Ms. Spiro’s recommendations from the Santa Fe Summit 2008 convened by the American College of Mental Health Administration which focused on Impacting Healthcare Reform
To address the fundamental disconnect between the system and the real needs of people served more opportunities are needed to develop leadership skills for mental health consumers. Training opportunities, resources and supports are needed so that consumers will more actively engage in articulating barriers, developing solutions and advocating for change. Adequate funding and organizing of consumer run networks and services is needed in every state. We need to expand the national consumer and family TA system to further accelerate the development of consumer and family involvement in transforming the mental health system to one based on principles of civic engagement, self-determination, empowerment and recovery.
On both the state and federal level Medicaid should provide more leadership in systems transformation by ensuring that stakeholders (including consumers, families, state mental health directors, etc.) are knowledgeable about options and flexibility within waivers and state plan options such as those that allow self-directed care and individual budgets. Medicaid, on both the state and federal level, should have a consumer and family advisory board with responsibilities that include oversight and accountability. It would serve all stakeholders well to have clearer mutual understanding of how the regulations and rules impact the lives of people and communities. Communication between regulators and auditors on the state and federal levels needs to be enhanced. This communication chasm has resulted in providers being fearful of innovation due to lack of clarity of the intent and parameters of the regulations. This could be addressed by having interpretive guidelines for the Medicaid regulations so that they are more explicit and provide examples of innovative service deliver and methods of accountability. Consumer/survivors and family members should have input into the development of the interpretive guidelines. Lastly, innovative and or cost-saving programs should be rewarded with recognition and CMS should ensure that best-innovative practices are communicated across states and across federal agencies.
CMHS could increasingly serve as a catalyst of transformation by convening panels, meetings and/or dialogues and reconvening them after an appropriate time to evaluate progress towards goals, develop or refine further action steps and continue the momentum of systems change. CMHS could provide support to assist in tracking and implementing the actions steps. Consideration should be made to producing educational materials that document successful systems change (such as CDs, DVDs, monologues) that could be an outcome of these meetings.
SAMHSA/CMHS needs increase consumer representation on its National Advisory Committees and to further promote the consensus definition and the ten components of recovery.
We need community wide wellness dialogues and innovative wellness zones with incentives between and among public and private programs and providers. SAMHSA/CMHS, other federal departments and/or private providers and foundations could give grants to train trainers and/or conduct community dialogues focused on building wellness zones. These dialogues should result in specific action plans to transform human service delivery and create a culture of healthy, resilient communities. Awards or recognition should be given to communities that develop innovative practices, systems, and collaborative initiatives with effective outcomes. We need to do a better job of educating communities as well as inspiring and rewarding them for innovation that better meets the needs of vulnerable citizens.
We need community, county and regional health and wellness centers with one stop shopping for health, mental health, substance use, jobs, entitlements, information, resources, services, supports, etc. Providers need to get out of the office- as appropriate, be mobile, use technology to reach people (particularly in frontier and rural areas) and we need to connect people to resources (including other people- human resources)
Mentorship programs can be developed at very low cost and provides benefits in various domains such as stigma busting, professional development, personal development, and systems transformation. Programs or organizations could develop a web based mentor match program and provide guidelines for participants. Organizations could take the model, guidelines and materials and further develop the program to suit their needs. Mentors and mentees could find one another on-line based on their individual needs or desires. Matches could go across stakeholder lines. For example a c/s mentor might be matched with a manager who wants to better understand recovery and how to implement it on an individual, group or organizational level.
Accrediting bodies (CARF, JCAHCO, etc.) should incorporate standards that encourage providers to be more knowledgeable about recovery-focused, consumer-directed, wellness and resiliency oriented, trauma informed approaches to service provision. Knowledge of these approaches should be part of new staff orientation, ongoing training and professional development competencies. A list of resource-rich organizations, including those that are consumer-run and recovery-focused, should be made available to staff, administrators, and persons receiving services.
Public libraries and civic organizations could be more engaged in systems transformation. SAMHSA/CMHS and other federal agencies as well as public and private agencies should include these community partners when disseminating information and delivering tangible resources, such as the recovery consensus definition brochure, and other user friendly wellness-focused recovery-oriented educational documents.
NIMH funding priorities should be shifted to ensure that a significant portion of its budget is devoted to research into recovery, resiliency and alternative approaches to wellness.
Successful consumer –run programs (e.g., Rose House) should be promoted as models for systems innovation and transformation. We should invest in research and develop an evidence base for the efficacy and cost-effectiveness of consumer-run programs. This will result in decreased stigma and increased recognition of consumer-led initiatives that foster a new understanding of healing and implement the consumer and family-driven system as envisioned by the New Freedom Commission.
The three day Summit ended with participants sharing the actions they would take. I shared a number of ideas, mentioned above and said that the most important thing I want to share with you this morning is that I will continue to advocate that people with the lived experience of recovery and families be at the head table so that we continue to move towards eliminating the oppressive policies, practices and attitudes that contribute to spiraling healthcare costs, unnecessary suffering and premature death. Lastly, I said that at next years' summit I hoped to hear from more consumers and families about successful, innovative programs.
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