Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Mental Health Transformation in Action: Cross-System Collaboration for Consumers and Stakeholders
Keynote Address
March 16, 2007
Miami, FL
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Today is May 16—your day to honor excellence by people who are transforming mental health care in your community. Quite coincidentally, today also is the anniversary of the first Oscars, or the popular name for the Award of the Academy of Motion Picture Arts and Sciences. The first Oscars were given in 1929. Since then, nearly every industry has created its own special award to recognize excellence and achievement.
We at the Substance Abuse and Mental Health Services Administration (SAMHSA) have our own award. Two years ago, we introduced the “Voice Awards.” Our awards recognize writers and producers who give a face and a “voice” to individuals with mental illnesses. They do so by using dignified, respectful, and accurate portrayals of them in film, TV, and radio productions. Our Voice Awards also acknowledge the tireless efforts of consumer leaders across the country. Sandra McQueen-Baker, of Fresh Start of Miami-Dade, received a consumer Voice Award last year. In fact, she and I had a chance meeting in an elevator in Los Angeles, which led her to invite me here today. Sandra, thank you for including me in this celebration.
The awards that you make at this luncheon, similar to the Oscars or the Voice Awards, are a wonderful idea. We need to recognize excellence in action…to call attention to the incredible achievements of those who believe in a more enlightened, humane, and recovery-focused mental health system…and who also act to make this system a reality. Let me extend my most heartfelt congratulations to the people who soon will be honored. Roll out the red carpet—you are the shining stars of this event.
I’d now like to issue a casting call to everyone else in the audience. You, too, have a major part to play in making transformation of the mental health system a reality. No role is too small, no part can go unfilled. Transformation ultimately is about newness—about new values, new attitudes, and new beliefs that are expressed in new behaviors of people and institutions. The greater the number of people who abandon the antiquated myths, outdated science, and outmoded financing of current mental health care, the faster transformation will occur.
Today, I’d like to discuss the three overlapping elements of successful transformation of the mental health system. The first two are leadership and cross-system collaboration. The third element is the inclusion and empowerment of consumers as a vital and indispensable foundation for change.
Transformation implies a sharp break with the status quo. Consequently, the kind of leaders we need to guide transformation must possess the courage and conviction to move bravely from old methods to bold actions.
Judge Steven Leifman is a good example of a transformational leader. At age 18, he was exposed to the conditions under which individuals who have a mental illness are incarcerated. His concern for their plight stayed with him as he grew in his career. The higher he rose in the judicial ranks, the greater his efforts to engage the system and others in radical change. Driven by a vision of what could and should be, Judge Leifman became empowered…and empowering. Today, he is nationally recognized as a caring, compassionate, and effective reformer. Here in Miami-Dade County as well as in Florida, he has become a champion for mental health reform.
Judge Leifman’s evolution as a transformational leader demonstrates the paradox of change described in Robert Quinn’s book entitled Deep Change: Discovering the Leader Within. The paradox is that we cannot change the system around us until we have experienced personal change within us. Quinn writes,
“All of us are potential change agents. As we discipline our talents, we deepen our perceptions about what is possible….We then bring a discipline to our visions and grow in integrity. Life becomes more meaningful. We become empowered and empowering in our context. Having experienced deep change within ourselves, we are able to bring deep change in the system around us.”
Each of you—consumers, law enforcement professionals, service providers, and others—can be a change agent. You do not need to be a judge or a high-ranking administrator to pursue a vision and inspire others to follow. Leaders often are ordinary persons who are driven by their humanity to achieve extraordinary results.
Lance Secretan is a British pioneer in leadership theory and team motivation. In his words,
“Leadership is not so much about technique and methods as it is about opening the heart. Leadership is about inspiration—of oneself and of others. Great leadership is about human experiences, not processes. Leadership is not a formula or a program, it is a human activity that comes from the heart and considers the hearts of others. It is an attitude, not a routine.”
Transformation of the mental health system has much to do with human experiences. Let’s consider your ongoing efforts to reform the treatment of individuals with mental illness who come in contact with law enforcement. According to the National Alliance for the Mentally Ill, or NAMI, about 40 percent of individuals with serious mental illnesses will come in contact with the criminal justice system at some time. Nationwide, at least 300,000 individuals with mental illnesses are in our jails and prisons. Another half-million are on probation. The problem is particularly acute here in Miami-Dade, which may have the highest percentage of individuals with serious mental illnesses of any urban community in the country.
