Transforming Missouris Mental Health System

1
Transforming Missouris Mental Health System
Creating Communities of Hope May 17, 2007
2
New Freedom Initiative

• In February 2001, President George W. Bush
  announced his New Freedom Initiative to promote
• increased access to educational and employment
  opportunities for people with disabilities.
• increased access to assistive and universally
  designed technologies and full access to
  community life.
• The President identified three obstacles
  preventing Americans with mental illnesses from
  getting the excellent care they deserve
• Stigma that surrounds mental illnesses,
• Unfair treatment limitations and financial
  requirements placed on mental health benefits in
  private health insurance, and
• The fragmented mental health service delivery
  system.

3
New Freedom Commission

• The President established the New Freedom
  Commission on Mental Health. In its Interim
  Report to the President, the Commission declared
  
• "... the mental health delivery system is
  fragmented and in disarray ... leading to
  unnecessary and costly disability, homelessness,
  school failure and incarceration.
• The report described the extent of unmet needs
  and barriers to care, including
• Fragmentation and gaps in care for children and
  adults,
• High unemployment and disability for people with
  serious mental illnesses,
• Lack of care for older adults, and
• Lack of national priority for mental health and
  suicide prevention.

4
Achieving the Promise Final Report by the
Presidents New Freedom Commission on Mental
Health
The time has long passed for yet another
piecemeal approach to mental health reform.
Instead, the Commission recommends a fundamental
transformation of the Nations approach to mental
health care.
4
5
In a Transformed System?
Goal 1. Americans understand that mental health
is essential to overall health. Goal 2.
Mental health care is consumer and family
driven. Goal 3. Disparities in mental health
services are eliminated. Goal 4. Early mental
health screening, assessment, and
referral to services are common practice. Goal
5. Excellent mental health care is delivered
and research is accelerated. Goal 6. Technology
is used to access mental health care and
information.
5
6
Missouri Transformation Initiative

• Missouri one of 9 states awarded transformation
  grant by the Substance Abuse and Mental Health
  Services Administration (SAMHSA) for 5 years
  effective October, 2006.
• Designed to build upon cross-departmental work
  to date. (e.g. Childrens Comprehensive System)
• Grant funds will help support infrastructure
  required for transformation such as planning,
  workforce development, evidence-based practice
  implementation and technology enhancements.
• Primary focus of first year is the development of
  Missouris first Comprehensive State Mental
  Health Plan that transcends departmental
  boundaries and crosses the lifespan.

7
Grant Requirements

• Governor Initiative
• Cross-departmental Transformation Working Group
• Comprehensive State Mental Health Needs
  Assessment and Inventory of Resources (due to
  SAMHSA 9/2007)
• Comprehensive State Mental Health Plan (due to
  SAMHSA 3/2008)
• Organized around 6 goals of New Freedom
  Commission
• Governance Structure
• Evaluation
• Annual Plan Updates

8
Timeline

• January 07 Transformation Working Group
• March June 07 Chartered Work Groups
• June 07 Work Group Draft Recommendations
• July 07 First Draft Comprehensive Plan
• August September 07 Public Review
• September 07 Final Draft Comprehensive Plan
• September November 07 Action
  Planning/Implementation Teams
• December 07 Final Comprehensive Plan
• Annual Plan Updates

9
Ive Been Here Before!

• Super Waiver - 1993
• System Redesign - 1998

Whats Different This Time?
10

• Autobiography in Five Short Chapters
• by Portia Nelson
• Chapter One I walk down the street. There is a
  deep hole in the sidewalk. I fall in. I am
  lost... I am helpless. It isnt my fault. It
  takes forever to find a way out.
• Chapter Two I walk down the same street. There
  is a deep hole in the sidewalk. I pretend I dont
  see it. I fall in again. I cant believe I am in
  this same place. But, it isnt my fault. It still
  takes a long lime to get out.

11
Chapter Three I walk down the same street. There
is a deep hole in the sidewalk. I see it is
there. I still fall in. Its a habit.., but my
eyes are open. I know where l am. It is my fault.
I get out immediately. Chapter Four I walk down
the same street. There is a deep hole in the
sidewalk. I walk around it. Chapter Five I walk
down another street. Center for Community Change
12
Whats Different This Time?

• Public Health Model (vs. Managed Care)
• Guiding Principles of Resiliency, Recovery and
  Self-determination
• Governor-led cross-departmental planning with
  participation by state agencies, community
  representatives, providers, consumers, and family
  members
• Unprecedented cross-agency collaboration at
  federal and state level
• The real and meaningful involvement of consumers
  and family members in decision making
• System Transformation vs. System Reform,
  Redesign, etc.

