Neal Brown November 5, 2013

 NIMH response to problems of deinstitutionalization  Systems change initiative  Beyond just mental health treatment - concentration on rehabilitation  Small grants to states (most funding $150-$300K per year)  Contacts in each State  Established System of Care – “Community Support System”  National CSP Network  Consumer empowerment  Support to families  Most funding

 Thousands of community rehabilitation programs established (e.g. ACT, clubhouses, supported housing)  Established SMI as a priority population  Helped states move resources from institutions to community care  Facilitated the expansion of the consumer movement  Helped launch and support the national family movement

 A small amount of strategic money can leverage major system changes  Supporting consumers and families facilitates system changes  People learn from others in a network

 SAMHSA program to help communities adopt exemplary mental health practices by building community “buy-in” and support  Sponsors were primarily community and consumer/family organizations  Phase I – consensus building ($150K)  Phase II – training and preparation for implementation ($150K)  Best practices determined locally  Focus on adults with SMI and children with SED  Diversity of programs and populations involved  Program lasted five years ( )

 Funded 137 sites for new programs in 48 states and territories  More than 70% achieved full consensus and implemented best practices  Supported a diversity of organizations and practices  Became a catalyst to change policies at the state and local levels  Promoted culturally competent services

 Implementation of Best Practices is enhanced by consensus building  Community organizations can successfully manage a process leading to new program implementation  Consensus building process can lead to changes in policies and practices at the state level

 Mental Health Transformation State Incentive Grants (MHT-SIG)  SAMHSA supported infrastructure grants to states to improve service delivery, access to care and the provision of effective services  To implement President’s New Freedom Commission recommendations  Focus on adults and children  Grants to nine states (governors) of up to $2.7 million a year for 5 years  Connecticut, Maryland, New Mexico, Ohio, Oklahoma, Texas, and Washington (starting in 2005)  Hawaii and Missouri started in 2006

Transformation Working Group Needs Assessment and Inventory of Resources Comprehensive Mental Health Plan I Infrastructure Changes Service Improvements Improved Consumer Outcomes

All states conducted infrastructure activities such as:  Creating and revising policies  Involving consumers, family members and youth in advisory bodies  Developing innovative financing strategies  Conducting public awareness campaigns  Engaging in workforce development activities

 Assertive Community Treatment (ACT)  Family Pschoeducation  Illness Management and Recovery (ILR)  Integrated Treatment for Co-Occurring Disorders  Multi-Systemic Therapy (MST)  Permanent Supportive Housing  Trauma-Informed Care  Supported Employment  Wellness Recovery Action Plan (WRAP)

 CMHP implemented  New Freedom Commission goals achieved  Significant policy changes in each state  Political changes overcome (Ohio, Hawaii, Maryland)  Washington – significant gains in consumer involvement  Connecticut – maximized support for criminal and juvenile justice initiatives  Oklahoma – enhanced tribal – state relations  Missouri – implemented MH First Aid

 Promoting recovery and system change (through WRAP training, recovery training, Recovery Centers of Excellence)  Changing public perceptions of mental illness (focus on Mental Health First Aid training)  Strengthening the Public Mental Health System (pilot for Self- Directed Care; first state to launch Network of Care site for Veterans; workforce development; statewide implementation of EBPs – SE, ACT, FP; reduction in use of seclusion and restraint; coordination of primary and mental health care; increased access to high quality services through tele- psychiatry; increased housing resources; developed consumer quality teams (CQT); Outcomes Measurement System to track trends in services)  Services to Children, Youth, and Families (Systems of Care and Wrap-around Services, Transition-aged Youth activities)

 Engaging consumers, family members and youth in every step in the change process is fundamental to bringing about services that are consumer-driven, family-centered, youth-guided, and recovery oriented.  Possible to promote changes simultaneously at multiple levels.  Partnerships can be powerful vehicles for change at all levels.  Adoption of a recovery approach is fundamental to transformation.

 Personal relationships make a difference  Significant consumer involvement is absolutely necessary