In 1996 when Colorado began its shift to a statewide "capitated" managed behavioral health care system, family member Marti Bloom1 faced a sudden crisis. Her 10-year old son, diagnosed five years earlier with bipolar disorder, was attending what she felt was an excellent children's day treatment program and school at a Denver hospital, all paid for by Medicaid.

"My son was making progress. Everything was going well," she recalls. "Then came capitation. Like everybody else, I was just terrified."

What began in fear, however, has turned out "much better than I expected," Ms. Bloom acknowledges today. Although the journey that she and her son began two years ago in moving away from the hospital-based program to receiving services from the local mental health center has been far from easy, her persistence and perseverance as an advocate for mental health services at both the local and state levels has paid off in improved community-based services for the state's children, including her son.

Ms. Bloom served as a family member representative on the state mental health planning council's Medicaid capitation subcommittee, which participated in the development of Colorado's first managed care request for proposals (RFP). She has used this and other experiences as a mental health advocate in her current role as a member of the consumer and family advisory board of her local community mental health center.

Fortunately, she notes, state and local mental health officials have shown a definite willingness to listen to her and to other consumers and family members and to include them in the planning and decisionmaking that are deciding how the state's mental health system will function.

What happened in the case of Marti Bloom and her son mirrors the struggles and growing pains that many mental health systems and stakeholders are experiencing across the nation as they navigate the shifting currents of managed behavioral health care. In an effort to provide high-quality, cost-effective, community-based mental health services and supports, mental health systems are increasingly seeking to strategically plan their futures rather than simply to react to crises or to changing budget allocations.

"Without planning, you are just spending money," contends Leila Salmon, Chair of the New York Mental Health Planning and Advisory Council and member of the National Association of Mental Health Planning and Advisory Councils. "The only way to effect real change is to plan, to coordinate with others who are addressing the same problems and to work toward outcomes that will change people's lives."

Federal Efforts To Promote Planning

The 1992 federal mental health block grant legislation (P.L. 102-321), which updated the original "State Comprehensive Mental Health Plan Act of 1985" (P.L. 99-660), includes a number of provisions designed to bolster planning by state mental health agencies. In order to receive a federal mental health block grant, states must submit plans to the federal Center for Mental Health Services (CMHS) describing in detail how their block grant funds will be used in a statewide effort to promote and improve comprehensive, community-based mental health services and supports.

The legislation also mandates the establishment of state mental health planning councils with strong consumer and family member representation whose duties include: (1) reviewing and making recommendations concerning the state's federal block grant plan; (2) serving as advocates for adults with serious mental illness, children with serious emotional disturbances and other individuals with mental or emotional problems; and (3) monitoring, reviewing and evaluating "the allocation and adequacy of mental health services within the state" at least annually.²

Since the block grant legislation was enacted, mental health planning councils have evolved along different paths in different states. In some cases, their role encompasses all aspects of a state's public mental health planning, regardless of the source of funding, including community-based services, inpatient services, managed behavioral health care and a range of other services and supports. Others focus solely on block grant services planning. Even when focusing on block grant planning, however, councils usually participate in broad state mental health services planning through their oversight and advocacy responsibilities.

Beginning this year, with an eye toward giving states greater flexibility and promoting longer-range strategic planning, CMHS has revised federal mental health block grant planning requirements. States are now permitted to submit block grant plans for up to three years as an alternative to the annual plans required previously. In addition, the number of criteria that state plans must address has been substantially reduced. As a result, states should now find it much easier to modify their plans to meet changing environmental trends and priorities. [See article on new block grant guidelines beginning on page 1.]

Exploring Strategic Planning Models

State mental health agency officials acknowledge that developing effective statewide mental health plans and planning strategies is not easy. "The public mental health enterprise has become more complex," notes Michael Hogan, Ph.D., Director of the Ohio Department of Mental Health. "Thirty years ago we had relatively closed state institutions operated by a single department. Planning is more complicated these days with diffused, open community systems and lots of stakeholders and forces at work."

To meet the demands of today's environment, Dr. Hogan believes that public mental health systems will need to employ new planning models from a variety of sources, especially business. Specifically, he points to models such as those identified in The Fifth Discipline: The Art & Practice of The Learning Organization by Peter M. Senge of the Massachusetts Institute of Technology's Sloan School of Management as examples of the new ways of thinking that public mental health agencies will need to acquire.

According to Mr. Senge, the most effective organizations are those that create an environment in which people are always learning, "where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free and where people are continually learning how to learn together."³

At the CMHS Performance Outcomes Technical Assistance Workshop held May 2-5, 1998, in McLean, Va., Ronald Manderscheid, Ph.D., Chief of the CMHS Survey and Analysis Branch, urged state mental health planners and mental health planning council members to view consumers of public mental health services and their families as customers and to develop programs and services designed to meet their needs. "Planning needs to drive budgeting," Dr. Manderscheid contends. "Planning must be tied to information systems and performance measures. All of this has to be put into a total quality contract that provides value to customers and employees and ensures high-quality services."

