Matrix: Mental Health System Transformation

Developing Infrastructure to Improve Availability and
Effectiveness of Mental Health Services

Mental Health Transformation State Incentive Grant Program

Pre-Application Technical Assistance

Questions and Answers from Conference Call, March 31, 2005

1.  Who is eligible to apply for an MHT SIG?

The immediate office of the Chief Executive Officer (e.g., Governor) in the States, Territories, the District of Columbia, and Federally-recognized American Indian/Alaska Native Tribes or Tribal Organizations. The RFA defines “tribal organization” as follows: “The recognized governing body of any Indian tribe or any legally established organization of Indians which is controlled, sanctioned, or chartered by such governing body or which is democratically elected by the adult members of the Indian community to be served by such an organization and which includes the maximum participation of Indians in all phases of activities.”

To qualify as a “Tribal Organization,” an organization has to meet one of three criteria. It must be:

•  The recognized governing body of any Indian tribe, OR

•  A legally established organization of Indians which is controlled, sanctioned, or chartered by the governing body of an Indian tribe,  OR

•  A legally established organization of Indians which is democratically elected by the adult members of the Indian community the organization intends to serve.

If an organization meets one of these three requirements, AND if it includes maximum participation of Indians in all activities, then it may classify as a tribal organization.

Eligibility for the MHT SIG is limited because recipients of the Mental Health Transformation State Incentive Grants must have the ability to leverage and coordinate multiple sources of funding and other resources in order to achieve the goals of the President's New Freedom Commission on Mental Health.

2. Is an Urban Indian Health Board or a Regional Indian Health Board eligible to apply?

If it is a “tribal organization” as defined in question #1, it may apply.

3. Are U.S. territories eligible to apply?

Yes. All States, Territories, and the District of Columbia that are eligible for the Community Mental Health Services Block Grant program are eligible for the MHT SIG.   

4. Can the Department of Mental Health apply?

The Director/Commissioner of Mental Health is a required member of the Chief Executive's Transformation Working Group. However, for transformation to be successful, it is necessary to have a strong, coordinated commitment by the State, Territory, District, or Tribal Chief Executive because he or she is the only person who has the authority to convene all the relevant department/agency/ office heads and to hold them accountable for their performance. Senior-level administrators from many different entities must be willing to invest their time and resources. No single one of these entities can apply directly for the grant. The application has to come from the Chief Executive.

5. Can the Mental Health Commissioner be the Chairperson for the Governor's or Chairperson's Mental Health Transformation Working Group?

Virtually anyone may serve as Chairperson of the Transformation Working Group as long as he/she is:

•  in the words of the RFA, “ a dynamic leader who has a broad and powerful operational vision of what constitutes transformation, has experience managing projects that require the integration of diverse perspectives and/or agencies, and has outstanding oral and written communication skills,”

•  appointed by the Chief Executive Officer, and

•  able to devote full time to mental health system transformation.

The key questions to address regarding the Mental Health Commissioner's -- or any other current employee's -- serving as Chairperson are:

•  Are all his/her responsibilities related to transforming the mental health and related systems?

•  If not, who will handle his/her non-transformation related responsibilities during the five years of this grant program?

6. Could we bring in someone from out of state to be the Chairperson?

There is no prohibition against bringing someone in from outside as long as he/she can do the job, is good at bringing people together, is eager to move to your State, and is willing to make the five-year commitment. We would draw your attention to the review criteria in the RFA under sections B, C and E where there's mention of the chairperson. That's what the reviewers are going to be looking for.

7. One problem in creating the Governor's Transformation Working Group is that there is a lot of turnover at the highest levels of most State governments. When governors change, so do most cabinet members. The kinds of people who are in a state for the long haul aren't necessarily the most senior people. How do we manage this issue for this grant?

The Chief Executive's Transformation Working Group must be comprised of executives representing their cabinet level departments. If one department's Secretary left, then the new Secretary would be on the workgroup. It is the position, and the authority that goes with that position, more than the individual people that are essential. Obviously, there will be a lot of people beyond the executive level workgroup who will work on transformation and actually make it happen. But the commitment of the cabinet level executives is also essential.

8. Our Commissioner of Mental Health reports to an Assistant Secretary, who reports to the Secretary of the Department of Human Services, who reports to the Governor. In having the Chairperson of the working group report directly to the Governor, it seems that we're setting up a parallel system.

