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Director's Report
June 20 - 21, 2002

Program Activities and Initiatives

CMHS Office of the Director

Farewell and Best Wishes: Dr. Camille Barry, CMHS deputy director, resigned from Federal service, effective May 3, 2002. Dr. Barry served as the deputy director since January 2001, and prior to joining CMHS, she was deputy director of the Center for Substance Abuse Treatment. Dr. Barry brought an energy and enthusiasm to SAMHSA that will greatly be missed.

Presentations by the CMHS Director: CMHS Director Bernard S. Arons, M.D., made presentations to a variety of mental health audiences throughout the country, including:

• A Grand Rounds presentation, entitled The United States Mental Health System: 21st Century Overview and the Impact of Terrorism, at George Washington University in Washington, DC, February 26, 2002.
• Remarks about the importance of improving services for people with co-occurring mental health and substance abuse disorders at the Co-occurring Disorders Report to Congress Constituent Input Meeting in Bethesda, MD, March 11, 2002.
• Remarks about the importance of using prevention science to work toward delaying or preventing the onset of mental and behavioral disorders at the SAMHSA/National Association of State Mental Health Program Directors (NASMHPD) Roundtable: Prevention/Treatment Continuum in the Public Mental Health System in Bethesda, MD, March 14, 2002.
• Remarks in support of a dialogue between CMHS and the National Institute of Mental Health (NIMH) as it relates to research and evaluation of mental health services at the CMHS Services/Evaluation Workgroup in Bethesda, MD, March 20, 2002.
• An update on CMHS initiatives and priorities and discussion of the Federal role in caring for the Nation's mental health, especially as it relates to the needs of ethnic minorities, at the Okura Leadership Forum, held at NIMH in Rockville, MD, April 16, 2002.
• Remarks about the Protection and Advocacy role within CMHS and the role of legal advocacy in the mental health system at the National Association of Protection and Advocacy Systems' CEO Training Meeting in Washington, DC, April 17, 2002.
• Remarks about how psychiatric and corporate communities can collaborate on preparing for and responding to the effects of disaster, terror, and trauma in the workplace at An Expert's Roundtable: Disaster, Terror, and Trauma in the Workplace in Washington, DC, April 25, 2002.
• Remarks about SAMHSA's role in convening stakeholders for a National Forum in Fall 2002 to begin identifying strategies and tactics for eliminating disparities in mental health care for African Americans at a planning meeting in Rockville, MD, May 20, 2002.
• Opening remarks and introduction of SAMHSA Administrator Charles Curie at the National Conference on Mental Health Statistics in Washington, DC, May 29, 2002.
• Remarks at the 2002 SAMHSA Joint Council Meeting in Gaithersburg, Maryland, June 19, 2002.

Consumer Affairs

Restraint and Seclusion: CMHS consumer affairs staff continues to provide leadership in SAMHSA efforts to develop a strategic plan that addresses concerns with restraint and seclusion. The goal of the plan is to eventually eliminate restraint and seclusion practices in behavioral health settings. In addition, production is currently underway for a consumer-centered training manual that offers alternatives to the use of restraint and seclusion in mental health facilities. The manual is designed to assist staff of these facilities in working with consumers.

Training and Technical Assistance: In March 2002, CMHS consumer affairs staff provided training on mental health service delivery issues to National Institutes of Health (NIH) Clinical Center staff and consumers. In April 2002, staff provided training and technical assistance at the annual conference of the New Jersey-based Coalition of Mental Health Consumer Organizations.

Consumer Dialogue: A Dialogue Between Consumers and Members of Faith and Community Organizations is being planned for the Baltimore-Washington area. The primary goal of the dialogue is to build mutual understanding and respect among these groups and to improve communication in an effort to create effective and cooperative relationships to promote recovery. Dialogue participants will also develop specific recommendations for how CMHS and others can increase collaboration between consumers and members of faith and community organizations. Planning committee members are meeting to choose a date and exact location, as well as to identify dialogue participants and a facilitator.

New Freedom Initiative: CMHS consumer affairs staff continues to provide leadership for the New Freedom Initiative announced by President Bush on February 1, 2001. The initiative is a comprehensive plan that directs the Federal government to remove barriers to equality and community living for people with disabilities. HHS Secretary Tommy Thompson delivered a Preliminary Report of Federal Agencies' Actions to Eliminate Barriers and Promote Community Integration to President Bush in December 2001. On March 25, 2002, Secretary Thompson delivered to the President reports from the nine agencies participating in the self-evaluation of program and policy barriers to implementing the Olmstead decision. The final report offers more than 400 specific solutions that agencies can use to support community living. The report is available online at http://www.hhs.gov/newfreedom/final/pdf/hhs.pdf. SAMHSA staff participates in a number of HHS New Freedom Initiative Solution Workgroups, including Home and Community-based Services Reform; Services for Children in Treatment; Self- determination/Self-direction; Technical Assistance and Clarification of Medicaid Policies Affecting Individuals with Psychiatric and Co-occurring Disorders; Work with States/ Universities to Ensure a Base of Knowledge to Inform Policy Making; and National Technical Assistance Strategy.

