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

3rd Annual Mental Health Transformation State Incentive Grant Meeting

November 14, 2007
Bethesda, MD

Thank you, Fran [Randolph], for your kind introduction and for the invitation to be with you today. Those of you who know me well know how passionate I am about mental health transformation. I believe deeply in the job we have been called on to do and in our ability—and indeed, our responsibility—to make a difference in the lives of the people we serve.

Red Sox Nation

What you might not know about me is that, as a resident of Rhode Island and an ardent baseball fan, I’m a proud member of the “Red Sox Nation,” the unofficial fan club of the Boston Red Sox.

Here’s what I can tell you about members of the Red Sox Nation:

1. We are fervent, committed, and unwavering in our dedication to our team, win or lose (though we just may get used to winning).
2. We are not content to rest on our laurels. We broke Babe Ruth’s curse in 2004 but came back stronger than ever just 3 years later.
3. We take ourselves seriously—this year, we even elected a Red Sox Nation president following a debate among candidates moderated by NBC’s Tim Russert—but we always remember to have fun.

Transformation Nation

You needn’t be a Red Sox fan to share these attributes. Each and every one of you in this room is equally devoted, dedicated, and steadfast in your support of mental health transformation. In fact, you are the leading edge of what I’ve come to think of as the “Transformation Nation.”

I know we share a collective vision of what it means to be a Transformation Nation. In a Transformation Nation:

• The mental health system is grounded in a belief that recovery is possible and is the expected outcome of treatment.
• The full range of comprehensive services and supports an individual needs to recover are accessible, flexible, individualized, and coordinated. Services are respectful of racial, cultural, and gender differences and are provided for as long as the individual wants them.
• Consumers plan, deliver, and evaluate services, conduct research, and provide training.
• Services provided by mental health consumers are deemed acceptable adjuncts or alternatives to “more traditionally” run services.
• Creative contracting and financing mechanisms support evidence-based practices and recovery-based services.
• Individuals with mental illnesses who are able to do so live independently in regular housing of their choice.
• Employment is viewed as an essential outcome of mental health recovery and is incorporated into treatment and housing.
• Finally, in a Transformation Nation, mental health consumers are accepted as valuable members of their families, schools, jobs, and communities.

As you can see, transformation is a deep, profound, and ongoing process along a continuum of innovation. It is a way of creating something possible from the perceived impossible. It implies profound change—not at the margins of the system, but at its very core. In our Transformation Nation, new sources of power emerge and new competencies develop. Opportunities and challenges are looked at with a new perspective.

The bottom line is that because of the hard work you are doing as innovators in the Mental Health Transformation State Incentive Grant program, people with mental and substance use conditions of all ages have the opportunity to live, work, learn, and participate fully in their communities. This is what I like to call transformation in action!

Innovation Nation

I know we are making great strides [insert some specific State accomplishments here]. But, like Red Sox fans, we are not content to be judged by what we have accomplished thus far.

Today, I want to encourage us to take the next step to become an “Innovation Nation.” The term was coined by John Kao [Kay-oh], a leading expert on innovation, who has been a psychiatrist, Harvard Business School educator, and a Tony-nominated executive producer of theater and film.

In his book, Innovation Nation, Kao tells us, “In tomorrow’s world, even more than today’s, innovation will be the engine of progress.” He believes that, as a country, we have lost the competitive edge that allowed us to marshal all of our resources in response to the Soviet’s 1957 launch of Sputnik to send a man to the moon only 12 short years later.

An Innovation Nation, Kao says, is “a country that is committed to constantly reinventing the nature of its innovation capabilities to improve the lot of humanity.”

I have to wonder if Kao is a Red Sox fan himself when he notes, “Americans love the national narrative of a good come-from-behind story… And we certainly enjoy the idea of being number one. But, unfortunately,” he cautions, “we’re also very good at drifting along in our current direction—sideways.”

In behavioral health, what are the hurdles we have to overcome if we’re going to stop our sideways drift? They include bureaucratic silos, parochial interests, standard operating procedures, lack of imagination, and mind-set differences.

We must get beyond these difficulties if we are going to improve the human condition for individuals with mental and addictive disorders. Kao’s book gives us a template.

1. First, we must “move beyond old, established ways of thinking. We [have] to be able to entertain ‘impossible’ possibilities.”
   
