Summit identified specific needs and potential barriers to self-directed care and developed their visions for a self-directed care system. You can read more about the work that has been accomplished in the report, Free to Choose, available on our Web site at www.samhsa.gov.
We have sponsored a series of Web casts on self-directed recovery. The latest one will be online very soon. You can view these Web casts by going to www.connectlive.com.
Through our Comprehensive Community Mental Health Services Program for Children and Their Families program, we are involving families of children—and children, themselves, when feasible—in making decisions about services.
SAMHSA has funded seven Consumer/Peer Operated Services Programs and a coordinating center in order to evaluate whether these kinds of services are effective at improving outcomes and quality of life for people with mental illnesses. Findings confirm: Adding consumer-operated services to traditional mental health services increases well-being, may reduce the use of health services, and contributes to recovery. In particular, we have seen that drop-in center programs show significant impact.
In 2002, SAMHSA funded aSurvey of Organized Consumer Self-Help Entitiesto provide the first national estimates of the number, use, and characteristics of consumer-operated services, mutual support groups, and self-help organizations run by and for mental health consumers and/or families. The findings confirm that consumer-operated services are a critical component of the recovery equation.
In a one-day "snapshot", the survey found that over 41,000 Americans attended a mental health mutual support group…over 1,000,000 belonged to a mental health self-help organization.
The survey also found that:
- over 534,000 people were served in mental health consumer-operated services in one year;
- there are more self-help organizations (7467 nationwide) than all other forms of traditional mental health services (4546);
- self-help organizations support key elements of recovery as well as support the goals of the President's New Freedom Commission on Mental Health including that more than 80% of self-help organizations and consumer-operated services engaged in public and community education;
- more than 75% engaged in rights protection;
- over 1/2 provided help with housing, over a 1/3 assisted with employment, and approximately 70% assisted with social supports.
Every one of these activities, as Nancy Fudge from Florida SDC, a SAMHSA-supported self-directed care program, has said, “...is a seed that will grow into a healthy, empowered self-directed life.”
SAMHSA continues to examine the critical role of peers in the workforce. P eer support programs go hand in hand with self-directed recovery. The peer-to-peer model is an exceptional example of the innovative ways in which we can help the system overcome its own barriers. Peer-support programs are not just empowerment programs. They are an expression…and an example…of the way the system is going to have to fundamentally change to foster healing relationships, and create an environment conducive for recovery.
We are distributing a Federal resource kit on peer-supported recovery throughout the country . The kit will be sent out to Commissioners and advocacy groups in each State. With the kit, every State will be equipped to adopt the Medicaid-billable peer training service and certification process developed in Georgia…a process that will help to build an emerging workforce of people in recovery from mental illnesses… people who are strengthening their own recovery by helping others with their recovery.
With this training, consumers learn to identify strengths and to help peers use these strengths to manage their own recovery. What an incredibly powerful concept! An entire workforce of peers driving change…opening up a whole new way of operating.This kind of initiative is literally changing the face and character of the delivery of mental health care in this country!
Change is happening across America. We are on a mission, to forge collaborations with the States to fuel transformation across this country. It is here, in Vermont…and in States and Territories across this country…where transformation is really taking shape. Achieving the Promise gave enormous responsibility for transformation to the States. States are the proving ground in which transformation is being tested.
Slide 10/Progress Toward Transformation
Many States are already in position for the 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.
For example, Georgia has launched an historic partnership between its Department of Human Resources and the Medical College of Georgia that 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 will mental illnesses. Ohio’s behavioral health leaders have created the Adult Recovery Network, which provides a framework for local and Statewide leadership on recovery practices. Through this effort, the State is fostering shared leadership and building capacity for change at every level.
Florida has formulated a State Action Plan promoting a system of care aimed at recovery and resilience. The New Mexico Interagency Behavioral Health Purchasing Collaborative will replace that State’s fragmented system with a single behavioral health delivery system, thus minimizing confusion for providers, consumers and families. 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. The Nevada Legislature has passed a law creating the Nevada Mental Health Plan Implementation Commission, a group charged with formulating strategies to move the State toward the goals defined in Achieving the Promise.
The progress that has been realized here in Vermont with the support of the provider community and advocacy groups such as NAMI-Vermont is exemplary.
In many ways, Vermont is a national model of revolutionary and transformative activities. Your comprehensive parity legislations stands out as a perfect model of what transformation is all about. This legislation mandates equal treatment for the mind and body. It 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 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 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.