Eliminating Barriers Initiative: To assist with promoting the President's New Freedom Initiative, CMHS consumer affairs staff is developing an anti-discrimination and stigma initiative. Under this new effort, CMHS will develop public education approaches to overcoming barriers to treatment and community participation for persons with psychiatric disabilities.

Regional Meetings for Consumers: On May 1, 2002, CMHS consumer affairs staff convened its Sixth regional meeting for consumers in Chicago, IL. This meeting was one of a continuing series of meetings being held in various parts of the country to identify the pressing needs, issues, and concerns of people with mental illnesses and to provide consumer guidance in planning SAMHSA/CMHS activities. The information gathered at these meetings is also shared with the States in the region where the meeting is held to assist in quality improvement and systems planning activities. The States represented at the Chicago meeting included Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin. A summary report is being made available. The next regional meeting will be held in Denver, CO, in fall 2002.

Discrimination and Stigma: CMHS announced the opening of a new Resource Center to Address Discrimination and Stigma Associated with Mental Illnesses (ADS Center). The Center will help States, local communities, providers, managed care organizations, advocates, family members, and mental health consumers design, implement, and operate programs and campaigns to reduce discrimination and stigma. The Center will provide target audiences with information—through Internet resources and technical assistance—about available publications, events, and issues of relevance for people or organizations interested in combating discrimination and stigma. The ultimate goal of the Center is to enhance the independence and community participation of mental health consumers. The Center's toll-free telephone number is 1-800-540-0320. A Web site is being developed. The ADS Center is an offshoot of the National Mental Health Symposium to Address Discrimination and Stigma held by CMHS in Spring 2001.

Also in the area of discrimination and stigma, CMHS consumer affairs staff supported the development of and piloted a new workshop, Responding to Stigma: Effective and Applicable Strategies for the Work Environment. Additional workshops are being planned for June and early fall 2002.

Recovering Your Mental Health Booklets: CMHS consumer affairs staff worked with author, lecturer, and consumer leader Mary Ellen Copeland to develop six new booklets in the Recovering Your Mental Health: A Self-help Guide series. New booklet titles include "Building Self-esteem," "Making and Keeping Friends," "Dealing with the Effects of Trauma," "Developing a Recovery and Wellness Lifestyle," "Speaking Out for Yourself," and "Action Planning for Prevention and Recovery." This series of booklets, which will be available soon, grew from the success of the first self-help guide, which offered 32 pages of tips on understanding symptoms of mental illness and judging their severity, identifying the range of resources available, and seeking and getting help. The original booklet also covered the advantages of counseling, additional options for professional help, relaxation techniques, and paths to positive thinking.

Presentation for Deaf Mental Health Consumers: In April 2002, CMHS consumer affairs staff delivered a presentation on building recovery-focused programs and consumer leadership for deaf mental health consumers. The presentation was made at the seventh BREAKOUT conference, a meeting that focused on psychosocial rehabilitation services to deaf persons with mental illness.

Consumer Support: A significant effort is underway to support consumer participation at national and other mental health meetings in order to promote communication of consumer perspectives related to mental health policy and program development and implementation to mental health professionals, policymakers, and State officials. This effort also provides CMHS with valuable consumer perspectives on current cutting-edge treatment, rehabilitation and support services, and emerging trends and issues in mental health service delivery. To date, more than 90 consumers have either been identified or have already participated in four national meetings.

Office of Policy, Planning, and Administration

Invisible Children's Project: The Office of Policy, Planning, and Administration concluded a policy study on the nationally recognized Invisible Children's Project in Orange County, NY. The final report is now available. This program, which provides home-based, family-centered case management services, is one of few programs available to meet the needs of parents and children in families with a parent who has a mental illness. The project came about as a result of the need to learn more about what is helpful for families and what is effective with respect to enhancing family and family member functioning and quality of life. It was founded upon the assumption that mental illness does not preclude good parenting and that all parents want to be the best parents they can be. The final report provides an evaluation of the project as it affects families with a history of child welfare involvement. The evaluation concluded that parents with mental illness and their children who received family-centered case management services through the project showed improvement across multiple outcomes. Department of Social Services workers stated unequivocally that children were returned home, or maintained in the home, as a direct result of project involvement. While service costs increased for some families, benefits were significant. Parent and agency goals were achieved, and expensive, disruptive, and potentially damaging out-of-home placements, such as hospitalization and residential care or foster care, were avoided. For more information about the report, contact Judith Katz-Leavy, CMHS senior policy analyst, at 301-594-2707 or by e-mail at jkatz@samhsa.gov.