According to Dr. Manderscheid, states need to establish long-range goals and develop realistic strategies for achieving them. "If you engage in long-range planning, one year may be a bad year financially, but put in the context of five years, you have a totally different spin. Taking the longer view is motivating."

Differing State Strategies

Faced with the challenges posed by today's turbulent and rapidly changing environment, some states are developing innovative consumer- and family-oriented public mental health planning strategies. Drawing on their strengths and traditions, states are fashioning new planning approaches aimed at providing high-quality, cost-effective public mental health services and supports.

At the heart of Colorado's public mental health planning process, for example, is the state mental health planning council. This large, active group represents the full spectrum of the state's culturally and ethnically diverse mental health stakeholders. The council is instrumental not only in developing Colorado's federal block grant plan but also in planning all of the state's publicly funded mental health programs and services.

Several years ago, the council took the lead in collaborating with the state mental health agency to develop a comprehensive five-year plan for mental health services. "This was the first time we had developed a strategic plan in Colorado," notes Tom Barrett, Ph.D., Director of Mental Health Services for the Colorado Office of Health and Rehabilitation Services. "In the past, there was a federal plan, a legislative plan, four or five different plans that were not always in synch. This comprehensive plan reflects an integrated approach to integrated services."

In addition to providing a framework for achieving long-range statewide goals, the strategic plan sets the planning agenda for community mental health authorities throughout the state, which are required to submit their own annual plans describing their goals for the coming year and explaining how they will identify and respond to unmet needs for services.

Colorado's emphasis on communication and coordination throughout the mental health system has resulted in the establishment of strong links among the state mental health agency, the state mental health planning council, regional mental health assessment and service agencies (MHASAs), local mental health centers, consumers, family members and citizen advocates. The resulting model ensures that stakeholders such as Ms. Bloom and her son have a strong voice in discussions regarding the state's rapidly changing mental health system.

Dr. Barrett points out that the strategic planning process, with its emphasis on interagency cooperation, has placed the public mental health system on a stronger footing with the state legislature. "They are more willing to make an investment when presented with a well thought out plan," he notes, "particularly when the plan has been signed off on by all the key players."

In Massachusetts the state mental health planning process benefits from the historical "richness of citizen voices" in guiding state policies, notes Marylou Sudders, Commissioner of the Massachusetts Department of Mental Health. In what Ms. Sudders describes as a "wonderfully fluid process," the state's 33 geographically and demographically diverse local area advisory committees composed of consumers, family members and other mental health advocates engage in a yearly planning process that provides the building blocks for the development of the mental health department's annual statewide mental health plan and budget request.

In a custom that reflects New England's tradition of town meetings, local area advisory committees hold a series of meetings each year facilitated by state mental health department staff to identify and discuss the community's mental health services needs and priorities. Each advisory committee also develops profiles of the problems faced by community members with mental illness and the services and supports they need.

"We try not to have a cookie cutter approach to planning," Ms. Sudders emphasizes. "Each committee defines its own needs based on a statewide framework that requires us to address services for kids, adults and the elderly and to focus on cultural diversity and recovery." The reports provide an array of priorities that reflects the state's geographic, cultural and demographic diversity.

Once community plans come to the Department of Mental Health, Ms. Sudders and her staff collaborate with the state's broadly representative mental health advisory council, which is a separate entity from the state's mental health planning council, to meld the wide-ranging priorities into an annual state plan and budget proposal.

"The state plan says, 'Here is what we are doing and who we are serving,' " Ms. Sudders notes. "It also identifies the gaps between what we are doing and what we need to be doing. It points out where the system needs to change, grow and adapt." Although the Massachusetts mental health planning council is separate from the state's mental health advisory council, representatives of the planning council sit on the state advisory council.

One of the key challenges the mental health department faces, according to Ms. Sudders, is incorporating this inclusive planning approach into the state's Medicaid managed behavioral health care "carve-out," which has responsibility for inpatient and ambulatory services for mental illness and substance abuse.

Under this arrangement, the Department of Mental Health sets clinical standards and requirements while the Medicaid agency contracts for designated services. Ms. Sudders notes that the Medicaid agency did not have the same level of active consumer and family involvement as the department until recently. "It's a developmental process. Five years ago, we had little involvement with Medicaid. Now they are coming to understand the importance of consumer and family involvement," she says.

