Transforming Americas Mental Health Care

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Transforming Americas Mental Health Care
A. Kathryn Power, M.Ed., Director Center for
Mental Health Services
July 25, 2005 Washington, DC
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The 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.
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Federal Partners Workgroup
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Federal Action Agenda First Steps(available
online at www.samhsa.gov)

• Provides a model for shared responsibility at
  State and local levels
• Features the five principles around which the New
  Freedom Commission on Mental Health framed its
  work and its vision
• Describes the "state of success" for each
  principle
• Highlights current activities and proposes Year 1
  action steps for each principle

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The Framework for SAMHSAs Federal Action Agenda
for Mental Health
Five principles guiding the work and vision of
the New Freedom Commission, which focus on

• Consumer opportunity for a full life in the
  community
• Models of comprehensive, community-based care
• Maximization of existing resources
• Use of research findings to influence service
  delivery
• Promotion of innovation, flexibility, and
  accountability at all levels of government

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Medicaid and Mental Illnesses

• Medicaid is the largest single payer of mental
  health services in the United States.

State Mental Health Financing Trends
1987 1992 1997 2002
2007 2012 2017
Estimated
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Homelessness and Mental Illnesses
Two million Americans experience homelessness
each year about half have a mental health
problem.
Individuals who are chronically homeless are
likely to Have acute and chronic physical health
problems Use alcohol and drugs Have escalating,
ongoing psychiatric symptoms Become victimized
and incarcerated
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Unemployment and Mental Illnesses

• Individuals with mental illnesses have one of
  the lowest rates of employment of any group with
  a disability.
• Only about one in three persons with a serious
  mental illness is employed.

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Justice and Mental Illnesses

• Each year, U.S. jails and prisons admit about
  800,000 persons with serious mental illnesses.

Of teens in juvenile detention centers,
two-thirds of boys and three-quarters of girls
have at least one psychiatric disorder.
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SAMHSAs National Outcome Measures for Mental
Health

• Decreased mental illness symptomatology/improved
  functioning1
• Increased/retained employment (adults) return
  to/retention in school (children)1
• Decreased criminal justice involvement1
• 1Developmental

(Cont.)
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SAMHSAs National Outcome Measures for Mental
Health

• 4. Increased stability in family and living
  conditions
• 5. Increased access to services
• (number of persons served by age, gender, race,
  and ethnicity)2
• Reduced utilization of psychiatric inpatient beds
  
• (rates of admission for 30 and 180 days)1, 2
• 
  
  

1Developmental 2Required by the Office of
Management and Budget Performance Assessment
Rating Tool (PART) review
(Cont.)
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SAMHSAs National Outcome Measures for Mental
Health

• Increased social supports/social
• connectedness3
• Client perception of care outcomes2
• Use of evidence-based practices (EBP)
• (cost effectiveness measure)
• (number of persons receiving EBPs and number of
  EBPs provided by State)2
• 2 Required by the Office of Management
  and Budget Performance Assessment Rating
  Tool (PART) review
• 3 For Access to Recovery, social
  support of recovery is measured
  by client participation in voluntary recovery or
  self-help groups as well as
  interaction

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Mental Health Transformation SIGs

• Seed money to help States develop the
  infrastructure needed to meet the comprehensive
  needs of consumers and families.
• Nearly 19 million has been allocated for fiscal
  year 2005.
• Applications currently are being reviewed.
• Grantees must comply with the essential
  principles of transformation.

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Transforming State Mental Health Systems

• Partnership between CMHS and the NGA Center for
  Best Practices
• Four regional meetings to bring together
  influential State teams to
• Create a vision for transformation in their
  States
• Reach consensus on priorities and strategies for
  achieving their vision

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State Implementation of Transformation Goals

• The majority of State mental health agencies
  are
• Working with Medicaid and State health
  departments to better integrate mental and
  primary health care
• Reducing fragmentation of services across
  agencies
• Adopting recovery mission statements and
  developing recovery-oriented services
• Providing prevention and early intervention
  services
• Investing heavily in technology to enhance
  quality and accountability

Source State Profile Highlights, May
2005 NASMHPD Research Institute, Inc.
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Principle D
Consider how mental health research findings can
be used most effectively to Influence the
delivery of services.

• Goal 5. Excellent mental health care is
  delivered and research is accelerated
• Accelerate research to promote recovery and
  resilience and, ultimately, to cure and prevent
  mental illnesses
• Advance evidence-based practices using
  dissemination and demonstration projects and
  create a public-private partnership to guide
  their implementation
• Improve and expand the workforce providing
  evidence-based mental health services and
  supports
• Develop the knowledge base for
• Eliminating mental health disparities
• Assessing long-term effects of medications
• Reducing the impact of trauma
• Improving acute care

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Implementation Resource Kits www.mentalhealth.samh
sa.gov

• 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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Science-to-Service Cycle
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• Recovery

is a process, sometimes lifelong, through which a
person achieves independence, self-esteem, and a
meaningful life in the community.
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Patients' Diversity Is Often DiscountedAlternativ
es to Mainstream Medical Treatment Call for
Recognizing Ethnic, Social Differences (Sunday,
June 26, 2005 A01)
Social Network's Healing Power Is Borne Out in
Poorer Nations (Monday, June 27, 2005 A01)
Racial Disparities Found in Pinpointing Mental
Illness (Tuesday, June 28, 2005 A01)
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• Research and Recovery

We have always held to the hope, the belief,
the conviction, that there is a better life, a
better world, beyond the horizon. Franklin
Delano Roosevelt
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