Director's Report to the National Advisory Council
April 1996
To behave like free spirits in the presence of fate is strength
undefeatable.
--Helen Keller
Introduction:
CMHS Offers Help in the First Anniversary
of the Oklahoma City Bombing
Next Friday marks the first anniversary of the Oklahoma City bombing.
The bombing profoundly touched the lives of the staff here at the Center
for Mental Health Services CMHS--not only as Americans, who suddenly and
tragically witnessed the Nation's vulnerability, and not only as Federal
employees, who felt under fire and threatened--but as mental health
professionals called to duty in emergency and disaster relief efforts.
The approaching anniversary serves as a vivid reminder to all of us that
our work at CMHS is critically important to improving the lives of
ordinary people who must face the challenges of day-to-day life in the
midst of extraordinary circumstances.
The role played by the Center for Mental Health Services in the
immediate aftermath of the Oklahoma bombing is a good example of how
CMHS programs directly affect people's lives. During the chaotic hours
and days following the disaster, CMHS advised Oklahoma City and State
officials on how to manage the influx of help. We assisted local
officials in planning for the kinds of mental health services people
would need down the road, after media and public attention had waned and
the citizens of Oklahoma were left to cope with enormous psychological
trauma.
At that point in our planning, we were on familiar ground. From our
work on disaster relief efforts nationwide, we knew how to guide State
grantwriting efforts for emergency relief funds from the Federal
Emergency Management Agency. We knew how to organize training programs
for local mental health providers, most of whom are not experienced in
counseling disaster victims. We knew how to help States and cities plan
for long-term followup and assistance.
Despite our experience, much of our work in the Oklahoma disaster was
new to us, especially in terms of the crisis counseling needs associated
with a man-made disaster. As we work with our partners in Oklahoma and
with various groups, including the Department of Justice, we continue to
learn more about the mental health ramifications of coping with a man-made
disaster. What we learn will have implications for the field long
after our work in Oklahoma City has been completed.
With the approach of the first anniversary of the bombing, CMHS staff
have worked closely with officials from the Department of Justice, the
American Red Cross, and Oklahoma City and State governments to address
citizens' mental health needs, especially the role of crisis counseling
during anniversary dates.
Brian Flynn, Ed.D., Chief of the Emergency Services and Disaster Relief
Branch, participated in a media roundtable in Oklahoma City. His goal
was to sensitize print and electronic journalists to the psychological
issues surrounding not only the anniversary, but also the change in the
location of the trial and the trauma the trial is likely to cause to
survivors and victims in Oklahoma City.
CMHS: Shared Purposes and Goals
The Center's ongoing response to the Oklahoma City disaster exemplifies
how CMHS programs benefit real people. No matter what public mental
health need arises, CMHS staff respond. Often, it is the Center's
responsibility to anticipate problems, with the hope that doing so will
eliminate or lessen their effect. Such is the case in the Center's work
on behalf of people with severe mental illnesses; in services research
for people who are homeless; for children and families; and for women,
minorities, and other underserved groups.
Our responses are guided by three central objectives:
- At a systems level, to promote coordinated and comprehensive
strategies and services across all levels of government and with
private sector organizations;
- At a research level, to understand what programs work best
for what groups under what conditions; and
- At a personal level, to ensure that people get the help and
information they need when they need and for as long as they need
it.
CMHS Promotes Systems Change
The last Council meeting briefly focused on the work of a new project--the
GAINS Center--a collaborative effort among CMHS, the Center for
Substance Abuse Treatment, and the National Institute of Corrections.
GAINS stands for Gather, Assess, Interpret, Network, and Stimulate. The
Center's goals are to gather information, assess what works,
interpret facts, network with key stakeholders, and
stimulate change. Basically, GAINS emphasizes the importance of
serving individuals who have co-occurring disorders no matter where they are
in the justice system--jails, prisons, probation, or parole. GAINS is
charged with disseminating information about effective mental health and
substance abuse services for people with co-occurring disorders who are in the
justice system.
In June, GAINS will sponsor two regional forums--one in San Francisco and
another in Orlando--to highlight planning mental health and substance
abuse services in jails. Teams of jail administrators, sheriffs, county
mental health and substance abuse officials, consumers, and family
members will discuss and learn about ways to develop new programs or
revamp existing services for detainees.
