# Presentation: 257777

## Slide 1

## Mental Health System Transformation

## The Commission’s Vision

## Defining 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.*

## Defining Transformation

*... **a continuous process, without end...meant to create         *
*    **or anticipate the future  *
*...**identifies, leverages, and even creates new *
*   **underlying principles for the way things are done*
*...**identifies and leverages new sources of power  *
*...**once the process is begun, a profoundly different *
*   **organization emerges, including changes in structure, *
*   **culture, policy, and programs*
**	****	**
*Retired Vice Admiral Arthur Cebrowski*
*	**	**Special Assistant for Transformation,  *
*U.S. Department of Defense** *

## T = (V + B + A)  (CQI)2

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

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

## Transformation as a Strategy                      for Innovation

- Continuous Small Steps
- A  focus on core missions, improving what the system is already doing.

- A Series of Many Exploratory Medium Jumps
- Pushing the boundaries of core competencies, trying to create something new within the existing paradigm.

- A Few Big Jumps
- New rule sets that leverage new ideas.

## Steps Toward Transformation

- Broad Inventory

- Strategic Assessment

- Vision Described

- Alignment

- Investment in Change

- Begin to Transform:  Record & Model

## Research

- Funding

- Policy

**The Golden            Triangle of               Systems Change**

## The Science to Services Initiative

**The Science to Services Initiative is embedded in the transformational agenda.**

- Research/services collaborations will be critical to inform and facilitate the transformation process.
- An effective CMHS/NIMH partnership is essential to ensure rapid progress in moving science to service and service to science.
- Significant opportunities exist to integrate a national mental health research agenda into mental health system transformation efforts.

## Goal 1

**Goal 1**
**Goal 2**
**Goal 3**
**Goal 4**
**Goal 5**
**Goal 6**

- Americans understand that mental health is essential to overall health.
- Mental health care is consumer and family driven.
- Disparities in mental health 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.

## An Effective Science to Services Partnership Requires...

- We do business in a different way
- All involved parties benefit from the activities of the work undertaken jointly
- Each member brings ideas and resources to the table
- The process includes cooperation, collaboration, and prioritization
- All must understand the key role played by States in developing, improving, and maintaining an infrastructure
*The Science to Services process is one that concerns us all, and if done properly, it will benefit us all.*

## SAMHSA Science to Services/ Transformation Activities

**Mental Health Transformation Grants...**

- Are a key component of SAMHSA’s mental health system transformation strategy
- Will facilitate the development and implementation of comprehensive State mental health plans
- Offer an unparalleled opportunity to better our understanding through research about how to effectively create a system that is fully responsive to the needs of the people it serves

## SAMHSA Science to Services/ Transformation Activities

**Strategic Prevention Framework...**

- Involves a step-by-step process that empowers communities to identify and implement the most effective substance abuse prevention and mental health promotion efforts for their specific needs
- Is designed to engage communities and practitioners in the translation process and performing local process and outcome monitoring activities
- Will ensure accountability, program effectiveness, and feedback to the research community
- Will be invaluable as we begin the process of transforming the Mental Health System

## SAMHSA Science to Services/ Transformation Activities

**Re-engineered Discretionary Grant Program...**

- Includes four standard funding mechanisms that follow the Strategic Prevention Framework
- Infrastructure Grants
- Best Practices Planning and Implementation Grants
- Service Grants
- Service to Science Grants
- Ensures that planning and allocation of funds can proceed upon release of the President’s budget—providing ample time to collaborate with NIMH to develop GFAs or program announcements
- Understands that collaboration with NIMH can affect how dollars are allocated across the science to services cycle by providing intelligence about the status of specific programs/practices in the field

## SAMHSA’s National Registry of Effective Programs and Practices (NREPP)

**NREPP Review Summary       As of August 2004**

**1,124 submitted**

**1,039 reviewed**

**63 Promising**

**52 Effective**

**57 Model**

## National Evidence-Based Practices (EBP) Project

**The Six Current EBP “Toolkits”**

- Illness Management & Recovery
- Medication Management Approaches in Psychiatry
- Assertive Community Treatment
- Family Psychoeducation
- Supported Employment
- Co-Occurring Disorders:  Integrated Dual Disorders Treatment

## Components of a Transformed System

- Focus on Recovery
- Evidence-based Practices
- Comprehensive State Mental Health Plans
- Individualized Plans of Care

## Recovery

*New Freedom Commission on Mental Health*
*July 2003*

- “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.”

## Recovery refers to...

- The process by which people are able to live, work, learn, and participate fully in their communities
- The ability to live a fulfilling and productive life despite a disability
-  A reduction or complete remission of symptoms
- The ability to make important decisions affecting one’s own life

*There is a growing evidence base that supports                   the concept of recovery.*

## The Recovery Research Agenda

- CMHS-sponsored National Consensus Conference—brought together researchers, policymakers, consumers, families, and other stakeholders to identify a commonly understood definition of recovery
- The Consensus Conference—a partnership with the Department of Education’s Interagency Council on Disability Research—is a model for interagency efforts
* **NIMH participation is vital to developing a uniform, operational definition of recovery.*

**How Do We Define It?**

## The Recovery Research Agenda

- System Level—A number of longitudinal studies have examined recovery processes and outcome measures
- Visit the Repository of Recovery Resources Web site
- http://www.bu.edu/cpr/recovery
- Individual Level—CMHS is currently developing a prototype Consumer Report Card to examine individual measures of recovery that embody consumer values
*NIMH can assist CMHS in determining interventions that are scientifically effective in supporting recovery.*

**How Do We Measure It?**

## The Recovery Research Agenda

*NIMH and CMHS can collaborate to develop an implementation plan to apply the recovery construct in policy and practices.*

**How Do We Put It Into Practice?**

## “The dogmas of the quiet past are inadequate to the stormy present.  The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew, and act anew.” 

* **Second Annual Message to Congress*
*December 1, 1862*

- “The dogmas of the quiet past are inadequate to the stormy present.  The occasion is piled high with difficulty, and we must rise with the occasion. As our case is new, so we must think anew, and act anew.”