Mental Health System Transformation

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Mental Health System Transformation
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The Commissions Vision
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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.
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Defining Transformation
a continuous process, without endmeant 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,
U.S. Department of Defense
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The Transformation Equation
T (V B A) ? (CQI)2
Transformation ? (Vision ? Belief ? Action) ?
(Continuous Quality Improvement)2
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Transformation as a Strategy
for Innovation
A Few Big Jumps New rule sets that leverage new
ideas.
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.
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Steps Toward Transformation
Broad Inventory
Strategic Assessment
Vision Described
Alignment
Investment in Change
Begin to Transform Record Model
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Catalysts for a Transformed System
Research
The Golden Triangle of
Systems Change
Funding
Policy
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The Science to Services Initiative
The Science to Services Initiative is embedded in
the transformational agenda.

• Research/services collaborations will be critical
  to inform and facilitate the transformation
  process.
• An effective CMHS/NIMH partnership is essential
  to ensure rapid progress in moving science to
  service and service to science.
• Significant opportunities exist to integrate a
  national mental health research agenda into
  mental health system transformation efforts.

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The Goals of a Transformed System
Goal 1 Goal 2 Goal 3 Goal 4 Goal 5 Goal 6
Americans understand that mental health is
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.
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An Effective Science to Services Partnership
Requires

• We do business in a different way
• All involved parties benefit from the activities
  of the work undertaken jointly
• Each member brings ideas and resources to the
  table
• The process includes cooperation, collaboration,
  and prioritization
• All must understand the key role played by States
  in developing, improving, and maintaining an
  infrastructure
• The Science to Services process is one that
  concerns us all, and if done properly, it will
  benefit us all.

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SAMHSA Science to Services/ Transformation
Activities
Mental Health Transformation Grants

• Are a key component of SAMHSAs mental health
  system transformation strategy
• Will facilitate the development and
  implementation of comprehensive State mental
  health plans
• Offer an unparalleled opportunity to better our
  understanding through research about how to
  effectively create a system that is fully
  responsive to the needs of the people it serves

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SAMHSA Science to Services/ Transformation
Activities
Strategic Prevention Framework

• Involves a step-by-step process that empowers
  communities to identify and implement the most
  effective substance abuse prevention and mental
  health promotion efforts for their specific needs
• Is designed to engage communities and
  practitioners in the translation process and
  performing local process and outcome monitoring
  activities
• Will ensure accountability, program
  effectiveness, and feedback to the research
  community
• Will be invaluable as we begin the process of
  transforming the Mental Health System

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SAMHSA Science to Services/ Transformation
Activities
Re-engineered Discretionary Grant Program

• Includes four standard funding mechanisms that
  follow the Strategic Prevention Framework
• Infrastructure Grants
• Best Practices Planning and Implementation Grants
• Service Grants
• Service to Science Grants
• Ensures that planning and allocation of funds can
  proceed upon release of the Presidents
  budgetproviding ample time to collaborate with
  NIMH to develop GFAs or program announcements
• Understands that collaboration with NIMH can
  affect how dollars are allocated across the
  science to services cycle by providing
  intelligence about the status of specific
  programs/practices in the field

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SAMHSAs National Registry of Effective Programs
and Practices (NREPP)
NREPP Review Summary As of August 2004
1,124 submitted
1,039 reviewed
57 Model
63 Promising
52 Effective
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National Evidence-Based Practices (EBP) Project
The Six Current EBP Toolkits

• Illness Management Recovery
• Medication Management Approaches in Psychiatry
• Assertive Community Treatment
• Family Psychoeducation
• Supported Employment
• Co-Occurring Disorders Integrated Dual
  Disorders Treatment

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Components of a Transformed System

• Focus on Recovery
• Evidence-based Practices
• Comprehensive State Mental Health Plans
• Individualized Plans of Care

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Recovery
Because recovery will be the common, recognized
outcome of mental health services, the stigma
surrounding mental illnesses will be reduced,
reinforcing the hope of recovery for every
individual with a mental illness.
New Freedom Commission on Mental Health July 2003
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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
  ones own life

There is a growing evidence base that supports
the concept of recovery.
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The Recovery Research Agenda
How Do We Define It?

• CMHS-sponsored National Consensus
  Conferencebrought together researchers,
  policymakers, consumers, families, and other
  stakeholders to identify a commonly understood
  definition of recovery
• The Consensus Conferencea partnership with the
  Department of Educations Interagency Council on
  Disability Researchis a model for interagency
  efforts
• NIMH participation is vital to developing a
  uniform, operational definition of recovery.

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The Recovery Research Agenda
How Do We Measure It?

• System LevelA number of longitudinal studies
  have examined recovery processes and outcome
  measures
• Visit the Repository of Recovery Resources Web
  site
• http//www.bu.edu/cpr/recovery
• Individual LevelCMHS is currently developing a
  prototype Consumer Report Card to examine
  individual measures of recovery that embody
  consumer values
• NIMH can assist CMHS in determining interventions
  that are scientifically effective in supporting
  recovery.

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The Recovery Research Agenda
How Do We Put It Into Practice?
NIMH and CMHS can collaborate to develop an
implementation plan to apply the recovery
construct in policy and practices.
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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.
President Abraham Lincoln Second Annual Message
to Congress December 1, 1862