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
Furthering the Transformation Vision:
Second Meeting of the Mental Health Transformation State Incentive Grant Program
November 14, 2006
Arlington, VA
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Good morning. My pleasant responsibility this morning is to welcome you to this meeting and get it off to a rousing start. It’s not a difficult job because you all know very well why you came and the purpose of the gathering. We are here to determine how we can further the vision of mental health transformation.
Last year, the Substance Abuse and Mental Health Services Administration (SAMHSA) launched a radically different grant program, which we know as State Incentive Grants for Mental Health Transformation, or Transformation SIGs. Our standard grant program provides funds so that a State can improve a particular type of service or better meet the needs of a particular group at risk. Our new SIG program aids States in developing the infrastructure that will help them plan for and support needed services for all individuals at risk. We awarded 5-year grants to seven States. Just recently, we were able to award grants to two more States: Missouri and Hawaii.
Nine States now are involved in our flagship program for change. Nine States! Together, your States represent almost one fifth of our Nation. Even one State has incredible power to lead social change through precedent. Our national history is built around pioneering States that, through their actions, stated, “This is right and just and works for the benefit of all.” In 1869, Wyoming, although still a territory, granted women the right to vote and hold public office. In 1802, Ohio outlawed slavery. What we hope you can accomplish is no less significant…and will similarly benefit a group of citizens that often has suffered discrimination. We are looking to you to create model mental health systems that other States will emulate. Our ultimate goal is to ensure that all Americans with mental illnesses will have equal access to effective treatment and to a full life in their community.
Each State is taking a different approach to transformation, based on its resources and the needs and desires of its constituents. This diversity of Transformation SIG States is its own challenge to furthering the transformation vision. You are intended to be role models for other States—even though their circumstances may differ significantly from yours. So our challenge as transformation leaders is to identify what the commonalities in your successes while we also capitalize on your differences. Your unique visions of transformation and the steps you are taking to achieve it can be…and, in fact, must be…as diverse as the needs of individuals with mental illnesses.
The next two days are an opportunity to take stock of the progress we’ve made and to make plans to further the transformation vision. As you requested, our agenda features dialog rather than lectures. To facilitate discussion, we have invited experts from several areas to contribute their ideas and act as resources. Many thanks to Fran Randolph and Neal Brown—the “Connectors”— and to the State planning group for developing our agenda, and a most grateful welcome to our facilitators and presenters.
One objective for this meeting is to further the transformation vision by identifying opportunities to operationalize critical aspects of transformation. How can we better cross-train providers…or integrate outcome measures across agencies…or use technology to expand treatment access? How can we move what works from your State to States with similar populations and challenges?
Do not focus solely on your successful strategies. Look also to your not-so-successful attempts at transformation so that we, as a group, can learn from them. As the American entrepreneur Henry Ford observed, failure is an excellent opportunity for us to begin again—only more intelligently. We want you, as a peer-to-peer learning community, to ease the transformation process for each other by (1) identifying the shortest pathways to success and (2) sharing the detours and pitfalls to avoid. If there’s a short summary of the goals of this meeting, it is to help you engage, expand, and excel in transformation through collaboration.
This morning, I’m going to use a business technique to frame my remarks. Transformation of the mental health system implies a new way of doing business, so I believe that one of the ways in which we can further the transformation vision is to learn from business. This approach may be familiar to those of you who have been able to attend our policy academies.
Business organizations facing major change use a SWOT analysis to guide decision-making. SWOT is an acronym for Strengths, Weaknesses, Opportunities, and Threats. The organization considers its strengths and how it can take advantage of them and its weaknesses and how it can minimize them. It looks at opportunities and how to capitalize on them. Finally, the organization looks at the threats that may affect success and how it can effectively deal with them.
Your strengths as Transformation SIG States are many. At SAMHSA, we observed that all of the States that received grants possessed some common characteristics. These include an active and invested Governor, collaboration across agencies, leveraged grant funding, and consumers and families who are very active in and central to the process. The issue before you then is, how can you take advantage of these strengths?