During the first year of the GAINS project, the Center is examining the
special needs of women. In February, the Advisory Workgroup on Women's
Issues met for the first time. In May, GAINS is sponsoring a workshop
on developing a universal screening tool for women in the criminal
justice system, and, in July, the Center will host a meeting of service
providers and program representatives to discuss women's issues.
CMHS Promotes Services Research
CMHS is proud of the work being done by ACCESS, a demonstration project
focused on meeting the needs of people who are homeless and who have
severe mental illnesses. Last month, CMHS presented preliminary
findings from the ACCESS program to the Interagency Council on
Homelessness. Secretary of Housing and Urban Development Henry Cisneros
serves as Chairman of the council; Health and Human Services Secretary
Shalala serves as one of the vice chairs; Mrs. Tipper Gore is the
Honorary Chairwoman.
The findings are quite interesting. ACCESS is a 5-year demonstration
project that is being conducted in 18 matched communities in 9 States.
The project includes a rigorous evaluation component. Findings from
ACCESS will have implications for communities nationwide, especially in
terms of organizing service systems for vulnerable populations.
One of the most surprising--and encouraging--things learned is that the
time between first contact by outreach workers and actual enrollment in
case management is shorter than originally thought. The average length
of time is 31 days. Many people believe that people who are homeless
are not interested in, or willing to enroll in, services programs. What
ACCESS has found is that given the right services and support, people
are more than willing to participate.
Early work on the project indicates that:
- Communities need to identify for themselves their service
priorities and how to coordinate them. The most effective ACCESS
sites are those that have made the earliest and most aggressive
use of interagency coalitions.
- Interagency management information systems are a critical tool for
promoting systems integration.
- Technical assistance helps projects make mid-course corrections.
- The use of a formal evaluation design allows organizations to
document the changes that take place in local systems and the
effect of those changes on client outcomes.
CMHS is pleased to have this preliminary information and is very excited
about the prospect of the final evaluation, which will help to improve
services today and in the future.
CMHS Promotes Personal Empowerment
CMHS generates, collects, analyzes, synthesizes, prepares, publishes,
and presents an enormous amount of information, all of which is
important to some individual or organization, and any of which can be a
key factor in improving or changing a person's life. Thus, one of the
Center's key objectives is to get information to people who can most use
and benefit from it. Giving people information that they can use to
learn more about mental health and mental illness, to make informed
choices, or to work for changes in public policy is an important and
challenging task. In the past several months, two of the Center's major
programs--SAMHSA's National Mental Health Information Center, and the "Caring for Every
Child's Mental Health" Initiative--have made major progress in meeting
the Center's information dissemination goals.
Since the Council last met, the Information Center has moved to a new facility which is
closer to CMHS. The Information Center has established a Web site on the Internet, which
links users to other sites with information about mental health. In
March, the Information Center introduced its services to CMHS staff.
CMHS staff are very excited by the prospect of using the Information Center not only to
distribute publications, but for an interactive and real-time connection
to constituents. In the coming months, the Center expects more and more
Branches to work with Information Center staff to get information out quickly and
effectively.
On March 5, CMHS launched "Caring for Every Child's Mental Health,"
a national, 4-year public awareness campaign to educate the public that
mental health problems in children are real, that they can be diagnosed
and treated, and that help is available. Mrs. Tipper Gore, Secretary
Shalala, Substance Abuse Mental Health Services Administrator, Dr.
Chavez, and the Sturtevant family from Vermont spoke to an audience that
included local schoolchildren, the media, representatives of partner
organizations, government officials, and SAMHSA staff. National media
coverage of the event, which was held at the Duke Ellington School for
the Arts in Washington, DC, reached millions of television viewers,
radio listeners, and newspaper readers. Press coverage has included
referrals to the Information Center toll-free number. The Information Center is the central dissemination
point for the campaign. Information Center staff refer callers to State and local resources
for more information about children's mental health.
Significant Challenges, Significant Accomplishments
Budget Information
CMHS is operating under its twelfth continuing resolution. CMHS may
receive a 1996 appropriation, but it is unclear to what degree programs
will be funded. A table outlining the President's 1997 budget proposal
for SAMHSA and CMHS is attached. There has been little change since the
Council last met. The White House and Congress have not yet reached an
agreement on the appropriations bill that includes the fiscal year 1996
budget for CMHS.