   “Impossible possibilities” sounds like an oxymoron, but I have a good way to explain what it means. Later this morning, you are going to be watching a film by two of my favorite thinkers, Rosamund Stone Zander and Benjamin Zander, authors of the national bestselling book, The Art of Possibility: Transforming Professional and Personal Life.
   
   As you watch the film, and as you consider what it means to entertain the impossible, think about this story the Zanders share in their book:
   
   A shoe factory sends two marketing scouts to a region of Africa to study the prospects for expanding business. One sends back a telegram saying,
   
   SITUATION HOPELESS_ STOP_ NO ONE WEARS SHOES
   
   The other writes back triumphantly,
   
   GLORIOUS BUSINESS OPPORTUNITY_ STOP_ THEY HAVE NO SHOES
   
   Leaders in an Innovation Nation articulate possibilities. Instead of predicting failure, they sense opportunity. When others ask “why,” they ask “why not?”
   
   
2. Second, we must make, as Harvard Business School Professor Clayton Christensen does in his book, The Innovator’s Dilemma, “a vital distinction between innovation that simply improves what is and innovation that defines what could be.”
   
   Cleary, there’s nothing wrong with incremental innovation, as Kao points out. In fact, he notes, “it’s essential for ordinary progress: Semiconductors get faster every year; medications become more effective; cars become more stylish and, [it] is hoped, more fuel efficient; [and] government makes itself more efficient (or not).”
   
   However, what Kao calls, game-changing innovation, requires one to assume “a far higher level of risk. You really don’t know how things are going to turn out, so all those linear, predictive models just don’t apply.”
   
   Earlier, I spoke about baseball, but this brings to mind a football game. How often is it that a team can run the ball straight into the end zone? Players zig and zag, trying to avoid the hurdles that are designed to throw them off course.
   
   You are the quarterbacks of mental health transformation in your States, and while the goal posts are in sight, it’s clear you may take a few hits along the way. Budgets are tight. Multiple stakeholders need to be heard. Data have to be collected and reported.
   
   But the game-changing innovations you make are about so much more than compiling the highest score. They are about impacting individuals’ lives. Every time you take a risk—every time you forge ahead not knowing whether the path will be clear—you are making a positive difference in the lives of the people you serve. This is transformation in action!
   
   
3. Third, to become a true Innovation Nation, we have to construct scenarios of our preferred future. In French, the word “scenario” literally means “screenplay.” The construction of scenarios is a technique pioneered at Royal Dutch Shell by noted futurist Peter Wack. During the 1970s, the technique proved its value by allowing the firm to anticipate soaring oil prices and constricted supply and to have in place a strategy for seizing advantage.
   
   In his work with corporate and government clients, John Kao uses scenarios to drive leadership teams to a more holistic—and often emotional—understanding of plausible futures. Scenarios are a way of recognizing the signs of change and being prepared for them.
   
   I laid out a scenario of a transformed system of care earlier in my remarks. But let’s take it a step further. As mental health innovators, we often talk about, and promote, the right of individuals with mental and addictive disorders to live in the community. Certainly, this is part of what drove the U.S. Supreme Court’s landmark 1999 decision in Olmstead versus L.C.
   
   It might be enough, for a Transformation Nation, to aim for supporting the rights of adults and children with mental and emotional disorders to live in the community.
   
   But to be a true Innovation Nation, people with disabilities of all types must be of the community.
   
   Listen to how Norma Ware and her colleagues, writing in a recent issue of the journal Psychiatric Services, describe the difference:
   
   Despite decades of deinstitutionalization and the best efforts of community mental health services, individuals with psychiatric disabilities living outside the hospital may be described as in the community, but not of it [emphasis added]. They may live in neighborhoods alongside people without disabilities. Their residences may resemble those of their neighbors. Yet many people who are psychiatrically disabled lack socially valued activity, adequate income, personal relationships, recognition and respect from others, and a political voice. They remain, in a very real sense, socially excluded.”
   
   Being of the community, then, means having socially valued activity, adequate income, personal relationships, recognition and respect from others, and a political voice. It also means having the opportunity to be valued for one’s uniqueness and abilities, just like everyone else.
   
