# Presentation: 205905

## Moving From Vision To Reality: Transformation of the Mental Health System July 29, 2004

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

## The Commission’s Vision

- “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.”

## The Public Health Model

**A community approach to preventing and treating illnesses. Its premise is that caring for the health of an individual protects the community. While caring for the health of a community in turn protects the individual, with society at large reaping the overall rewards.**

**The Public Health Model**

## Crossing the Quality Chasm

**Institutes of Medicine Report calling for major reform in US health policy, organization and financing**
**Committee explored implications for the field of mental health and addictive disorders**
**A strategic blueprint for redesign of behavioral health care delivery expected to be released August 2005**
**SAMHSA adopted reports as basis for *****mental health care transformation in America***

## 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,  Department of Defense****** ***

## The Transformation Equation

**The Transformation Equation**

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

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

## 
Vision–direction for our work  
Belief–guides our work  
Action–makes our vision and beliefs a reality
Continuous Quality Improvement–ensures our actions reflect the wishes and needs of the community

**The Transformation Equation**

**V****ision****–***direction for our work  *
**B****elief****–***guides our work  *
**A****ction****–***makes our vision and beliefs a reality*
**C****ontinuous ****Q****uality ****I****mprovement****–***ensures our actions reflect the wishes and needs of the community*

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

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

- 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.

## Transformation of Mental Health Care will take...

**Better coordination/collaboration across Federal, State, local and private agencies**
**Focus on quality and outcomes**
**Adoption and adaptation of best practice models at the community level.**
**State and local, public and private sector engagement**

## Broad Inventory
Strategic Assessment
Vision Described
Alignment
Investment in Change
Begin to Transform: Record & Model  

**Broad Inventory**
**Strategic Assessment**
**Vision Described**
**Alignment**
**Investment in Change**
**Begin to Transform: Record & Model  **

## Americans Understand that Mental Health 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

**The ****Goals**** of a Transformed System**

- Americans Understand that Mental Health 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

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

## Goal 1

**Americans Understand that Mental Health Essential to Overall Health**

**Goal 1**

**Recommendation 1.1****—****Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention**
**Recommendation 1.2****—****Address mental health with the same urgency as physical health**

## Goal 1

**Americans Understand that Mental Health Essential to Overall Health**

**Goal 1**

**Build essential mental health messages in all social marketing efforts**
**Integrate suicide prevention into all program aspects**

**Steps to Success for TA Providers**

## Goal 2

**Mental Health Care is Consumer and **
**Family Driven**

**Goal 2**

**Recommendation 2.1****—****Develop an individualized plan of care for every adult with a serious mental illness and child with a serious emotional disturbance**
**Recommendation 2.2****—****Involve consumers and families fully in orienting the mental health system toward recovery**

## Goal 2

**Mental Health Care is Consumer and **
**Family Driven**

**Goal 2**

**Recommendation 2.3****—****Align relevant Federal programs to improve access and accountability for mental health services**
**Recommendation 2.4****—****Create a Comprehensive State Mental Health Plan**
**Recommendation 2.5****—****Protect and enhance consumers’ rights**

## Goal 1

**Mental Health Care is Consumer and **
**Family Driven**

**Goal 2**

**Provide recommendations to the field on how to define consumer and family driven, the conditions necessary to make the shift to consumer and family driven systems of care and how to ultimately measure whether a service system has become or is consumer and family driven.**
**Develop prototype individual recovery plan**

**Steps to Success for TA Providers**

## Goal 2

**Mental Health Care is Consumer and **
**Family Driven**

**Goal 2**

**Expand technical assistance beyond the mental health system per se to include all government agencies and other organizations relevant to service provision for the population of people with serious mental illnesses and serious emotional disturbances.**
**Involve consumers and family members in all activities **

**Steps to Success for TA Providers**

## Goal 3

**Disparities in Mental Health Services are Eliminated**

**Goal 3**

**Recommendation 3.1****—****Improve access to quality care that is culturally competent**
**Recommendation 3.2****—****Improve access to quality care in rural and geographically remote areas**