SAMHSA Reorganization
To respond to the ongoing budget crisis and the Administration's stated
goal of creating a government that is more efficient and responsive to
the needs of communities, Dr. Nelba Chavez has initiated a
reorganization of SAMHSA. Secretary Shalala has approved the
reorganization plan, and she supports its implementation. Funds saved
by streamlining and consolidating administrative functions will be
redirected to programs that directly serve the public interest. An
implementation team is refining and implementing the reorganization.
CMHS Deputy Director Tom Bornemann, Ph.D., and Ted Searle are assigned
to this team.
The reorganization will consolidate and "rightsize" administrative
functions across the three centers. A new Office of Program Services
will be established with responsibility for grants and contract
management; personnel services; information resources; financial
management and budget formulation; and administrative services,
including facilities management and management policy. This should lead
to a 25- to 30-percent reduction in total administrative staff. The
reorganization is also designed to strengthen CMHS' program development
and implementation capabilities. New organizational plans and structures
should respond to the changing Federal role and new program needs. CMHS
has submitted its reorganization plan to the Administrator.
Where We Are Going: The Future of CMHS
The challenging and changing political times have created a certain
uncertainty for the future of Federal agencies and their programs.
Despite this challenge, CMHS staff have continued to move toward the
agency's most central goal: to improve the lives of people with severe
mental illness by improving the systems that treat and support them,
their families, and their communities.
For several months, CMHS has been working on what is known as the
"Futures Report." In the process of developing that report, staff
have had to think hard and thoughtfully about CMHS' place in the American
mental health field, about where the field is going, and how the Center
can continue to provide Federal leadership to States and communities.
This reflection has been productive, and staff insights should guide the
Center's programs for several years.
In spite of these uncertain times, CMHS Division and Office Directors
remain committed to their work. Their enthusiasm speaks to the heart of
what we--as public servants, as mental health providers, as consumer
advocates, and as researchers--do each day.
Mike English, Esq., who directs the Office of Policy and Planning and
is Acting Director of Demonstration Programs, notes the importance of
emphasizing and celebrating the landmark achievements of the Community
Support Program and the Child, Adolescent, and Family Branch. These
programs and their accumulated knowledge are, he says, "fundamental to
good services." The challenge for the future, he says, is to
synthesize our knowledge of best practices and to get that information
quickly and effectively to the field, so that our most vulnerable
populations can receive the effective services they need.
Jim Pittman, Director of the Division of Program Development, Special
Populations and Projects, will continue to focus on getting to the field
what the Division knows about crisis counseling and about working with
vulnerable populations who have special needs. For example, the
Emergency Services Branch is increasingly called on by other nations to
provide information and guidance on how to help disaster and emergency
victims through crises. It is also leading the field in developing
stress management programs to help disaster workers cope with their own
stress and grief when dealing with emergencies. The Division is excited
about projects that look at ways to help ordinary people get through
unusual and unexpected problems--for example, addressing how to help
farmers and miners through layoffs and periods of economic downturns,
and how to help employers avoid workplace violence.
Finally, he notes, "The issues of prevention will not go away, and we
need to talk about the distinction between mental health and mental
illness, and how to promote the former and prevent and treat the
latter."
And Joyce Berry, who directs the Division of State and Community Systems
Development, says that the ongoing challenge to her staff is to address
its congressional mandate and to manage the largest amount of funding
CMHS makes to the States. "Our challenge is to work with the States and
communities as they develop systems of care, to help States in building
their capacities at the State and local level, to work in partnership
with them, and to keep consumer involvement as a priority."
Even when dealing with something as seemingly impersonal as statistics
or block grants, the Branch is really dealing with people and keeping
people first.
The Office of External Liaison continues to look for new, innovative
ways to get the word out about the great work being done at CMHS.
Charlotte Mehuron, who directs this Office, says, "CMHS is doing
incredible and exciting things, and it is a challenge for us to get
information into the hands of people who can use it. What we are
realizing is that bulk mailings are being replaced by e-mailings; that
newsletters are being replaced by Web pages; and that discussions occur
on electronic bulletin boards and on the World Wide Web. There is
tremendous interest among journalists in the work we are doing. We
don't simply want to know about the information superhighway--we want to
help construct the information highway. SAMHSA's National Mental Health Information Center
is making that goal a reality."
Regardless of the specific duty to which CMHS staff are assigned, we all
would agree with a statement Dr. Berry made: "We need to keep people
from being lost or left behind or unattended." Indeed, keeping people
first--not budgets, not politicking, not numbers--is the true mission of
the Center and a constant challenge to the field of mental health.
KEN96-0039
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