Pete Earley’s book, Crazy: A Father’s Search Through America’s Mental Health Madness, took a particularly close look at local—but hardly isolated—conditions. So did the “Forgotten Floor,” the news story that sparked moral outrage in your community and is leading to necessary changes.
Let me take a moment to commend the many people it took to bring that story to television and to those who continue to pursue reform measures. Your efforts bring to mind the challenge issued by Martin Luther King, Jr. In urging others to support equal rights for all Americans, he said,
“Cowardice asks the question, ‘Is it safe?’ Expediency asks the question, ‘Is it politic?’ Vanity asks the question, ‘Is it popular?’ But, conscience asks the question, ‘Is it right?’ And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but one must take it because one’s conscience tells one that it is right.”
To the shame of our Nation, there is hardly a community in America that doesn’t need better solutions to the needless and inappropriate jailing of nonviolent consumers who come in contact with the judicial system. Justice facilities never were intended to be mental health treatment centers. The aims and conditions of incarceration actually work against recovery. The classic purposes of incarceration are punishment, deterrence, and rehabilitation. Note that the first purpose is punishment. Incarceration takes from individuals any control over their own lives, making them feel powerless and vulnerable. It can worsen the distress felt by a consumer and intensify symptoms. Punishment will not “cure” a mental illness—but it can make it worse.
The second purpose of incarceration is deterrence. For deterrence to work, a person must have the motivation and the social and economic alternatives to avoid another arrest. For many persons with mental illnesses, these alternatives simply do not exist. Many have co-occurring disorders. Many are unemployed. They are twice as likely as other inmates to be homeless. If they are released back into their community with minimal provision for treatment and follow-up services, the conditions contributing to their arrest have not changed. The prospect of recidivism is highly likely.
Rehabilitation holds out some prospects for success if a person’s recovery is such that he or she has the capacity and ability to respond. Recovery, however, is based on consumers having access to a range of services and supports. This may seldom be the case in a justice facility.
The bottom line is this: inappropriate incarceration of persons with mental illnesses is neither effective nor fiscally and socially responsible. It wastes money, it wastes valuable recovery time, and it wastes lives.
More effective mental health treatment within the judicial system is critical to transformation. However, more effective mental health care outside of and in collaboration with the judicial system also is critical. We need these improvements to reduce the burden of care placed on the judicial system…and we need these improvements to move us closer to the overarching goal of transformation, which is a system focused on recovery.
What do I mean by “recovery”? According to the consensus developed through SAMHSA,
“Mental health recovery is a journey of healing and transformation for a person with mental health problems to achieve full human potential or “personhood” in leading a meaningful life in communities of his or her choice.”
A few words based on a wealth of beliefs! The most unshakable premise is that every individual desires the most simple, basic, and universal goal of human experience: to be a contributing and valued member of his or her community.
To achieve this goal, consumers need seamless access to jobs, housing, transportation, and other aspects of life that support recovery. To achieve this goal, any system that touches the lives of children, families, and adults must assume some responsibility—some accountability—in promoting mental health and recovery among the people it serves.
I’m thrilled that so many different systems are co-sponsoring this event today. Cross-system collaboration is essential to transformation. SAMHSA’s first step toward implementing the recommendations of Achieving the Promise, the final report of the President’s New Freedom Commission on Mental Health, was to form a Federal Partners Workgroup. Our group includes nine Federal departments, the Social Security Administration, and the Equal Employment Opportunity Commission. Among the departments are housing and urban development, justice, labor, and the veteran’s administration, as well as health and human services. The departments of agriculture, defense, and transportation are the newest members of our group. We intend for the actions we take at the Federal level to be a model for collaboration at the State and local levels.
Cross-system collaboration not only is possible, it is absolutely phenomenal in what it can achieve. I’m going to read two excerpts from your grand jury report on mental illness and the criminal justice system in Miami-Dade. These excerpts correspond to the report’s title of “A Recipe for Disaster—A Prescription for Improvement.”
The first excerpt describes the outcome of a lack of coordinated services across systems:
“For many inmates [with mental illnesses, the medication, counseling, and treatment they receive in prison] restores their mental stability. They are then released back into the community with no case managers and no follow-up treatment and eventually their mental instability returns….Eventually, they will do something that will bring them to the attention of the police and they will be arrested again. The cycle begins anew.”
