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Grant aims to
'transform' mental health care
(July
2006 Issue)
By Catherine Robertson Souter
A war is being fought in this country that when won, will benefit
everyone. In 2001, President Bush declared war, so to speak, on
the health care system for disabled Americans. The New Freedom Initiative
was created to promote increased access to educational and employment
opportunities for people with disabilities, including mental health
disabilities. One year later, he created the New Freedom Commission
on Mental Health, designed to specifically address the problems
in the current mental health system that limit treatment for those
in need. The problems were identified as threefold: the stigma that
surrounds mental illness; treatment limitations on insurance benefits;
and the fragmented mental health delivery system.
As part of the Commission's goals, states were offered federal
grants through the Substance Abuse and Mental Health Services Administration
(SAMHSA) to design, create and implement massive transformations
of state-wide systems of mental health care. In 2005, seven grants
were awarded. Connecticut was the only New England state to win
an award.
For nearly six years, Connecticut's Department of Mental Health
and Addiction Services (DMHAS) has been working to transform its
system of care to one of a recovery-oriented system. It is this
work, already started before the grant application that helped the
state receive its award of $13.6 million.
"For two years, from 2000 to 2002, we worked with consumers and
advocacy groups to identify recovery principles and values," explains
Wayne Dailey, Ph.D., the agency's public information officer and
senior policy advisor. "Thomas A. Kirk, Jr., Ph.D., commissioner
of DMHAS, issued a policy statement that made developing a recovery
oriented system of care the overarching goal of all we do. It wasn't
just a new program started as an office down the hall. It's woven
into everything we do: physical, clinical, quality monitoring, policy
training, everything."
With the award, the state has been able to increase the scope of
its plan, incorporating 13 other state departments, the Judicial
Branch, consumers and family members, along with state and private
providers.
"A total of 15 different agencies in Connecticut government are
involved," says Dailey. "DMHAS is the lead agency." The grant money
will be distributed to the state over the course of five years,
during which DMHAS will be expected to first create a plan of action
and then follow it through to implementation.
The grant money is intended to help states strengthen the infrastructure
of their mental health delivery system and must not be used for
mental health services or programs themselves.
"As budgets across the nation are cut for mental health, the dollars
that get cut are usually the infrastructure dollars, dollars that
go for training and education, for the pieces of the system that
supports the work we do," says Pat Rehmer, MSN, deputy commissioner
of DMHAS and chairperson of the Mental Health Transformation Grant.
"No one wants to cut services. The system has been ebbed away at
over the years so we need to build infrastructure back up in order
to change the way mental health services are delivered."
During this first year of the program, Connecticut has created
seven work groups to address concerns about the mental health system.
Made up of members of the various agencies along with patients,
families, advocate groups, private and public stakeholders and local
and state professional organizations, each of the groups meets regularly
to evaluate specific concerns and recommended solutions.
One of the bonuses of the workgroups is having all of the agencies
and other parties affected by the mental health care system sit
down together and discuss how that system works.
"The transformation process is really to address the issues that
were raised in the president's New Freedom Commission report. One
of the overarching concerns of the report was that there is too
much fragmentation. People are getting services from different agencies
that had no infrastructure to talk to one another, share information
or coordinate retention in care and continuity of care," Dailey
says.
The workgroups will each write up a final report addressing successes
and failures, a needs assessment and suggestions for transforming
the system. It can be a monumental job, given the number of people
within the workgroups and their varied backgrounds.
"As you can imagine with 150 people across seven workgroups, building
consensus is a bit of a task. But, I went to two workgroups yesterday
and I was shocked at how much consensus we did have. People are
really thinking about the larger system and what we need to do to
get where we need to be," Rehmer says.
Each workgroup will complete a final report with recommendations
for change by the end of the first year of the grant and a written
report will be submitted to SAMSA. Once the plan is approved by
the federal agency, the state's next task will be to implement its
transformation plan. Although the transformation grant program is
a five-year process, organizers realize it won't be complete after
such a relatively short time.
"We don't think that $13.6 million over five years is going to
transform the mental health system. It's not like we are going to
spend this money over the next five years and say, 'okay, we're
done.' We see this as funding that will help start the process of
how we are thinking about the system and how it's funded." Rehmer
says. "This is the beginning of process and it's very exciting.
In the short time we've been working on this, you begin to see how
the agencies can talk to each other. For me, this is one of most
exciting parts. It will be interesting to have a conversation a
year from now and see where we are. In a year from now, we'll be
doing some pretty exciting things," she adds.
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