Lessons Learned From Federal Programs

Neal BrownNovember 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 1978-1987

Community Support Program

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

CSP Accomplishments

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

Lessons from CSP

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 (1997-2002)

Community Action Grants

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

CAG Accomplishments

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

Lessons Learned from CAG

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

Mental Health Transformation Grants

Transformation Working Group

Needs Assessment and Inventory of Resources

Comprehensive Mental Health Plan I

Infrastructure Changes

Service Improvements

Improved Consumer Outcomes

MHT Logic Model

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

State Transformation Highlights

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)

Practices Promoted Across All Nine States

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

MHT State Successes

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)

Maryland Transformation Highlights

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.

Lessons from MHT-SIG

Personal relationships make a difference Significant consumer involvement is absolutely

necessary

Overall Lessons