# Presentation: 261444

## President’s New Freedom Commission on Mental Health Achieving the Promise: Transforming Mental Health Care in the Department of Veterans Affairs August 17, 2004

- A. Kathryn Power, M.Ed., Director
- Center for Mental Health Services

## Mental Health System Transformation

- “...to conduct a comprehensive study of the United States mental health delivery system, including public and private sector providers, and to make recommendations to the President on methods for improving the system. The Commission’s goal shall be to recommend improvements to enable adults with serious mental illness and children with serious emotional disturbances to live, work, learn, and participate fully in their communities.”
- 			Executive Order 13263 of April 29, 2002

## Mental Health System Transformation

**15 appointed commissioners from the public and private sectors, including:**
** ****State governments**
** ****Judicial branch**
** ****Mental health providers and advocates**
**7 ex-officio***** *****Federal members****	**

## The Commission’s Conclusions

Recovery from mental illness should be the overriding goal of the mental health system

The time has passed for another piecemeal approach to mental health reform

The mental health care delivery system in America must be transformed

- Recovery from mental illness should be the overriding goal of the mental health system
- The time has passed for another piecemeal approach to mental health reform
- The mental health care delivery system in America must be *transformed*

- Mental Health System Transformation

## Mental Health System Transformation

- “We envision 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.”

## Goal 1 	Americans Understand that Mental Health Is Essential to Overall Health
Goal 2	Mental Health Care Is Consumer and Family Driven
Goal 3	Disparities in Mental Health Services Are Eliminated
Goal 4	Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice
Goal 5	Excellent Mental Health Care Is Delivered and Research Is Accelerated
Goal 6	Technology Is Used to Access Mental Health Care   and Information

**Goal 2****	**Mental Health Care Is Consumer and Family Driven
**Goal 3**	Disparities in Mental Health Services Are Eliminated
**Goal 4**	Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice
**Goal 5**	Excellent Mental Health Care Is Delivered and Research Is Accelerated
**Goal 6****	**Technology Is Used to Access Mental Health Care   and Information

- The Goals of a Transformed System

- Mental Health System Transformation

## Mental Health System Transformation

**transformation **\*n* (15c) From the Latin roots to change TRANS (across) and FORMA (shape). 1: a change in form, appearance, nature or character  2: the process of doing so
***The New Freedom Commission described transformation as a vision, a process, and ******an outcome.***

## Mental Health System Transformation

**T = (V + B + A) ******** (CQI)****2**

**                           ****Transformation ******** **
**(****Vision ******** Belief ******** Action****) ******** ( ****Continuous Quality Improvement**** )****2**

##                              Transformation  
    (Vision  Belief  Action)  ( Continuous Quality Improvement )2

Vision that provides direction for the work we do
Belief that guides the work we do
Action that is taken to make our vision and beliefs a reality; and
Continuous Quality Improvement which helps ensure that our actions reflect the wishes and needs of the community being served

**                             ****Transformation ******** **
**    ****(****Vision ******** Belief ******** Action****) ******** ( ****Continuous Quality Improvement**** )****2**
**Vision** *that provides direction for the work we do*
**Belief**** ***that guides the work we do*
**Action** *that is taken to make our vision and beliefs a reality; and*
**Continuous Quality Improvement** *which helps ensure that our actions reflect the wishes and needs of the community being served*

- Mental Health System Transformation

## Continuous Small Steps:  Includes a focus on core missions and improving what the system is already doing.  Incremental capability enhancements are termed “modernization.”
A Series of Many Exploratory Medium Jumps:  Pushing the boundaries of core competencies and trying to create something new within the existing paradigm.  Produce significant capability improvements within the current system.	
A Few Big Jumps:  New rule sets that leverage new ideas.  Combines new technologies with innovative operational concepts to go beyond the existing paradigm.  

- Continuous Small Steps:  *Includes a focus on core missions and improving what the system is already doing.  Incremental capability enhancements are termed “modernization.”*
- A Series of Many Exploratory Medium Jumps:  *Pushing the boundaries of core competencies and trying to create something new within the existing paradigm.  Produce significant capability improvements within the current system.**	*
- A Few Big Jumps:  *New rule sets that leverage new ideas.  Combines new technologies with innovative operational concepts to go beyond the existing paradigm.**  *

- Mental Health System Transformation

## Mental Health System Transformation

- Focus on quality and outcomes
- Adoption and adaptation of best practice models at the community level
- State and local, public and private sector engagement

- Transformation of Mental Health Care Will Require...

