NASW Practice Snapshot:
The Transformation of the Mental Health System

Office of Social Work Specialty Practice

The Report of the Surgeon General stated in 1999 that mental illness is real and very treatable.  Then in April 2002, the President’s New Freedom Commission on Mental Health was established to explore gaps and problems in the mental health system, and to make concrete recommendations for how to improve the system at all levels.  Government and organizational representatives (including NASW) met, and a year later, in May 2003, the Commission reported back with six recommendations needed to transform the system (see references for Web address to the full report).  Now the Substance Abuse and Mental Health Services Administration (SAMHSA) has launched its first Federal Action Agenda for transforming mental health care in America.  This agenda aims to move the mental health system forward so that all individuals with mental illnesses can participate fully in their communities.

Charles Curie, the administrator of SAMHSA and a social worker, stated that, “Recovery is the expectation not the exception.”  He also emphasized that there was no intention of having a recommendation for mandatory screening of children for mental health needs.  For individuals who do have a mental illness, however, the intent is to create a positive environment, and to make available the resources for all individuals to recover.  The hope of SAMHSA will also be to create individualized electronic plans of care and progress for each person, which could be used to coordinate care among different providers.  The “endgame” is attaining and maintaining recovery from mental illness for everyone.

The Action Agenda Steps:

Mental health issues can affect almost all areas of social work practice.  Thus, it is important for all social workers to be aware of developments in this field.  SAMHSA has outlined five first steps to its Federal Action Agenda for transforming the delivery of mental health services in America. 

1. Focus on the desired outcomes of mental health care, which are to attain each individual’s maximum level of employment, self-care, interpersonal relationships, and community participation.
   This step, which aims to help each individual achieve his or her maximum potential in life, will include:  a public education campaign about mental illness; initiatives to prevent suicide; educational initiatives about men and depression; individualized care plans to promote personal strengths; strategies to improve education/employment opportunities; education on the importance of healthy early childhood development; development of a consumer-friendly Web site; and efforts to promote the civil rights of individuals with mental illnesses.  
2. Focus on community-level models of care that effectively coordinate the multiple health and human service providers and public and private payers involved in mental health treatment and delivery of services.
   The step’s goal to work from the community level will include:  launching a Federal Executive Steering Committee of high-level agency representatives; establishing a task force to work towards eliminating disparities in mental health care; initiating projects to ensure cultural competence in the mental health workforce; developing a rural mental health plan; developing appropriate strategies for working with children; and including mental health care in federally funded Community Health Centers. 
3. Focus on those policies that maximize the utility of existing resources by increasing cost-effectiveness and reducing unnecessary and burdensome regulatory barriers.
   Aiming to maximize the use of resources, this step will include:  support of Medicaid demonstration projects; efforts to help parents retain custody and obtain mental health care for their children; support of the Ticket to Work program, which attempts to eliminate work disincentives for people who receive SSI or SSDI; education of employers on the benefits of paying for mental health services; development of a strategy to advance new technology in the mental health field; and exploration of a possible capital investment fund for technology.
4. Consider how mental health research findings can be used most effectively to influence the delivery of services.
   Making an effort to increase the utility of research for practitioners, this step will include:  NIMH efforts to accelerate mental health research; expansion by SAMHSA of the national registry of evidence-based practices to include mental health; creation of new toolkits for practitioners on how to use specific evidence-based practices; creation of a task force to identify the utility and further needs for promising practices and evidence-based practices so that they can be implemented and/or further researched; and NIMH expansion of research centers working to reduce disparities in mental health.
5. Follow the principles of Federalism, and ensure that [the Commission’s] recommendations promote innovation, flexibility, and accountability at all levels of government and respect the constitutional role of the States and Indian tribes.
   This step aims to focus initiatives at the level of the states and Indian tribes, and includes:  continued support of SAMHSA’s three-year system transformation grants to help develop new ideas for local mental health systems; continued support of SAMHSA’s five-year Child and Adolescent State Infrastructure Grants to complement the system transformation grants; establishment of a Samaritan Initiative Foundation to provide permanent supportive housing for chronically homeless individuals; collaboration with the Departments of Justice and Labor to help serve the mental health needs of former prisoners returning to the community; and continued support of SAMHSA grants to enhance state capacities for alternatives to seclusion and restraint in mental health settings. 