13
Transformation Working Group Membership

• Diane McFarland, Chair
• DMH Office of Director
• Co-Chair - Open-Pending
• DMH Office of Director
• Jodi Stefanick
• Sr. Healthcare Policy Advisor, Office of Governor
  
• Anita Morrison
• Consumer Leader
• Consumer Leader - Open-Pending
• Beth Viviano
• Family Leader
• Cindi Keele
• Family Leader
• Robert Qualls
• Division of CPS State Advisory Council Chair

14
Transformation Working Group Membership

• Dora Cole
• DMH Division of CPS
• Mark Stringer
• Director, Division of ADA
• Bernard Simons
• Director, Division of MRDD
• Director - Open-Pending
• Office of Comprehensive Child Mental Health
• Paula Neese
• Director, Childrens Division, Department of
  Social Services
• Tim Decker
• Director, Division of Youth Services, Department
  of Social Services
• Sandra Levels
• Director of Program Management, DSS Division of
  Medical Services
• Paula Nickelson
• Prevention Service Coordinator, Dept. of Health
  and Senior Services

15
Transformation Working Group Membership

• Betty Sims
• Division of Senior Disability Services, Dept.
  of Health and Senior Services
• Mariann Atwell
• Chief of Mental Health Services, Department of
  Corrections
• Sandy Rempe
• Public Safety Manager, Department of Public
  Safety
• Gary Lyndaker
• ITSD-IT Director for DMH, Office of
  Administration
• Asst Commissioner - Open-Pending
• DESE Division of Vocational Rehab
• Asst. Commissioner - Open-Pending
• DESE Division of Special Education
• Missouri Housing Commission - Open-Pending
• Office of State Court Administrators -
  Open-Pending

16
Chartered Workgroups

• 6 workgroups have been chartered to address each
  of the New Freedom Commission Goals
• Broad-based membership representing multiple
  state departments, private community
  organizations and citizens, providers, consumers
  and families across populations
• Over 220 appointed members
• Twice monthly half-day meetings February-June.

17
Workgroup Focus Areas

• Mental Health Essential to Overall Health
• Primary Secondary Prevention including Stigma
  Reduction and Disaster/Trauma Preparedness
• Integrated Health/Mental Health Practice
• Consumer Family Driven System
• Individualized Care Plans
• Consumer/Family Support Networks
• Consumer/Family Involvement
• Disparities Are Eliminated
• Cultural and Linguistic Disparities
• Disparities in Income, Housing, Employment, Other
  
• Geographic Disparities and Local Ownership and
  Investment
• Easy, Early Access
• Tertiary Prevention-Screening, Assessment
  Referral
• Public/Private System Access Capacity
• Evidence-Based Practices

18
So what is this Transformation? - a science
lesson

• Two caterpillars are conversing and a beautiful
  butterfly floats by.
• One caterpillar turns and says to the other,
  "You'll never get me up on one of those butterfly
  things."

19
"One cannot become a butterfly by remaining a
caterpillar."
"In the change from being a caterpillar to
becoming a butterfly, you're nothing more than a
yellow, gooey sticky mess.
20
The Science of Transformation

• We need to deal with the gooey glop that most
  people find uncomfortable. But..
• you have to metamorphose in order to transform
  and that will involve going through the
  discomfort of being less and less a caterpillar
  while you are in the process of becoming a
  butterfly.

21
History Lessons

• Those who cannot learn from history are doomed
  to repeat it.
• George Santayana
• There is nothing new in the world except the
  history you do not know
• Harry S Truman (1884-1972)

22
19th Century History LessonsScientific
Innovations that Transformed Lives

• The Industrial Revolution started with the
  invention of the Steam Engine. The Steam Engine
  changed industry, economy and society butit did
  not produce anything new, it just produced the
  same goods on a larger scale and at high speed.
• Howeverby introducing the vision of a
  Transcontinental Railroad, the Industrial
  Revolution fundamentally transformed the nation.
  It shortened distance and gave people freedom to
  move for the first time in history. It produced a
  national market.

23
20th Century History Lessons21st Century
Transformation(s)

• The Information Technology Revolution started
  with the invention of the Computer. The computer
  brought the ability to process data and perform
  complicated calculations at high speed butit did
  not produce anything new.
• Howeverby introducing the vision of E-Commerce,
  the Information technology revolution
  fundamentally transformed the world. E-commerce
  makes distance disappear. It produced a world
  economy.

24
Do You Remember when there were no.

• Self-service Gas Stations?
• Automatic Teller Machines?
• E-Commerce Airline Tickets?

25
A Final History Lesson

• BEWARE OF THE CONTINUOUS IMPROVEMENT OF THINGS
  NOT WORTH IMPROVING W. E. DEMING
• Becoming Blind to Your Core Purpose Extinction
  (no matter how much you improve your product or
  service)
• TDK Audio Tapes
• Stuckeys

26
One Final Science Lesson-The Power of the Human
Senses

• Our natural senses give us perceptual sensitivity
  that is incredible. Biologically, if your
  physical senses are working normally
• How Far Away from a Burning Candle can you be to
  see it? (once your eyes have adapted to the dark)

27
Biologically, if your physical senses are working
normally, you can

• See a burning candle from 28 miles away if you
  are dark-adapted
• Feel on your fingertips a pressure that depresses
  your skin .00004 inch
• Smell one drop of perfume diffused through a
  three room apartment
• Taste .04 ounce of table salt dissolved in 530
  quarts of water
• See distinguish among more than 300,000
  different colors
• Hear gauge the direction of a sound's origin
  based on a .00003-second difference in its
  arrival from one ear to another
• Thus, we have the sensitivity to be extremely
  perceptive. But.. we typically block our
  sensitivity and it goes unrealized and
  underutilized, just like most of our other
  capabilities and potential.