Listening to Consumers and Family Members

In Alabama the initial impetus for bringing consumers and family members into the public mental health planning process came from the federal mental health block grant legislation's mandate for consumer and family involvement, explains Gregory J. Carlson, M.B.A., Planning Director for the state Department of Mental Health and Mental Retardation. "For the first time, we asked consumers and family members what they wanted," Mr. Carlson notes. "It was a rude awakening for many of us. Before that we had been planning in a vacuum and thought we knew what they wanted. We found out otherwise."

Since that time, Mr. Carlson points out, Alabama has developed its own well-defined planning process, which ensures that consumers, family members, advocates and other mental health stakeholders have a strong voice in both state and local public mental health planning. There is a new emphasis on cultural and ethnic diversity in both the planning process and in the resulting services. "We realize that consumers and family members have to be involved in decisionmaking and that there has to be cultural diversity in order for planning to work," Mr. Carlson says.

Honoring Differences and Diversity

A key contribution of state mental health planning councils nationwide during the past decade has been to promote participation in the mental health planning process by a culturally, ethnically and demographically diverse range of public mental health stakeholders, including adults with serious mental illness; family members; children with serious emotional disturbances and their families; individuals from rural, urban and suburban areas; state and local mental health officials; advocates; and providers.

Involving consumers and family members in state and local mental health planning efforts benefits everyone, says Sharron Thomas, a mental health consumer and Co-Chair of the Colorado Planning and Advisory Council's Resource Committee. Better plans are developed by including the expertise of persons with mental illness, she notes, while consumers and family members are empowered by playing an active role in an undertaking that has a major impact on their lives.

"If we are listened to with respect and our remarks are taken seriously, we can contribute knowledge from experience that will make a real difference in the mental health system," Ms. Thomas emphasizes. "At the same time, think of what that experience does for our self-esteem and dignity!"

With diversity come divergent viewpoints, acknowledges Leila Salmon of the New York planning council. "Part of what we have learned is to honor each other's differences while trying to reach understandings about our commonalities," she emphasizes. "We can't hide those differences, in fact it's essential to acknowledge them, but through dialogue and teamwork, we often find that we have far more agreements than disagreements. Sometimes it seems like putting together a jigsaw puzzle, but it pays off."

Please send us a copy of your state's mental health strategic plan and related planning materials (not block grant plans). All materials received will be incorporated into our national information resource data base so that mental health stakeholders throughout the country will have access to the wealth of information developed to date on state mental health planning. Since these materials may be placed on-line, please send them electronically, if possible. Copies may be sent to andrea.sheerin@nasmhpd.org via e-mail or shipped to Andrea Sheerin, NTAC, 66 Canal Center Plaza, Suite 302, Alexandria, VA 22314. For further information, call Ms. Sheerin at 703-739-9333, ext. 22.

¹A pseudonym has been used to protect the family's confidentiality."
²The Alcohol, Drug Abuse and Mental Health Administration Reorganization Act of 1992 (P.L. 102-321), section 1914 (a) and (b).
³Senge, P. (1990). The Fifth Discipline: The Art & Practice of The Learning Organization. New York: Doubleday/Currency p. 3.

State mental health officials and planning council members are responding favorably to plans by the Center for Mental Health Services (CMHS) to allow states greater flexibility in developing federal mental health block grant plans.

"The guidelines are more state friendly and more planning friendly," says Gregory J. Carlson, M.B.A., Director of Planning for the Alabama Department of Mental Health and Mental Retardation, who headed the CMHS Block Grant Simplification Work Group, which developed the revised planning guidelines. "The new guidelines provide a tremendous amount of flexibility. Now we can get back to planning."

Many state mental health officials historically have expressed concern about what they viewed as the rigid nature of the earlier block grant planning rules, which required states to submit annual plans and penalized them with loss of funds if they failed to achieve the objectives included in the plans. As a result, many states chose to scale back on their more ambitious and innovative goals when they developed the block grant plans, promising only what they were certain could be accomplished. "That's not planning," Mr. Carlson comments. "Planning is striving for a vision, taking chances, taking a risk."

States utilize their mental health planning councils in a variety of ways. Some states have established their own mental health advisory panels that operate separately from the federally mandated planning councils to engage in long-term strategic planning and to address issues that may not be covered in the block grant plan. Although the block grant legislation invests state mental health planning councils with responsibility for monitoring and evaluating all activities of the state mental health system, in practice some planning councils focus primarily on block grant planning.

Multi-Year Plans

Under the new block grant application guidelines, state mental health agencies may now file multi-year plans covering two or three year periods. States also have the option to report on five "consolidated criteria" rather than on the 12 traditional criteria required previously. In addition states now have greater flexibility to modify plans submitted to CMHS to meet changing priorities and circumstances.

"There is far greater flexibility than ever before," notes Michele Edwards, A.C.S.W., M.A., Senior Project Officer with CMHS's State Planning and Systems Development Branch. Under the new guidelines, she points out, state mental health agencies, in consultation with state mental health planning councils, can modify their block grant plans for a variety of reasons, including changes in budget allocations or state priorities stemming from an emerging issue or need not anticipated in the original plan.