   Is this scenario pie in the sky? Absolutely not. This is what it means to recognize the signs of change and prepare for them. Individuals with mental illnesses have the right, the ability, and the responsibility to be fully functioning members of their communities. They deserve nothing less.
   
   Will responding to this scenario be easy? No. Fundamental change that transforms the way people think and behave is never easy. But it can be done. More than that, it must be done.

Again, John Kao shows us the way. The keys to driving this level of innovation, he believes, are “transparency, diversity, and the ability to connect to other people in ever more powerful ways.”

Let me repeat that. We need to strive for transparency, diversity, and connecting to people in ever more powerful ways.

Here’s how Kao describes the role that each of these attributes play:

“Openness and transparency inspire contributions from the many. Diversity ensures that a variety of frames of reference will be included. When an e-business or an army battalion or a corporation commits to openness, transparency, and diversity, it is tapping into the power of those numbers. It is saying…We want all of the connections and interactions, all of the friction and anomalies, all of the data and ideas we can get from our members or troops or employees, because we know that out of that stew will emerge the creativity and innovation vital to our progress.”

These are incredibly important and powerful ideas. We need to “inspire contributions from the many.” Our consumers and family members will lead the way.

We need to hear diverse voices, including those that may not always say what we want to hear. These are, in fact, the voices that we need to hear.

And we need to “connect to other people in ever more powerful ways.” Transformation and innovation aren’t done by a single individual or organization, and they don’t happen in a vacuum. This is a collective effort.

If you’ll permit me to again point to my beloved Red Sox, I was intrigued to read, in the New York Times, that their sweep of this year’s World Series was the first in 80 years to feature victories by four different starting pitchers. The last team to do this was the 1927 Yankees.

This was a true team effort. Likewise, transformation and innovation are group efforts. Each and every stakeholder in your transformation activities has an important role to play.

Leadership

But teams don’t take to the field without a strong leader. All of you in this room are transformational leaders. You are, in Kao’s words, the “heavyweight champion,” someone who “makes a bridge between stakeholders who may be unaccustomed to collaborating, motivates the right kind of action at the right time, insulates talent from the adverse effects of noble failure, and maintains the momentum of a complex initiative.”

Such heavyweight champions, Kao points out, “inspire individuals and teams to believe that great feats can be accomplished and that the rigors and uncertainties of the journey will be worth it.”

It will be worth it, when the individual who has lived on the streets for many years turns the key in his own apartment.

It will be worth it, when the person who was told she would never recover reports for her first day of work.

And it will be worth it, when a family torn asunder by outdated financing and outmoded treatment sits down together for dinner.

Wrap-up and Conclusion

CMHS and SAMHSA stand ready to help. Our role is to act as a catalyst at the Federal level for the transformative changes you are making at the State and local level. We can serve as a steward, not by dictating every aspect of the agenda, but rather by convening and facilitating the process.

We’ve convened you here for the next several days so you can collectively share the best of what you have learned with one another. We are a Transformation Nation. Working individually in your States, and together as a group, you are leading this country’s efforts toward a more humane, effective, and enlightened mental health system.

Now you are poised to be an Innovation Nation, moving beyond smaller-scale improvements to the type of broad and systemic change that alters the landscape as we know it, not forever, but for today.

Indeed, the paradox of this type of change is that what you create today isn’t the end all and be all of transformation. If that were the case, we would be right back where we started, perpetuating the status quo—albeit a new and improved status quo.

True innovation— “disruptive, game-changing innovation” —demands continuous adaptation to evolving circumstances. It was John F. Kennedy who said, “The New Frontier is not a set of promises. It is a set of challenges.” We must rise to the challenge, not once and for all, but each and every day.

I would encourage you all to read Innovation Nation. Let me leave you with this wonderful image from the book. The author’s premise is that we need a national innovation agenda, and he describes such an effort as “a free-flowing, unencumbered dance among the private and public sectors, among academics and [non-governmental organizations], entrepreneurs, and individual citizens. It is neither the bureaucratic top-down of a government agency, nor the invisible hand of the private sector. What we need is a blend of the two that finds the sweet spot between the invisible hand and the controlling hand—in short, the helping hand.”

The helping hand. I couldn’t have said it better myself.

Thank you. If we have time, I’d be happy to take your questions.