Evidence-based Practices for Parents With Mental Illness and Their Families: The Office of Policy, Planning, and Administration has concluded a policy study on a project to study Steps Toward Evidence-based Practices for Parents With Mental Illness and Their Families. The final report is now available. The project came about as a result of the need to develop an empirically supported evidence base before conclusions can be drawn about practices for parents with mental illness and their families. The project goal was to take the next steps toward evidence-based practices for parents with mental illness and their families by identifying and systematically describing existing interventions. Data were reported from two studies. The combined data from the two studies were used to identify core program components, key ingredients, and relevant outcomes. The project concluded that the rigorous evaluation of programs for parents with mental illness will only be possible when the necessary resources and technical assistance are provided to support the standardization and manualization of current interventions. This will require identifying or developing methods and tools that reflect participant and program goals and theories of change, capture program process and fidelity, and objectively measure meaningful outcomes related to adult, child, parent, and family functioning. For more information about the report, contact Judith Katz-Leavy, CMHS senior policy analyst, at 301-594-2707, or by e-mail at jkatz@samhsa.gov.

Issue Briefs on Families in Welfare Reform Reauthorization: A series of nine issue briefs were developed for the purpose of providing information about adults with mental health needs and children with special needs during discussions on the reauthorization of the Temporary Assistance for Needy Families (TANF) program. The issue briefs cover (1) descriptions of the families, (2) screening and assessment, (3) work participation requirements and definitions of work, (4) time limits, (5) child care, (6) Medicaid, (7) interagency coordination, (8) training and education of TANF workers, and (9) a summary of all recommendations. The primary goals of the briefs are to: (1) raise awareness about families on welfare reform who are confronted with barriers related to mental health problems and childhood disabilities; (2) highlight existing strategies for offering supports and resources to assist these families in achieving independence and self-sufficiency and; (3) suggest recommendations to address the issues discussed in each brief and increase the well-being of children and families. For more information about the issue briefs, contact Judith Katz-Leavy, CMHS senior policy analyst, at 301-594-2707, or by e-mail at jkatz@samhsa.gov.

Associate Director for Medical Affairs

Mental Health HIV Services Collaborative: CMHS developed the Mental Health HIV Services Collaborative Program as part of the SAMHSA Minority AIDS Initiative. Under this program, 21 community-based organizations received 5-year grants to expand their current service capacity for reaching and providing coordinated mental health and other support services to persons with HIV/AIDS and to evaluate the effectiveness of the constellation of services used in this effort. An important goal of the program is to identify culturally appropriate/competent approaches to mental health treatment in traditional and nontraditional settings. To date, all program sites are making progress in implementing their projects, and 18 sites have begun accepting clients. The coordinating center staff is conducting site visits and providing technical assistance to all of the projects.

HIV/AIDS Cost Study: The HIV/AIDS Cost Study is the first Federal effort to focus on people living with HIV/AIDS who also have a diagnosed mental health and a substance use disorder. Comprehensive data from approximately 1,000 cases and five assessments over time will detect changes in health, mental health, and substance use status as well as service use and costs. The resulting analytic database promises to yield an unprecedented level of new knowledge on effects and costs of integrated treatment for people living with multiple diagnoses. More than 800 baseline interviews have been conducted to date. Preliminary findings indicate that the study participants are more likely to have received HIV/AIDS and substance abuse care than mental health services. The failure to accurately diagnose and treat mental disorders is likely to be a significant factor in overall treatment adherence and health and mental health outcomes. Preliminary analyses point to the need to match treatment modalities with patient readiness for integrated treatment, including the initiation of pre-treatment interventions for those who are not ready or able to participate in standard treatment. The analyses show that, while individuals may be willing to undergo an extensive baseline interview, this is not necessarily a predictor of their willingness to engage or remain in treatment. The HIV/AIDS Cost Study is a combined effort of six Federal agencies. The program is in its fourth year and has a funding level of approximately $6 million per year.

Associate Director for Organization and Financing

• Major issues and trends in the delivery of mental health services under Medicaid
• Education and training on specific Medicaid policies that affect the delivery of mental health services
• Recent analyses of Medicaid data on mental health use and expenditures

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