## Goal 3

**Disparities in Mental Health Services are Eliminated**

**Goal 3**

**Steps to Success for TA Providers**

## Goal 4

**Recommendation 4.2****—****Schools should have the ability to play a larger role in mental health care for children**

**Early Mental Health Screening, Assessment, and Referral to Services are Common Practice**

**Goal 4**

## Goal 4

**Recommendation 4.4****—****Screen for mental disorders in primary health care, across the lifespan, and connect to treatment and support**

**Early Mental Health Screening, Assessment, and Referral to Services are Common Practice**

**Goal 4**

## Goal 4

**Develop mechanisms to incorporate all grant programs into broader state reform**
**Incorporate a broader continuum (e.g., prevention services for siblings of identified youth) into the system of care **
**Acknowledge that Schools are a unique culture and have differing sets of regulations/laws and processes**

**Early Mental Health Screening, Assessment, and Referral to Services are Common Practice**

**Goal 4**

**Steps to Success for TA Providers**

## Goal 5

**Recommendation 5.2****—****Advance evidence-based practices (EBPs) using dissemination and demonstration projects and create a public-private partnership to guide their implementation**

**Excellent Mental Health Care is Delivered **
**and Research is Accelerated**

**Goal 5**

## Goal 5

**Recommendation 5.4****—****Develop the knowledge base for...  **
-   Eliminating mental health disparities
-  Assessing long-term effects of medications
-  Reducing impact of trauma
-  Improving acute care

**Excellent Mental Health Care is Delivered **
**and Research is Accelerated**

**Goal 5**

## Goal 5

**Excellent Mental Health Care is Delivered **
**and Research is Accelerated**

**Goal 5**

**Implement proven care practices that achieve recovery and resiliency, and train the mental health workforce **
**Provide technical assistance to States and communities that supports the use of evidence-based practices**
**Disseminate research on important services, particularly the NFC Report recommendations**

**Steps to Success for TA Providers**

## Goal 5

**Excellent Mental Health Care is Delivered **
**and Research is Accelerated**

**Goal 5**

**Identify field-initiated emerging best practices and provide technical assistance to stakeholders to help move these practices up the evidence ladder**
**Provide TA and trainings focused on helping States and communities to implement specific evidence-based practices**

**Steps to Success for TA Providers**

## Goal 6

**Technology is Used to Access Mental **
**Health Care and Information**

**Goal 6**

**Recommendation 6.1****—****Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations**
**Recommendation 6.2****—****Develop and implement integrated electronic health record and personal health information systems**

## Goal 6

**Technology is Used to Access Mental **
**Health Care and Information**

**Goal 6**

**Implement modern information technology (IT) that promotes timely, high-quality  care and accelerates consumer empowerment**
**Use IT effectively to make it easy for consumers and family members to negotiate care and achieve good outcomes. (i.e. web sites, chat spaces, virtual care systems, electronic health records)**

**Steps to Success for TA Providers**

## TA Experts: Who You Are

**Recognized Experts in your Area**
**Over 50 Organizations**
**$44.5 Million Dedicated to Strengthen Technical Assistance**
**Shared Goal—to Support Mental Health Transformation**

## What TA Providers Need to Do...

**Conduct business in a new way**
**Have a strong focus on process, follow-through and follow-up**
**Ask questions; not deliver canned products**
**Have real experts on board and bring in new personnel if needed**
**Meet with the GPO and determine how to best align with the goals of transformation**

## What TA Providers Should Remember

**Transformation is ultimately about new values, new attitudes, and new beliefs; it is about how these changes are expressed in the behavior of people and institutions.**
**Transformation is “readiness to change” and “willingness to risk” compel the pace, scope, and character of transformation.**

## What TA Providers Should Remember

**Systems change when the established system no longer is perceived to work.**
**Systems change when evidence-based practices are implemented and they “stick.”**
**Systems change when social marketing and communications support becomes an important  component of a grant program’s ultimate sustainability.**

## What TA Providers Should Remember

**Individual Plans of Care **
**Evidence-Based Practices**
**Comprehensive State Mental        Health Plans**
**Recovery **

## 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**

## Recovery

- 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 their disability and learns how to cope. *Recovery does not imply a cure, but a lifelong journey and process.*

## Recovery

**Recovery**

**New Freedom Commission**

## “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.”