The structure described in the RFA was set up purposely to have that direct communication between the working group chairperson and the governor. The challenge for an applicant is how to organize the transformation structure to include the existing structure, and still have that direct report to the governor from the chairperson of the working group. The transformation system and the existing system are not really separate systems; they definitely must be interacting with each other.

9. Might an applicant focus on only one sector such as children's mental health, criminal justice, housing, or integrating mental health and substance abuse services, for example?

No. The purpose of the MHT SIG is for grantees to develop the infrastructure for truly comprehensive services for all their people. This means a lifespan approach, a true continuum of care, and collaboration among the many different entities mentioned in the RFA (and perhaps others as well).

10. Do we have to complete the Needs Assessment before we apply?

You need to respond to every bullet in the Statement of Need section of the RFA's Evaluation Criteria. In so doing, you will no doubt do considerable assessing of your systems' needs. However, doing a thorough assessment of the mental health related needs of all the organizations on the Chief Executive's Transformation Working Group will probably take longer than the 90 days you have to respond to the RFA. There will be time after awards are made to revise and update the Needs Assessment.

11. Can we use any of the MHT SIG funds for direct services?

No. The MHT SIG provides a unique opportunity for grantees to concentrate on systemic changes. Transforming mental health care in American requires a major restructuring of where and how services are delivered. The Allowable Activities in the RFA (p. 10) detail the kinds of infrastructure activities SAMHSA/CMHS believes will lead to the systems changes that are needed. The Community Mental Health Services Block Grant Program is more flexible in that its funds may be used for both infrastructure development AND direct services.

12. Our Department of Correction was wondering if the MHT SIG funds could be used for some pilot projects regarding offender reentry.

Integrating reentry, jail diversion, and other criminal and juvenile justice issues into the broad transformation agenda is extremely important. You could use the MHT SIG funds for any of the allowable activities described on page 10 of the RFA, but you could not use the funds for direct services for pilot programs. The SAMHSA/ CMHS-funded National Gains Center is providing some technical assistance around mental health and justice system issues. The Center's web site is www.gainsctr.com.

13. Is a Public Health System Impact Statement (PHSIS) required for the MHT SIG application?

No. The PHSIS applies to community-based organizations and not to State and local governments.  The reference to the PHSIS on the front page should have been deleted.

14. Is it permissible for the governor to direct the funds through a department other than the Department of Mental Health? For example, the Department of Public Health?

Yes. The Chief Executive has the authority to decide how to organize the implementation of the MHT SIG. For the application, it is important to explain why he/she chose a particular strategy.

15. The RFA says that SAMHSA/CMHS will provide “ a model Comprehensive Mental Health Plan and a model Individualized Treatment Plan.” When will these be forthcoming?

These will not be available until later in 2005, after the deadline for the application.

16. Can we use information from grants we already have through SAMHSA – grants for consumers and families, for example – and use that information for this grant?

Yes, but exactly how your state, territory, district, or tribe would incorporate it is up to the Chief Executive's Transformation Working Group. It would be useful to let the group know about this information for two reasons. First, the RFA requires consumer and family involvement in preparing the applications and in working on the transformation working group. In fact, one of the seven GPRA measures required for the grant is to increase consumer and family state network members. Second, the MHT SIG encourages linking among all relevant grants in the state, territory, District, or tribe, and grants related to consumer and family issues would certainly be relevant to the overall transformation process.

17. How much focus should we put on developing integrated mental health and substance abuse treatment for the MHT SIG?

The RFA directs you to think and plan in terms of the six goals and nineteen recommendations of the New Freedom Commission Report. The integrated mental health and substance abuse aspect falls primarily under goal four. It is a very important part of goal four, but there are the other goals to consider as well.

One of the requirements of the MHT SIG is that you create an inventory of resources for mental health. That survey should include the various grants that the state has, so that you can make all the grants start flowing in the same direction towards transformation. If your state has one of SAMHSA's State Incentive Grants for Co-occurring Disorders (Co-sig), that would certainly be included in the inventory of resources and considered by the transformation working group in considering what else needs to be done, how to use the resources, etc

18. When will the MHT SIG grants be awarded?

By the end of the Federal government's fiscal year, which is September, 30, 2005 . The likely starting date is October 1, 2005 .

19. If a state already has a block grant, is it eligible for the MHT SIG?

Absolutely. Every state, the District of Columbia , and every territory that is eligible already has a block grant. The same entities that are eligible for the block grant – plus federally recognized American Indian/Alaska Native tribes and tribal organizations -- are eligible for the MHT SIG grant.