NAMI Vermont is certainly playing an important position in transformation. By holding provider in-service trainings, like this one, it is leading the way to change for those of you on the front lines…bringing you the latest information on transformative issues like the ones you will be covering in today’s workshops—mental health and law enforcement training, evidence based practices and social security disability insurance. This is information you will need to make the real and meaningful changes necessary to support transformation.
I want to congratulate NAMI Vermont for its pioneering efforts in developing the model for the National NAMI Provider Education Program. Because of this innovative consumer-focused training program, thousands of providers across the country nowhave the opportunity to understand the reality of consumers’ true experiences…from their unique and profoundly personal perspective. When providers hear, first-hand, from the chorus of individuals who speak for themselves, they will design treatment plans that better appreciate and understand consumers’ needs, their desires, their hopes and dreams.
As it is here in Vermont, momentum toward transformation is building steadily across America. I am seeing a readiness and a willingness to change across the nation. People in every sector are ready to take this on! Other mental health consumer organizations in the private sector are positioning themselves closer toward the goals 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.
A few months ago, 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.
Stakeholders in government agencies and private organizations from coast to coast are working together to transform our mental health delivery system. And 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 our ability to meet them… demands which are growing still.
Slide 11/Katrina
That point was driven home to all of us when Hurricane Katrina struck America’s gulf coast two months ago 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.
It will take unwavering effort… from all of us…to restore hope to these courageous Americans.
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.
{pause}
Without hope, recovery can seem like an elusive goal, a quest that demands too much of a person. Hope plays a very integral part in the work we do. Too often, the people we serve are short on hope. Yet, hope can be as important as any medication. A powerful yet delicate concept, hope helps people prevail.
Hope gives a person the strength to fight for recovery. Hope helps a person overcome hurdles that he or she could not scale otherwise, and it moves a person forward to a place where healing and recovery can begin. Science confirms that hope plays a fundamental role in a person’s recovery.
Slide 12/Quote
The Rev. William Sloan Coffin, Jr. once said, “Hope arouses, as nothing else can arouse, a passion for the possible.”
Each of us has a responsibility to use our power and passion to deliver the message of hope and recovery across this Nation. Each of us must apply our particular and rare gifts to realize the possibilities of this moment.
NAMI Vermont and the provider community have made a good start on focusing Vermont’s strategy for change. How can you move forward from here to make the changes needed to realize the full possibility of this historic moment? I urge each of you to change your expectations of what is possible…and then, act on these expectations.
Slide 13/What You Can Do
Consumers and families—I urge you to know that there are systems out there that should be serving you and supporting you in ways that you think are effective. Demand that you have an individualized plan of care! Expect that your providers are working for you! Take a very active role in your own care. It’s completely appropriate. Sometimes you even have to fight for it! Join a consumer advocacy group or your mental health association or NAMI. Become engaged as your own advocate. Just as is true with all of healthcare, become knowledgeable and become your own advocate!
Providers, case managers, advocates, and others who accompany consumers on the road to recovery—I urge you to 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. 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.
I urge everyone in this room: keep pushing for consumer- and family-directed recovery in this great State. Be a shining example of the power of the pioneering spirit for the rest of us. Continue to be fearless…to be bold…to blaze new trails. Every Vermonter will be elevated…and empowered…by your efforts because they will more completely understand an essential component of their life—that is, their mental health. And they will more completely understand the kind of efforts that the State is taking to ensure that people with mental illnesses receive the care they need and deserve.
Remain determined to succeed in this journey to transform your mental health system. Be persistent. Be tenacious. Never give up. The difficult, risk-taking work of transformation is unending. It is an ongoing process of breaking the old molds, shifting our thinking, and discarding the traditional ways of doing things.
Coach Herb Brooks relied on this philosophy to take a team that entered the Olympics without much fanfare or favor all the way to the Gold Medal stand. He broke the old mold: he didn’t take an all-star team to the Olympics in 1980. Coach Brooks believed these “Dream Teams” often failed because they focused on the most talented individuals instead of the right players for the team. Instead, he selected players who were unafraid…players who would give their best…players whose talent could be harnessed into the most effective team. When asked what his best moment was at Lake Placid , Coach Brooks said it was “the sight of 20 young men of such differing backgrounds now standing as one.”
Slide 14/Closing
Like Team USA, we, too, must stand as one to achieve our goal…the goal of transformation. We must embrace our new roles. We must bring together the right players to realize the best possible team results. We must take risks. We cannot be afraid to change!
Team USA’s performance against the Soviets prompted broadcaster Al Michaels to utter the now-famous line, “Do you believe in miracles? Yes!” he proclaimed. I have equal confidence in our ability to succeed. Through transformation, we will triumph over the status quo. We will achieve the promise of a life in the community for everyone…here in Vermont…and across America.
Thank you.
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