Transforming State Mental Health Systems
As SAMHSA's Mental Health Action Agenda guides the national
effort to transform mental health systems across America
to more consumer-driven and recovery-oriented programs,
the states are becoming "the center of gravity" for that
transformation.
According to A. Kathryn Power, M.Ed., Director of SAMHSA's
Center for Mental Health Services (CMHS), "State mental
health agencies are working to reduce fragmentation of
services across systems, to increase their prevention
and early intervention programs, and to enhance their
investments in new technologies to improve services and
accountability for achieving measurable results."
"Transformation implies
profound changes in organizational policies, practices,
and funding. And transformation requires equally momentous
shifts in our own attitudes, beliefs, and values about
mental health."
A. Kathryn Power,
M.Ed.
Director, Center for Mental Health Services
To jumpstart that process and create models of transformation
for the states, CMHS recently awarded Mental Health Transformation
State Incentive Grants to Connecticut, Maryland, New
Mexico, Ohio, Oklahoma, Texas, and Washington State.
These grants total $92.5 million over 5 years.
"State by state, a recovery-focused system is truly
within our grasp," said Ms. Power, who noted the unprecedented
amount of evidence now available about what works when
it comes to helping individuals with mental illness become
productive members of society. "We are at the threshold
of a system of care in which recovery-and not disability-is
the expected outcome," she explained.
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Models of Transformation
The President's New Freedom Commission on Mental Health
issued a final report in 2003 calling for a radical overhaul
of the Nation's mental health system. (See SAMHSA
News,
Summer 2003.)
At the national level, SAMHSA responded by developing
the Mental Health Action Agenda, which details the steps
the Federal Government will take to transform mental
health services. (See SAMHSA
News,
September/October 2005.)
However, states are playing a pivotal role in transformation.
These grants will help states create mental health systems
that focus on consumer and family needs, build resilience,
and facilitate recovery.
"Transformation implies profound changes in organizational
policies, practices, and funding," Ms. Power said. "And
transformation requires equally momentous shifts in our
own attitudes, beliefs, and values about mental health."
With these grants, states must offer a comprehensive
continuum of services, ranging from mental health promotion
and mental illness prevention activities for healthy
individuals to treatment and recovery options for those
with mental disorders, especially children with serious
emotional disturbances and adults with serious mental
illnesses. States must also offer services appropriate
for all ages, including children, adults, and older adults.
And states must involve consumers and families as active
participants in transformation.
"The hope is that other states will adopt these practices
until every mental health system in the country is transformed,"
said Program Coordinator Nancy J. Davis, Ed.D., a public
health advisor at CMHS.
"The seven states will serve as models for learning
about what works and what doesn't work when it comes
to transforming mental health and related systems," Dr.
Davis explained. "We expect these states to share successful
strategies with other states, territories, and tribes
and tribal organizations."
The seven model states are already coming up with innovative
approaches to achieving these goals. For example:
-
Connecticut will continue to develop
a recovery-oriented system of mental health care
in which state and local systems work together seamlessly.
(See Connecticut's Transformation
Experience.)
-
Maryland will continue strengthening
partnerships among public sector providers, private
sector providers, and academics as a way of promoting
evidence-based practices in addition to emphasizing
a recovery-focused approach to service.
-
New Mexico will integrate the behavioral
health services offered by 15 different state agencies
into one coherent whole, bring together critical
partners locally throughout communities across the
state, and expand behavioral health coverage to remote
areas of the state.
-
Ohio plans to orient mental health
and other systems to recovery, resilience, and culturally
competent practices. Youth and adult consumers and
families will be actively engaged in their service
and recovery experiences, which will include person-centered
planning, peer support, and recovery and resilience-oriented
policymaking.
-
Oklahoma will develop a strong
sustainable infrastructure to promote lasting changes
across state agencies, enabling persons with mental
illness to access individualized care and support
expeditiously and to achieve and sustain recovery.
-
Texas will foster recovery, improve
quality of life, and meet the multiple needs of mental
health consumers in addition to moving to a coordinated
system of care that offers promotion, prevention,
and treatment services to residents across their
life spans.
-
Washington State plans to build
the infrastructure for an ongoing process of planning,
action, learning, and innovation in mental health
care.
The state will launch a social marketing campaign to
increase awareness of mental illness and reduce its stigma
as well as strengthen the statewide infrastructure for
consumer and family support.
To learn more about mental health transformation activities
within the states, visit the SAMHSA Web site at www.samhsa.gov/matrix/mhst_TA.aspx.
Current and back issues of SAMHSA's Transformation
Trends newsletter are also available at www.samhsa.gov/matrix/MH_transformation_
trends.aspx.
Updates of specific state activities are available online
on the National Association of State Mental Health Program
Directors' Web site at www.nasmhpd.org/targeted_ta.cfm. Click on "Recent State Activities
Under the New Freedom Commission." 
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Connecticut's Transformation Experience
By Rebecca A. Clay
When Connecticut's Department of Mental Health
and Addiction Services (DMHAS) decided its services
needed to become more consumer-oriented and recovery-focused,
it went straight to the source—consumers
themselves.
At the department's request, advocacy groups representing
people recovering from psychiatric disorders and
substance abuse identified values that make care
truly recovery-oriented. Those values—things
like consumer involvement, comprehensive care,
cultural competence, and peer support—guided
the development of a policy statement whose title,
"Promoting a Recovery-Oriented Service System,"
sums up the department's new goal.
"Instead of the system being oriented to
acute care and problems, we're making services
more focused on helping people improve their existing
strengths and increasing their involvement in the
recovery process," said Wayne F. Dailey, Ph.D.,
a senior policy advisor and public information
officer at DMHAS.
Working with the Yale University School of Medicine,
Connecticut has already created a Recovery Institute
to train providers in the theory and practice of
recovery. This ongoing series of trainings has
covered topics ranging from why peer-run programs
are beneficial to how to increase consumers' involvement
in managing their own illnesses.
"These trainings have a different slant than
the traditional training practitioners undergo,
because of the emphasis on recovery and consumer
empowerment," said Dr. Dailey. "We're
trying to help people understand why we're making
these changes, what the changes are all about,
and what they would look like in actual practice."
More than 5,000 practitioners around the state
have undergone the training so far.
Yale also helped the department craft guidelines
and standards for recovery-oriented services. There's
also a recovery self-assessment tool that service
providers can use to see if what they're currently
doing is in line with the department's recovery-oriented
ideals.
In addition, 16 "centers of excellence"
in the state are testing innovative programs exemplifying
recovery-oriented practices, such as having programs
run by peers or putting peer advocates in emergency
departments. Two "practice improvement initiatives"
involving 27 mental health and substance abuse
agencies use technical assistance and a train-the-trainer
approach to spread evidence-based, recovery-promoting
practices around the state.
The Mental Health Transformation State Incentive
Grant that SAMHSA recently awarded to the state—$14.7
million over 5 years—will help solidify these
gains, said Dr. Dailey.
"The big challenge of transformation is not
only to make the change but to have it become permanent,"
he explained. "We don't want it to be something
you just do a little while before slipping back
into your old ways."
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