Transformation: ACMHA, The President’s Commission, And the Change that we Seek

1. Transformation: ACMHA, The President’s Commission,And the Change that we Seek

2. (How DO we) Be the change that we want to see in the world.Mohandas Gandi Beginning (and concluding) thoughts… (Can we become) A small group of thoughtful people (to) change the world. Indeed, it's the only thing that ever has. Margaret Mead

3. Our Ideas: Comments on Selected Group Recommendations • De-stigmatize mental illness through direct contact, education, legislation • So much talk about stigma, so little action • Gauge audiences, tailor effective messages to influence power • YES to using communications technology • Next year: “Success Off” (Transformation successes) • Time to use a strengths-based approach! • ACMHA’s agenda should include innovation/ transformation skill development • YES: much known, little applied about science of change • Align business and financing models • Crucial: it’s not just policy and program • Support adoption of the 10 IOM rules to guide care delivery • Yes: IOM frame is right, IOM report on mental health will be “next new thing” providing momentum to field

4. But: Group Recommendations Perhaps Reflect a Too-Low Priority on Some Key Issues • Recovery: 5x…Are We Clear About the Vision? (and resilience, equity) • Medicaid: 1x…One recommendation re: the Biggest Funding Stream? (NB lots of conversation)

5. Illustrative Medicaid Dynamics; Ohio Department of Mental Health Community GRF (502+508+408) and Medicaid FY 1990 – FY 2007 (est) Deflated 3% per year millions millions $200 $200 Medicaid FFPMedicaid MatchRemaining GRF $150 $150 $100 $100 $50 $50 $0 $0 -$50 -$50 -$100 -$100 The Squeeze -$150 -$150 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007

6. Group Recommendations Perhaps Reflect a Too-Low Priority on Some Key Issues • Recovery: 5x…Are We Clear About the Vision? (and: resilience, equity) • Medicaid: 1x…One recommendation re: the Biggest Funding Stream? (NB lots of conversation) • IT/Internet/Software…One Mention: with Internet, Network of Care, Emergence of EMR, shouldn’t we be more focused?

7. Provocative Questions About Group’s Dialogue(Observations of “Roving Reporter” Arthur Evans) • Inclusiveness: More usual suspects, or others? • Transformation: Is it a process or outcome? (yes) If we are “doing transformation” is it enough? • What is the end point? • Treatment system change? • Changed societal approach to mental health and illness • Do we assume transformation and success requires more resources? Is this right? Is it likely? • Are transformations often stimulated by crisis? Can we do this without a crisis? • Can we learn from our history? • Deinstitutionalization • What happened following the Carter Commission

8. Some Reflections • Revisiting the Commission’s logic • Thinking about change

9. President’s Commission:The Contextand the Commission’s Approach • Presidential Commissions Are: • Rare Opportunities in Mental Health • Don’t blow it… with White House, shareholders • “Recommenders” not “Implementers” • Do the job we were assigned, AND • Leave a menu of opportunities Transformation was not Achieved by the Commission: It Depends on Action that We and Others Will Advance

10. What Problems Does Transformation Address?The NFC’s Diagnosis of Mental Health Care • The public mental health system is not oriented to recovery: • Late detection/intervention • Not consumer-centered, or deeply oriented to recovery…unintended ”maintenance” focus • Uneven quality/poor use of evidence based interventions, massive workforce problems • While care is not accessible in sectors/settings where it is needed: • Schools, early education, child welfare, JJ • Health care settings, law enforcement/criminal justice, workplaces, disability programs

11. Transformation is needed because OF REFORM: Our old mental model of community mental health SAMHSA-CMHS Federal level DMH State level Funding? County Local level Case Mgt. M.H. Care Social Services Coordinated Care School Child Court Clinic Income Support Meds

12. Complexity of Services and of Change after “Reform” HRSA Justice Medicaid CMHS ACF Education SSA DMH State Medicaid Agency Ed/SpEd.. Health DYS DSS BDD County Case Mgt. M.H. Care Social Svce LEA/School Family Child Court Meds ? Income Support Clinic

13. Because “Reform is Not Enough”…The Commission Proposed: • Transforming Mental Health Care, not Reforming It • Vision for Mental Health in America • National (and State and Local) Goals

14. Vision For A Transformed Mental Health System We envision a future where recovery and resilience are the expected outcomes and when mental illnesses can be prevented or cured. We envision a nation where everyone will have access to early detection and the effective treatment and supports essential to live, work, learn and participate fully in their communities.

15. This is Why “Reform is Not Enough”…The Commission Proposed: • Transforming Mental Health Care, not Reforming It • But, what is “transformation”? • Not: reform…to be “implemented” or “rolled out” • Linked Actions, at Many Levels • Large and Small Actions adding up to Dramatic Change • Change in Processes, Not Just Programs (e.g. “Using the Skills of Consumers and Families to Advance Recovery and Resilience”)

16. 24 -7 Copying Services across the country When it absolutely positively has to be there overnight – Order tracking and services Discounts with leather and screens Search the world with google-bots On-Line Auctions with volume The home of the Macintosh finds new music and a shuffle Mainframes to Services; in and out of PCs. From private banking to the #1 worldwide servicer of mutual funds and pensions and investment management of pensions. From Tweed to teen fashion with lust Examples of Business Transformation (Dick Dougherty) New Business Models and Products Transforming their Markets Discount Flights with transparent pricing for peanuts Businesses with Internal Transformations

17. Democratic Strategy Republican Strategy (since early ’80s) Political Transformation: Which Approach Has Been Effective? President Political Machinery Concept Communicators Concept Generators Big Focused Money

18. This is Why “Reform is Not Enough”…The Commission Proposed: • Transforming Mental Health Care, not Reforming It • But, what is “transformation”? • Not: reform…to be “implemented” or “rolled out” • Linked Actions, at Many Levels • Large and Small Actions adding up to Dramatic Change • Change in Processes, Not Just Programs (e.g. “Using the Skills of Consumers and Families to Advance Recovery and Resilience”) • Transformation is adaptive change…nonlinear change occurring via a “punctuated equilibrium” model • Transformation is like Recovery: • A process as well as an outcome • To paraphrase Ed Knight: No one can “transform” someone else…each must do their own work…. hope and supports are essential

19. Seven Ways of Leading (HBR April ’05)Managers Can Grow. WE can Grow. We can Grow Others. Action Logic Characteristics/Strengths % Mgrs

20. What Are Our Responsibilities? What Can Leaders Do? • First, do as little harm, and provide as little energy-sapping “leadership” as possible • Balance stabilizing and de-stabilizing forces. • Be clearer about which changes are transformational • Create capacity, don’t “roll out”: • Hope, motivation, energy for change • Tools • Toolkits plus • Information and platforms for learning • Infrastructure for change: • Support, participate in Leaning Communities • I. D. and support: Salesmen, Mavens, and Connectors • Facilitate “flow”

21. (How WILL we) Be the change that we want to see in the world.Mohandas Gandi Beginning (and concluding) thoughts… (Let ACMHA Become) A small group of thoughtful people (to) change the world. Margaret Mead

22. Thank You