Some of you are concerned that a change in your State’s governor or a shift in the dominant political party will slow your progress. Maryland, Massachusetts, and Ohio all have elected new governors. The need for better mental health care, however, is an issue that transcends partisan boundaries. While political parties may be divided on some issues, we all have the same stake in a humane, evidence-based, and effective mental health care system. SAMHSA has been working with the National Governors Association on ways to educate incoming governors about transformation as a critical issue. In addition, consider the primary intent of the Transformation SIG program. Our program is meant to enable your States to build the infrastructure that will embed transformation across your State systems.
The weaknesses of your mental health care system may primarily lie in service delivery. Needed services may be fragmented across providers or State agencies. Evidence-based practices may be under-used. There may be inequity of care for age, gender, or racial groups. As you consider ways to further the transformation vision in you State, ask yourselves how you can you minimize or, better yet, eliminate known weaknesses. One evident solution is collaboration. New partnerships can leverage human and economic resources to expand service options.
Let me take a moment to point out a weakness that is a function of government institutions. As leaders of transformation, we are striving to see that the right policies…the right practices…and the strongest infrastructure are put in place so that the best services are available across systems. However, we—as representatives of government—face a curious dichotomy in trying to achieve our objective.
Governments function in an environment that values stability and maintaining the status quo. This, in and of itself, can be good. There is strength in stability, and the public rightfully places its faith in institutions that hold fast to their mission. But what if the mission remains the same, but the right policy becomes radically different? We saw such a reversal in policies and practices when States began moving from mental institutions to community-based services.
Consider the concept of recovery. Many of our current policies and practices are based on an old—and erroneous—assumption. What is the assumption?—That individuals can not recover from serious mental illnesses. The evolving reality?—that individuals can and do recover…and that consumers also can be providers and leaders. By furthering the vision of transformation, we can ensure that mental health care reflects the new reality.
Opportunities to transform mental health care are limited only by our potential for innovation. Benjamin and Rosamund Zander are the authors of “The Art of Possibility,” a book about transforming our professional and personal lives. The Zanders’ premise is that “…many of the circumstances that block us in our daily lives may only appear to do so based on a framework of assumptions we carry with us. Draw a different frame around the same set of circumstances and new pathways come into view. Find the right framework and extraordinary accomplishment becomes an everyday experience.”
Today and tomorrow both, you will have an opportunity to attend roundtables about innovative practices in employment, housing, financing, and overall health. You will see how the right framework for examining an issue is leading to amazing new possibilities. Consider employment. Gainful employment is an important element of recovery and most individuals with mental illness want to work. As one recipient of mental health services observed, employment is the stigma-buster of all time. Our roundtable will discuss ways of thinking about employment programs that may go beyond the standard supported employment programs implemented by mental health agencies. We will discuss, for example, how you might incorporate existing resources and ways of viewing employment opportunities from the Department of Labor into your plans, as well as how consumer-operated service programs can contribute to helping consumers to reach their employment goals.
The current climate for change also presents opportunities. Within the past few years, we have had the Surgeon General's report on mental health, the Supreme Court’s Olmstead decision, the historic report by the President's New Freedom Commission on Mental Health, and two reports by the Institute of Medicine on how we can cross the quality chasm in health and behavioral health care. Last year, we received new Federal funding to create the Transformation SIG program. There are hopeful indicators that we may receive enough funding next year to award grants to more States. We’re seeing an unprecedented merging of science, research, consumerism, and political and social impetus for system transformation. It’s imperative that we respond with commitment, action, and accomplishment.
Within SAMHSA, we are continuing to pursue opportunities to model transformation. In the 3 years since Achieving the Promise was released, we have encouraged greater involvement of agencies governmentwide. Today, nine Federal Departments, the Equal Employment Opportunity Commission, and the Social Security Administration have joined the Federal Partners Workgroup for Transformation. Our workgroup is an unprecedented collaborative effort to change the status quo of mental health care. Members of our workgroup will be participating in this meeting. Many thanks to Susan Parker, Department of Labor; Steve Smith, Health Resources and Services Administration; Jane Pearson, National Institute of Mental Health; and Richard McKeon, Center for Mental Health Services, for joining us for the Town Meeting this afternoon. We also are fortunate to have Rhonda Basha, Department of Labor; Peggy Clark and Terry Pratt, Centers for Medicare and Medicaid Services; and Carolyn Aoyama, Indian Health Services, join us for roundtable discussions.