These five steps are being heralded by SAMHSA and other federal departments as a milestone in the gathering momentum transforming our mental health system into one in which all consumers are able to recover.  This is, in fact, the first time for such a federal initiative to be established, and is intended to be only the first among future Action Agendas to be created as knowledge and needs come to light. 

As one of the largest providers of mental health services in the United States, social workers will be in the forefront among professionals working to transform the way in which services are delivered in the mental health system. 

What exactly does recovery mean?

Because there have been diverse opinions over time about what “recovery” actually means, SAMHSA and the Interagency Committee on Disability Research (ICDR) held a conference in December 2004, which pulled together a national group of 110 experts.  The plan is that in late 2005 a consensus statement will be released on the definition of recovery.  A sneak preview of the statement was given:  “The expert panelists agreed that recovery is an individual’s journey of healing and transformation to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential” (U.S. Department of Health and Human Services, 2005, p. 4).

How will SAMHSA’s Federal Action Agenda affect us as social workers?

Each social worker should determine which actions listed under the five steps will be most relevant to their specific area(s) of practice.  Because mental health is a vital part of the overall health of each person, every social worker can probably find some way(s) in which this initiative will have an impact on their practice.  Some actions you might consider to help support both your work and these efforts:

1. Review the action steps in more detail to determine which are most relevant for your work.  See the full report at:  http://www.samhsa.gov/Federalactionagenda/NFC_TOC.aspx.
   A hard copy can be ordered directly from SAMHSA’s National Mental Health Information Center at 1-800-789-2647. 
2. All social workers can help in the “transformation” of the mental health system, and in their own practices by looking for evidence-based practices to use in their work.  Step D of SAMHSA’s Agenda focuses on evidence-based practices, which are particularly important for consumers because they have been shown to work.  Furthermore, Charles Curie of SAMHSA notes that, “Increasingly, policymakers and budget planners at all levels—federal, state, local, and private—are basing funding decisions on outcomes data” (SAMHSA, 2005, p. 11).  Implementation of evidence-based practices will provide opportunities for social workers to create ideas and methods for collecting outcomes data. 
3. Encourage others, especially non-social workers who may not have been taught the knowledge of our profession, to respect and promote these basic rights to which all people should be entitled.  Particularly in a time of political, economic, military and other instability and disagreements, people are prone to forget the rights of people who don’t have a strong voice.  Don’t forget these people, and don’t let others forget them.  Talk about this system transformation, and how it will benefit consumers in their lives and their recoveries. 
   
4. Look for new ways not mentioned here, that you can work to support a recovery-oriented environment for all individuals with mental illnesses.  No one has a monopoly on good ideas, and social workers have always been among those with creative ideas.  Try out or ask about new ideas with friends, co-workers, clients and others.  SAMHSA, along with some other governmental and many private foundations, usually has grant monies available to fund new and innovative ideas.  Go to their websites and inquire about possible opportunities.

Individuals with mental illnesses deserve to live lives with the most possible options and with the fewest possible constraints on their abilities.  Respect, support, and advocacy of such rights for disadvantaged individuals are the basis of the NASW Code of Ethics (1999), and the basis of the social work profession. 

References:

National Association of Social Workers. (1999). Code of ethics of the National Association of Social Workers. Washington, DC : NASW Press.

New Freedom Commission on Mental Health. (2003). Achieving the promise:  Transforming mental health care in America, final report (DHHS Publication No. SMA-03-3832). Rockville, MD: U.S. Department of Health and Human Services.

Substance Abuse and Mental Health Services Administration. (2005, July/August). Measuring outcomes to improve services. SAMHSA News, 13 (4), 11.

 

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. (2005). Transforming mental health care in America.  Federal action agenda:  First steps (DHHS Publication No. SMA-05-4060). Rockville, MD: U.S. Department of Health and Human Services.

U. S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. (2005, July/August). Mental health transformation trends:  A periodic briefing,  1(3), 4.

 

U. S. Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General [Online].  Retrieved from http://www.surgeongeneral.gov/library/mentalhealth/home.html on 7/25/05.

NASW, October 2005