## Mental Health System Transformation

**	****	****	****	**** ****	****     **Tommy G. Thompson
- 				           		      July 22, 2003

- The Charge to SAMHSA

## Established the work team, including Stanley Eichenauer, Sybil Goldman, Gail Hutchings, Kathryn Power, James Stone, and Mark Weber
Identified team objectives, established a timeline, and held weekly team meetings 
Reviewed the Commission Report, identified sub-recommendations and relevant Federal agencies 
Reviewed Carter Commission Report and other public documents to help design a format for the Action Agenda
Reviewed all New Freedom Commission Subcommittee reports 

- Identified team objectives, established a timeline, and held weekly team meetings
- Reviewed the Commission Report, identified sub-recommendations and relevant Federal agencies
- Reviewed Carter Commission Report and other public documents to help design a format for the Action Agenda
- Reviewed all New Freedom Commission Subcommittee reports

- Developing the First Federal
- Action Agenda

- Mental Health System Transformation

## 
Conducted inventory of CMHS portfolio cross-walked with the Goals and Recommendations of the New Freedom Commission 
Created and convened Federal Partners Work Group
Requested and received Federal Partners’ inventory and “wish lists”

- Conducted inventory of CMHS portfolio cross-walked with the Goals and Recommendations of the New Freedom Commission
- Created and convened Federal Partners Work Group
- Requested and received Federal Partners’ inventory and “wish lists”

- Developing the First Federal Action Agenda (cont’d)

- Mental Health System Transformation

## Mental Health System Transformation

- DEPARTMENT OF HEALTH 		   OTHER
-     & HUMAN SERVICES	             PARTNERS
- AoA		NIH/NIDA	Department of Education
- ACF		NIH/NIMH	Department of Housing
- AHRQ 		HHS/OS        and Urban Development
- CDC		 - ASPE 	Department of Justice
- CMS 		 - OCR 	Department of Labor
- HRSA 		 - OD 		Social Security Administration
- IHS		 - OPHS 	Department of Veterans Affairs 	 	SAMHSA

## Drafted first Federal Action Agenda
Based on the conviction that mental illnesses are treatable and recovery should be the expectation
Identifies the first practical steps that can be taken at the Federal level to initiate change in response to Achieving the Promise
Sets time-limited, realistic priorities for year 1 of a 5-year arc for transformation

- Based on the conviction that mental illnesses are treatable and recovery should be the expectation
- Identifies the first practical steps that can be taken at the Federal level to initiate change in response to *Achieving the Promise*
- Sets time-limited, realistic priorities for year 1 of a 5-year arc for transformation

- Federal Action Agenda

- Mental Health System Transformation

## Develop a CMHS Strategic Plan aligned with the Report and Action Agenda
SAMHSA Matrix Workgroup on Mental Health System Transformation
Annual Action Agenda Updates
Commit to an ongoing transformation process
Expand network of collaborations
Support through SAMHSA Grants and Contracts

- SAMHSA Matrix Workgroup on Mental Health System Transformation
- Annual Action Agenda Updates
- Commit to an ongoing transformation process
- Expand network of collaborations
- Support through SAMHSA Grants and Contracts

- CMHS/SAMHSA Activity - Ongoing

- Mental Health System Transformation

## Mental Health System Transformation

- Mental Health State Incentive Grants                 for Transformation

- A key component of SAMHSA's mental health system transformation strategy
- Will facilitate the development and implementation of Comprehensive State Mental Health Plans
- The President's Budget includes $44 million for this new program
- Planning is underway for the FY 2005 RFA

## “ Because recovery will be the common, recognized outcome of mental health services, the stigma surrounding mental illnesses will be reduced, reinforcing the hope of recovery for every individual with a mental illness.”
				New Freedom Commission

**	****	****	****	**New Freedom Commission
**	****	****	****	****           ****	**

- Recovery

- Mental Health System Transformation

## Mental Health System Transformation

- In the mental health arena, recovery is about individuals taking control of their own lives and not having others determine their care or treatment. The concept has evolved to mean the process by which an individual comes to terms with his or her disability and learns how to cope. *Recovery does not imply a cure, but a lifelong process.*

## Mental Health System Transformation

- The ability to live a fulfilling and productive life despite a disability
- A reduction or complete remission of symptoms
- The ability to help make important decisions affecting one’s own life

- Recovery refers to the process by which people are able to live, work, learn, and participate fully in their communities.

## Mental Health System Transformation

*	** *Jerome Groopman, MD
- _The Anatomy of Hope_** **

- The Role of Hope in Recovery

## Mental Health System Transformation

* *