The Federal Partners Workgroup is responsible for carrying out the Federal Action Agenda, which we created as our roadmap toward transformation. We’ve recently updated our agenda to reflect the progress we’ve made so far. Our evolving agenda is tangible evidence of how we will intend to further the vision of transformation and continuously move it toward reality. With this document, Congress, the Nation, and the people we serve can hold us accountable for achieving the goals we have set.
This brings us to the final step in the SWOT analysis, which is to identify threats to change; that is, to look at what factors may undermine success and how we can create an infrastructure that effectively deals with them.
Funding is always brought up as a threat to success—there always seems to be a gap between available dollars and the demand for services. How can States deal with this gap? The answer, again, is collaboration. The most effective way is to finance transformation is to leverage available resources through partnerships. The Comprehensive State Mental Health Plans that you’ve developed should help to bring the public and private sectors together. Broad-based partnerships are needed to ensure that consumers are able to access the care they need through any door in any system.
There are, of course, other threats to transforming the mental health system, but I believe that behind every threat lies an opportunity. If the threat to transformation is a workforce shortage, the opportunities include peer-support services and using telehealth to make services available where none currently exist. If the threat is lack of culturally competent services for consumers, an opportunity is better workforce training. We also need to explore opportunities to cross-train and develop stronger partnerships with primary care physicians. These professionals often are the first, sometimes only, providers of mental health services to millions of American adults and children with mental health challenges.
If the threat is stigma or discrimination, the opportunity is to educate the public about mental health, mental illnesses, and the very real possibility of recovery. This month, SAMHSA will be launching a new public education campaign to reduce stigma among young adults. Chris Marshall will tell you more about this exciting initiative during the social marketing roundtable tomorrow afternoon. I can’t predict how soon we will achieve transformation, but I do know that public attitude can powerfully influence the speed of change and the opportunities available.
As Transformation SIG States, you already have performed the basic steps of a SWOT analysis. As of this date, all of the States have completed extensive and labor-intensive cross-system needs assessment and resource inventories. You’ve examined your strengths and weaknesses, and you’ve identified opportunities for improvement. The results of your assessments are informing your State’s Comprehensive Mental Health Plans, which most of you have submitted. Even if you have submitted your first historic plan, your work is not complete. Comprehensive mental health plans are meant to be living, evolving documents. You will be updating your plans annually and using the outcomes from each year to hone in more and more on transformation needs.
At this point, all of you are about to embark on an evaluation of mental health transformation strategies and successes that will inform system change across the country. I’d like to welcome Chuck Lupton of MANILA Consulting and Steve Leff of HRSI and other members of the evaluation team. Our evaluation will consider infrastructure indicators and cost efficiencies. We’ll also examine transformation process measures and the effectiveness of national outcome measures as measures of recovery. We have hired five independent consumer and family consultants to be part of our evaluation team. They will continue to provide critical input during every step of the process, from planning through evaluation.
We at SAMHSA are excited about the progress you’ve made during the first year of the grant program. We anticipate even more groundbreaking accomplishments during the year ahead. Lack of leadership is not a threat to transformation. The SIG States already have stepped forward into that role, and each of you here at this conference has made a concerted effort to take part. You are here because you and your State want a voice in transforming mental health care for the future.
Now is your time to speak up, to contribute your ideas—as well as your ideals—to furthering the transformation vision. As Martin Luther King, Jr., noted, “Human progress is neither automatic nor inevitable....Every step toward the goal requires...the tireless exertions and passionate concern of dedicated individuals.” I’m delighted to see that we have more than one hundred such individuals in this room. Welcome to all of you. I look forward to hearing your ideas during the discussions to follow. Thank you, and have an inspirational conference.
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