In the Industrial Age, there was a tendency to look at each part…isolate what was broken…and fix it. That works on machines, but not on living human systems. We know now that consumers and families are at the very center of our network of living systems and we have to transform the rest of our support around them.

This is a huge shift in our thinking of how to provide services, but many other individuals, systems, and sectors are taking the leap along with us. The mental health services delivery system is a complex network. We all have a role to play in the transformation of this system… at the federal, state, local and individual level.

Our mission -- should we choose to accept it -- is to create a blueprint, create a map and apply a systems approach to building and strengthening our networks at the local, state and national levels.

Several years ago, the President’s New Freedom Commission on Mental Health released its final report—our “blueprint”, which it called Achieving the Promise: Transforming Mental Health Care in America. Achieving the Promise declares that millions of Americans with mental illnesses are being denied this promise. Stigma and discrimination, fragmented and inadequate services, poor opportunities for consumer involvement and self-determination -- these are the barriers to their hope in recovery and a life in the community. The report concludes that the only way to keep our promise to all Americans is to transform our mental health system.

The New Freedom Commission’s report found that “Services and funding are fragmented across programs”. Fragmentation comes from the Latin word “fragmentum” which means “a part broken off; detached; incomplete.” And that’s what we were experiencing in our mental health system at all levels.

This fragmentation causes barriers to services that prevent consumers from accessing the services they need. This fragmentation inhibits developing individualized treatment plans that meet service needs of consumers, because of the array of funders involved. Most funders and providers don’t know what the other funders and providers are doing.

And we are affected by budget realitie. This is a time of fiscal constraint. Funding available for mental health is declining, even as demand for services is increasing.

This situation highlights our critical need to move toward a transformed mental health system, where we can prevent as well as treat serious mental illnesses.

SAMHSA developed its National Outcome Measures (NOMs) in response to the public’s demand that government agencies demonstrate accountability to the taxpayer by wisely investing the resources we do have into treatments and services that produce positive outcomes. The NOMs reflect a transformed view of effective mental health care because they focus on positive outcome measures for consumers. I am pleased to report significantly increased numbers of States have reported on NOMs domains for both mental health and substance use programs.

As the NOMs partnership demonstrates, mental health care that moves along a continuum of services and across the lifespan demands greater collaboration among agencies. If we can accomplish this—if we can combine resources, braid funding streams, and cross-train our workforce—we can reduce the costs of mental health care.

Last July, we released Transforming Mental Health Care in America: The Federal Action Agend -- an unprecedented collaborative effort across the key people-serving agencies. You will have received a copy of this document as part of your conference materials.

This document outlines the important first steps that organizations within the Federal Partners Workgroup will take on the road to transformation. It describes time-limited, realistic priorities...and actions that can yield immediate results. It provides a roadmap of how we will move from a vision of transformed mental health care to its reality.

SAMHSA continues to work toward linking Block Grant resources with transformation activities. Consumers and families living with mental health problems have complex, multiple issues. These issues cut across departments, agencies, and systems. Consequently, only systemic change…and change that is collaborative, coordinated, and based on sound planning and data analysis…will provide all that successful transformation requires.

Change, however, doesn’t simply happen. People must make it happen. Your critically important role is to collect, analyze, and interpret data so that it will guide future improvements in service delivery. The State level is where true transformation will take place.

The Federal government can motivate, facilitate, and compel changes in the mental health care system at the Federal and State levels, but the State level is where the actual decision-making takes place. The State level is where individuals in need merge with services provided. Our job is to make sure they don’t encounter any detours or dead ends on the road to recovery.

We live in interesting times…network television programming, for example, is filled with “reality TV” that has no connection with reality. In the movies we see glamorous stars accept impossible missions that they handily solve in a two-hour setting…even the Da Vinci Code only took 48 hours to solve after thousands of years of remaining a mystery.

We don’t live in that world. There are no special effects teams to come in and make the impossible happen. There are no writers who can rewrite the endings of all of our lives to ensure the “happily ever after.”

For the millions of children and adults that live with mental illnesses… their reality cuts through all conceptual ideas of “how things could be” because they are in a system of “how things are now.” It’s our job to strengthen our networks and use our intelligence and experience to design networks for consumers and families that work.

Transformation is both an outcome and a process. It is not just a fancy word for change. It is ultimately about newness -- about new values, new attitudes, and new beliefs that are expressed in the changed behavior of people. The “people” aspect of transformation is crucial because people, just like you, are its architects.