SOCSI and NAC
February, 02; Rockville, MD
(I stayed to give the SOCSI report to the NAC and found it hard to participate, take those notes, make these notes. Full minutes will be webbed after approval at our June meeting.)
Members present: Jon Brock, Sylvia Caras, Kevin Fitts, Carrie Kaufmann, Paula Stockdale, Sharon Yokote, Donna Preston, Juli Lawrence by phone.
Representatives of the TA centers attended.
SAMHSA is "restructuring" and "delayering." Communication is consolidated at the SAMHSA level; policy and budget is being consolidated at the level of the political appointee. OEL will be no longer (Paolo is Acting Branch Chief); hiring freeze included advisory appointees which has just been lifted but the appointments are political choices. Current strategic planning is revising the SAMHSA direction so that both SAMHSA and HHS have *one* coordinated agenda. Commission on Mental Health (new name: New Freedom Commission on Mental Health) announcement due in about 60 days - people have been interviewed, are now being vetted. Dan Fisher is on the short list.
Aging services program will soon be launched.
Proposed FY 03 presidential budget which starts in fall 02 essentially straight-lines SAMHSA overall (state block grants, P&A) but increases PATH (because they had good data), substance abuse treatment; decreases CMHS by 7 million, decreases substance abuse prevention. 5 consumer and consumer-supporter TA centers, 161 community action grants, tx in non-mental health settings are all defunded. Emphasis on dissemination not development of knowledge. And delivering services. Alternatives can probably be funded in some way, as an add-on to an existing program grant.
The minutes from the September meeting were rejected as incomplete, will be posted when approved.
Campbell: "Collaboration takes time." The Executive Directors of the COSP sites are writing a book of program descriptions. APA, APA and Recovery Press have generated interest.
5x5 initiative (five by five) - by 2005, 5% of all mental health funding will go to consumer-operated services.
CMHS Emergency Services and Disaster Relief Branch carves serious mental illness out of people with disabilities.
"Disaster stress reactions may be difficult to discern from symptoms of serious mental illness." Several peer programs - Project Liberty in NYC (find web link through KEN) - have been involved in disaster responses - one suggestion - local planning and preparedness should maintain a roster of peer counselors. Definition: trauma events are events that overwhelm the coping capacity of the individual.
Discussion of budget cuts and what education is needed. House SAMHSA budget hearing Mar 12, 2 PM. Presidents budget is reviewed, house makes changes, senate makes changes, conference, ... . Larry Belcher assured us that CONTAC will continue.
Autry: SAMHSA priorities: citizen-centered, results-oriented, market-based. Budgets are consensus documents, Presidents set the highest priorities, especially when resources are shrinking. The Presidents budget is the first step. SAMHSA cannot ask for things that it didnt put in the budget (like the TA centers, community action grants). Then forces that come to bear on Congress will adjust this budget. SAMHSAs portion of the budget is at www.samhsa.gov.
SAMHSA priorities will be determined by a matrix of program by principles (in the 04 budget):
Programs/Issues: co-occurring disorders, substance abuse treatment gap, seclusion and restraint, prevention and early intervention, childrens agenda, new freedom initiative, terrorism/bio-terrorism, homelessness, aging, HIV/AIDS, criminal justice.
Cross-cutting principles: evidence-based/outcomes, collaboration, recovery/anti-stigma (may get changed to discrimination), culturally competent, community and faith-based, violence (physical and sexual abuse), financing and cost-effectiveness, private sector partnerships.
One finding of SAMHSA public hearings in late summer was to advocate using in-synch terminology. This was also a conclusion of the Independent Choices meeting last spring. This will encourage the replacement of "stigma" with discrimination.
Kaufmann: emphasize the volunteer aspects of the consumer movement to align with the administrations message.
CMS orientation: Sullivan: fraud and abuse: "You just cant have that much money out there." About status for self-determination waivers for people with psychiatric disabilities and waivers for home can community based services, contact firstname.lastname@example.org (Mary Jean Duckett). About coercive ACT, its a state issue, though Sullivan states CMS would disallow a violation of civil rights. Clark: changes will begin at local/state level. Sullivan: strategy - "save money." Pelz: work together.
Wolfe: Articulate and direct presentation about Homeless Programs Branch.
C/s regional meetings planned for Chicago (May) and Denver. Faith-based c/s dialogs being planned.
Curie to SAMHSA Advisory Council: all new knowledge should be developed by NIMH. SAMHSA is only about knowledge and application, no longer development.
SAMHSA is putting a high value on consistency across the three centers and using synchronous language. (I am pleased that there is an entry point for my own belief that language matters. S.)
Difficult discussion/decision about what to say to the NAC about our response to the explicit funding cuts. Two SOCSI members left early. Net result six recommendations.
Next meeting: June 17, 18. Agenda items: common language, ect, SOCSI strategic plan
NAC February 7, 8
The National Advisory Council meeting room overflowed, with 40 sitting in perimeter around 12 seats at the table, and some standing.
Autry: onesamhsa, onehhs, citizen-centered, positive outcomes, emphasis on consumers and families, discrimination (*not* stigma) and a common terminology, developing a management matrix in which data is a key element (for instance PATH increase was based on data), delayering - four between citizen and administrator: SAMHSA administrator, centers, divisions, branches (and fewer branches). Scientific study will be directed by NIH (ie biological. S.), CMHS will not be doing research, funding is towards closing the treatment gap (that means medication. S.) But NIMH was not apprised nor given more dollars and may be reluctant to add another knowledge development research agenda. Council member responses: primary care, unified health, discrimination, three voiced support for the TA centers and community action grants.
CMHS will staff the National Mental Health Commission.
Cynthia Wainscott is an extraordinary allly on the NAC, raises consumer inclusion issues at every opportunity. Another council member raised the concern that rights must be coupled with responsibilities. (Ive drafted some comments about responsibilities see www.peoplewho.org/XXX S.) SEND TO DONNA OR CYNTHIA and SOCSI
council member: "We know that the rates of abuse are higher among people who have serious mental illness." The Council members all nod in agreement. (This now seems like generally accepted information. S.) Higher rates of abuse among those who later enlist in the military.
Since there has not been an appointment to the NAC to fill the consumer seat, I gave the SOCSI report. There were five recommendations and one resolution. The resolution passed, with the addition of the word recovery - programs that promote recovery - ; affirmation of prior support for the TA centers passed, support of the NCD report was deferred, CEU units was ignored, voluntary parity was deferred with the suggestion there might be a fuller discussion of coercion, and funding for consumers and all conferences CMHS funds was dismissed with the comment that CMHS tries to do this.
Excellent presentation on disaster and cultural groups by Teresa Chapa and Josie Romero stressing how important language and cultural are to successful support. Disaster phases: heroic, honeymoon, uncertainty (a continuous state of limbo due to ongoing threats and the mulit-dimensional societal impact of terrorism), disillusionment, reconstruction. Process of grief and loss when there is a disaster: shock, denial, anger, bargaining, depression, preparation, reentry, acceptance.
Public comment: APA public policy disaster response: psychologists mobilized in NYC/DC. Arons testified to Senate on anticipated needs.
Wrap-up, next agenda items: how will Council input NIH research direction; clinical v services research might be a joint council discussion; prevention; disparities; parity/voluntary; activities of M H Commission (NFI).
(I gather input for my participation in these SOCSI meetings through an open unmoderated email list: email@example.com. Please subscribe if you would like to include yourself. Sylvia)