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SAMHSA News - January/February 2006, Volume 14, Number 1

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_

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." End of Article

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Connecticut's Transformation Experience

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." End of Article

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Inside This Issue

Screening Adds Prevention to Treatment
Part 1
Part 2

From the Administrator: The Value of Screening

Officials Plan for Flu Pandemic

Mental Health Campaign for Hurricane Survivors

Transforming State Mental Health Systems

The Road Home: Veterans Conference Planned

Two Reports: Substance Use Among Veterans

Town Hall Meetings Planned on Underage Drinking

Underage Drinkers Seek Help in Emergency Rooms

SAMHSA Grant Opportunities

"Fine Line" Detailed in Portraits

Rebuilding Afghanistan's Mental Health System
Part 1
Part 2

Statistics Released on School Services

Adolescents, Adults Report Major Depression

Guidelines Released on Marijuana Counseling

2006 Recovery Month Web Site Launched

Reach Out Now!

Advisory Available on Acamprosate

SAMHSA News Information

SAMHSA News - January/February 2006, Volume 14, Number 1

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