Transforming Mental Health Care to Achieve Lasting Recovery: CMHS Block Grant and Statistics Annual Conference. June 1 – 4, Washington DC

Sylvia Caras, PhD

Lots of familiar faces, more than I will enumerate. More than 5% of listed presenters are consumers. The word survivor seems to have dropped from the vocabulary and discrimination and stigma are no longer goals in the version of the SAMHSA matrix in our materials.

SAMHSA is coordinating a coalition with 17 other agencies to further transformation of the mental health services to achieve lasting recovery.

Fineberg, President, Institute of Medicine, need to reform health care industry. What medicine must "do for" patients. (I think we will have a true transformation when the medical mindset is "do with." S.) Medical errors are one of the top ten causes of US deaths. Health care should be safe, effective, patient-centered, timely, efficient, equitable (Crossing the quality chasm report). Redesign: continuous healing relationships, customization based on patient needs and values, patient as the source of control, shared knowledge and free flow of information, evidence-based decision making, safety as a system property, transparency, anticipation of needs, continuous decrease in waste, cooperation among clinicians. Change must be undertaken at multiple levels: individual, healthcare team (microsystem), health care organizations, environment – payment, oversight, accreditation. IOM committee charged with recommending changes to behavioral health field. Starting with a literature review, they are finding a dearth of data. www.iom.edu/project.asp?id=19405 – notice of meetings and description of study, final report fall, 2005.

Power: She’s a concise, clear, organized, passionate speaker. Transformation continuous, core, must be ready and willing. "The most compelling element of recovery is the belief that people with mental Illness can take charge of their own lives, their own wellness, and their own case management." New block grant application process will show funders/congress relevancy and accountability. Quality = positive outcomes for consumers.

Franczak: Arizona "success using blended funding to increase the amount of housing that is totally under control of the behavioral health system. Having this control over housing affords consumers who live there a degree of stability otherwise unachievable, thereby facilitating their recovery."

Jensen: "Barriers to employment included fears of losing Medicaid coverage, anxiety during the job orientation process, difficulty of maintaining a full time job while caring for health needs and keeping necessary practitioner appointments, and fears of being stigmatized by fellow employees."

Leff: recovery transcends symptom remission and functioning, mental health services have complex arrangements and soft boundaries, self-determination is about choice within an array of desired options.

I listened for a while to the meeting of the Academic Behavioral Health Consortium, a managed care group concerned with the business and administration aspects and mostly lacking psychiatrists. (There are about 125 academic psychiatry departments in the US). They are adequately funded and in considering how to focus their work next year the noted if you fund it, they will come. One thought was to create an economically sustainable model based on ebp and outcomes. Three other themes – corrections, disaster, disease management.

The laryngitis that began when I entered the Marriott Tuesday is still with me and I am wishing I had had the foresight to bring the eversion of my presentation or load it into my laptop and to have installed a voice synthesizer! Instead, it will be read for me, and I’ve handwritten a few asides and notes as well.

Of course the SAMHSA conference, federal, has no politics, no buttons, no T shirts at all. But, also at the Marriott is the Take Back America meeting, www.ourfuture.org, and the corridors are full of table covered with environmental literature, buttons, T shirts. Soros and Dean are two names I recognized who will be speaking. And Hillary Clinton is expected.

NAMI and DBSA are joining to reform the education of psychiatrists. The impact of the consumer and family voice will be strong.