The second excerpt describes the outcome of your jail diversion program that links individuals with mental illnesses to community-based services such as housing and treatment. The report reads like this:
“Does [the jail diversion] program work? Since its inception, there has been a drastic reduction of arrests….Prior to creation of the program, the recidivism rate for this population was estimated to be approximately 70 percent. It was reduced to 18 percent in the first year of operation and dropped an additional 2 percent the next year.”
Now that’s transformation in action! In addition, the collaboration that has developed through your jail diversion program is making a huge difference in the community. In working to decriminalize mental illness…and to get people off the streets, out of jail, and into services they need…your community partners are working better together and have more open communication than ever before. The evidence is right here in this audience.
A cost analysis of your program revealed a conservative cost savings to Miami-Dade County of $2.5 million in just one year. Your results are a clear signal to other communities in other States that better and more broad community-based services are both effective and cost efficient. Creating model programs that other States can replicate also transformation in action! SAMHSA is proud to have contributed one million dollars to your program expansion.
We also commend your efforts to train police in crisis intervention team (CIT) training. Since your training efforts got underway in 2004 with a SAMHSA grant, you’ve trained more than 12,000 officers—more than any other community in the United States. Thank you to CIT-trained individuals in this room. Your willingness to step outside of traditional police training is helping to make alternatives to needless imprisonment possible.
Let’s talk now about the role of consumers in transformation. SAMHSA’s collaborative efforts are aimed at moving policies, practices, and financing away from bureaucratic constraints to human need. We also are moving toward greater inclusion of consumers in determining what services or supports promote recovery. No one can speak about recovery with more passion, knowledge, and understanding than consumers can. No one is better informed about what works and doesn’t work in promoting and sustaining recovery. The real-life experiences of consumers speak of vision, determination, and—most important—hope for those who have mental illnesses.
Last year, SAMHSA declared 2006 as the Year of the Consumer. We began to develop prototypes for individualized plans of care. We started evaluating shared decisionmaking, which is when consumers and providers work together to make informed choices among treatment options. We are nearly done with a step-by-step guide to help States develop peer specialist programs. When it’s completed, we will send it out to constituency groups in all of the states. We’re excited about the guide because many services provided through certified specialists are Medicaid-reimbursable.
Consumers are the bridge between the mental health system as it exists now…and the system as it should be. It is their life, future, and hope for recovery at stake. Therefore, it is their needs, wants, and goals for recovery that should drive the decisionmaking process. Creating a system that meets their needs fully is not just a critical part of transformation, but the reason for undertaking the difficult and necessary work ahead.
Recovery, as I defined it earlier, is based on several fundamental principles, all of which assert the consumer’s rightful place at the heart of care. Recovery is a process that builds on the strengths of each individual. The process is nonlinear and self-directed. It is individualized and person-centered. It is holistic. It empowers consumers to make decisions that impact their lives. It recognizes the valued role of consumers in supporting others as they continue on their own journey toward recovery. It involves society’s respect for consumers and their rights. It involves a consumer’s responsibility, courage, and hope in moving toward recovery.
Consumer-driven care will grow out of a culture that fully embraces these principles. Cross-system collaboration that draws upon the insights of consumers…creates leadership opportunities for them…and values the healing power of peer-provided services can unlock amazing new doorways into recovery.
All facets of the mental health system, such as justice, child and family welfare, and education, have a responsibility to develop ways to accept the many different gifts offered by consumers. The steps to take may be as simple as conducting planning meetings at times that do not conflict with other activities that support recovery, such as employment. Another step that you already are taking is to establish peer specialist positions within your organizations.
I’d like to close with a passage from the final report of your Mayor’s Mental Health Task Force. Its members wrote, “…the current shortcomings of the community mental health and criminal justice systems did not arise recently, nor did they arise as the result of any one stakeholder’s actions or inactions. None of us created these problems alone, and none of us will be able to solve these problems alone. As a community, we all must be part of the solution.”
Please heed those words. None of us are as smart as all of us…and all of us are needed to transform America’s mental health system. With leadership, cross-system collaboration, and the meaningful involvement of consumers, we will succeed. Thank you.
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