28
Summing it all Up

• The problem is that most people will only focus
  on doing more of the same thing or just try to do
  the same thing better. They wont see or find a
  new and better way to get something done.
• Consumer Leader
• Technology Work Group

29
The Process of Transformation
30
Innovation Vision Transformation

• Lives Beyond Limitations
• People are free to live their lives and pursue
  their dreams beyond the limitations of mental
  illness, developmental disabilities or substance
  abuse disorders (MODMH)
• Communities of Hope- the vision of a
  transformed system
• Communities of Hope throughout Missouri support
  and sustain a comprehensive system of care where
• promoting mental health and preventing
  disabilities is common practice, and
• everyone at any stage of life has access to
  effective treatment and supports-essential for
  living, working, learning, and participating
  fully in the community.
• (Combined Draft- MO Transformation Application
  NFC)

31
Creating Communities of Hope - what does it mean?

• Community Defined Any place where a group of
  people come together for a common purpose-to
  live, learn, work, worship, socialize, receive
  services, etc.
• HopeDefined To expect, trust, anticipate,
  aspire, dream, plan, wish, look forward to, etc.
• What do Communities of Hope look like/mean to
  you?

32
What Missouri Consumers and Families are telling
us

• In a Community of Hope
• My child will be valued as a person who can live,
  work and worship without being stigmatized as the
  mental one or the retard.
• Somebody would notice the onset of my mental
  illness. (Mine occurred in college while living
  in a dorm and nobody noticed.)
• Medications are seen as a tool to be used as part
  of a continuum of care, and not to be used when
  they are ineffective or no longer needed.

33
In a Community of Hope

• There is no fear of improving just enough to lose
  my services and then needing them again. I would
  be able to get services before I try to commit
  suicide and need to be hospitalized. I would not
  have to wait for months before I qualify for
  services. People would be able to get help before
  they lose everything. People would be able to
  work and not lose needed services.
• I would have opportunities/supports to go back to
  work, get out of the boarding home and live on my
  own.

34
In a Community of Hope

• The public is educated about mental illness and
  there is no stigma. People see me as having a
  purpose in life, intelligent enough to work,
  capable of responsibility. I would have better
  access to a computer just to educate myself on
  what is going on in the mental health field.
• Locating and accessing services is easythe
  resources available are out in the open. Once you
  have accessed services you dont have to continue
  receiving services from a case manager, etc. just
  to be able to keep other services that benefit
  you.
• The way out of the system is always visible.

35
In A Community of Hope

• I have something to do to help keep my mind off
  of myself/problems and out of trouble.
• People are able to pursue goals and dreams
  without being treated as if goals and dreams are
  for others. They are treated as if they are just
  as smart as others. My mental health and
  physical health needs are being treated together
  and I know when one may be affecting the other.
  People understand that medication is only part of
  the solution.
• Services are coordinated, integrated delivered
  for all Missourians in non-stigma settings.

36
What Do Communities of Hope Look Like To
You? In a Community of Hope (Your
statement here)OptionalFeel free to work with
the person beside you!We would love to know what
part of Missouri you are from and what
perspective you are representing (e.g. consumer,
provider, interested citizen, family member,
etc.)Also, feel free to add your name and
contact information!
37
The Need to Transform- a few parting thoughts

• Most people with mental disabilities (MI DD)
  want to work and can work (some with
  supports)yet they have the lowest rate of
  employment (and highest rate of poverty) of any
  disability group.
• People want to recover and can recover yet
  recent studies have shown that the average life
  span of a person with a serious mental illness is
  25 years less on average than the general
  population.
• Can we really be successful if we just do more of
  the same thing or try to do it better?

38
Dedication

• Geody Frazier, a friend, esteemed colleague and
  appointed member of the Transformation Working
  Group recently died in his hometown of Kansas
  City. He was 53 years old. Geody was a driving
  force in creating Missouris transformation
  vision Creating Communities of Hope. Shortly
  before his death, Geody dedicated his talents to
  bring this vision to life through his creative
  artwork including the symbolic messages contained
  on your cards today.
• Geody was know for his compassionate,
  collaborative, yet very straightforward approach
  to life. He taught us that we would only get good
  results if we listened to the real experts. In
  his words, The titles and letters that come
  after my name may not mean the same thing as
  yours, but I do have many that go with all my
  diagnoses. That makes me somewhat of an expert,
  on a personal level.
• Goedy leaves us with a powerful legacy. His
  legacy is our vision. It is with renewed passion,
  hope and commitment that we will move forward to
  make it real. Andwe know we will only be
  successful if we are guided by the real experts
  every step of the way. We hope youll join us.

39
(No Transcript)