SAMHSA is implementing transformation based on the NFC Report. I was at one of four regional meetings organized through the National Governors Association to inspire states to take strong leadership roles.. I had been asked to present and then to be a resource person, so didn’t bring my laptop. This report is both anecdotal and cursory! There were two family members, Priscilla Ridgway and me, about 50 people.

One handout listed the stakeholders in mental health system transformation:

Governor’s Office

Mental Health Authority






Children’s Services




I first saw a list of stakeholders in a CMHS publication in the 90's. I counted 103 names, three consumer groups. I knew something was wrong with the picture and have felt silenced and invisible but not sure just why. At this meeting, I realized this supposed collaboration isn’t the model! Consumers aren’t one of many, now at the table, but perceived as only a piece of the many interests.

I think that’s not the framework. I think the model is the natural social tension between individual autonomy and group good. Various systems value the one over the other, from anarchy to dictatorship.

What’s wrong with how mental health issues are presented is that the individual wishes are folded into the group issues, one stakeholder among many. The proper model is of only two major stakeholders, the individual and the group, so that at any meeting there will be as many speaking for the individual (this will be consumers; depending on the culture, families; and, for, a few, advocates) and for the group (this will included the myriad of social stakeholders, professional guilds, education, corrections, payers, ... ).

That’s a better fit, a transformative fit.

Part of the transformation vision is to prevent and cure, which from a disability perspective can fit neatly into the arguments about euthanizing difference and devaluing diversity. I wish that language hadn’t gotten embedded

Goal 6, the technology piece is stated as only one-way, IT, not ICT.

Priscilla Ridgway noted Patricia Deegan’s statement that after medication there can be no self left to recover

Overheard: He’s Axis I not Axis II. That’s even worse than he’s SPMI!

Overheard: pride in discharging/paroling people from the correctional system to the mental health department, a Consensus Report between departments of mental health and departments of justice.