If states want to modify their block grant plans, Ms. Edwards explains, they should inform their respective CMHS Project Officer of the proposed changes and their rationale. "Communication is the key," she emphasizes. "We are fully aware that SMHAs go through profound changes and that flexibility is needed."

Federal-State Coordination

The new option for multi-year planning may make it easier for states to align their federal block grant plans with other statewide mental health planning efforts. In New York, for example, the one-year block grant planning requirement has been a "sore spot" because it was difficult to coordinate with the state's five-year mental health plans, notes Leila Salmon, Chair of the New York Mental Health Planning and Advisory Council. "Now that there is the possibility for three-year plans, there is much more potential for coordination."

The ability to develop multi-year block grant plans may also help to focus planning councils' time and energy on implementation and outcomes, rather than on developing new goals and objectives each year, notes Bernard J. Carey, Jr., Executive Director of the Massachusetts Association for Mental Health and co-chair of the state mental health planning council. He points out that council members devote substantial time and effort to developing the yearly plans and participating in the annual review process. "This could enhance the councils' involvement in monitoring and evaluating the mental health system, their other major responsibility," Mr. Carey points out. "Currently, most of the councils' energy goes toward approving the annual plan."

Reporting Requirements

Even if states choose to develop two or three year block grant plans, they are still required to submit certain materials on an annual basis, including yearly block grant funding information, certifications and written comments from the mental health planning council on the state's progress in implementing the goals of the mental health plan. CMHS will also continue to conduct annual site reviews.

Ms. Edwards notes that states must submit their block grant plans covering one, two or three years to CMHS by September 1, 1998. In addition, they must provide a year-end implementation report that describes state progress in achieving the plan's goals and objectives by December 1 of each year covered by the plan.u

This issue of networks addresses a subject that is of special interest to me. Some years ago I worked as a program planner at the local, regional and state levels of a state mental health system. It was an interesting, exciting and stressful time.

Federal regional offices were often directly involved in helping states and communities expand and transform their systems. Training through the National Institute of Mental Health's Staff College helped many of us learn about the latest clinical and administrative developments. Community mental health center boards of directors were wrestling with their vision and roles as they worked to advise and guide agencies in developing new community-based services for adults and children.

In those days, pleas to plan ahead were frequently met with reluctance or outright resistance that was offered with some variation of "Don't bother me with planning, we're having a crisis!" ("Too busy running the system!" and "Everything's going to change anyway, so what's the point?" were popular alternatives.) Planning was seen as a burdensome task, necessary to retain funding, meet a licensure or certification requirement, please a new agency head and so on. What planning was not seen as, by and large, was very helpful.

So how have things changed since then, if at all? One thing remains the same: Here we are, years later, still trying to make sense of it all in an environment of constant change. Among the more notable changes are a dramatic emphasis on performance indicators and outcome measures, strong consumer and family involvement and influence throughout mental health systems, continuing upheaval as a result of managed care and rapidly-developing psycho-pharmaceutical and clinical technologies. These and other trends are combining to present today's planners, advocates and administrators with a series of almost unparalleled professional challenges. With this issue of networks, we suggest that planning not only is possible in an atmosphere of change but that it is an absolute requirement for mental health advocates, consumers, clinicians and administrators who are seeking to proactively position their systems to face the future.

Collaboration among key actors has become a hallmark of solid strategic planning at all system levels. Partnerships among state and community mental health authorities; mental health, corrections, substance abuse, public welfare and health agencies; consumers, families and providers; mental health systems and the business community—these are all examples of the types of collaborative efforts that you will see reflected throughout this issue.

We are especially pleased to have collaborated recently with the Federation of Families for Children's Mental Health to offer child-focused planning workshops at the recent annual CMHS-sponsored planning conference in McLean, Virginia. Hopefully, participants in that meeting now have a stronger foundation on which to build mental health services for children with serious emotional disturbances, as well as for adults with serious mental illness.

As you read this issue, consider how far we've come in planning effective mental health services for adults and children, and how much still remains to be done. Examples of successful planning strategies and technologies can be found throughout the country. We are pleased to share some of them with you as we plan together for the future of the nation's public mental health system.

-Bruce D. Emery, M.S.W.

In its effort to prepare the state's public mental health system for the 21st century, Texas has developed a strategic planning process that emphasizes local planning and involvement by consumers, family members and citizen advocates while integrating statewide planning and budgetary processes and linking them to performance and outcome measures.

"Our system is based on performance and data, not on wishful thinking," notes Vijay Ganju, Ph.D., Director of Strategic Planning for the Texas Department of Mental Health and Mental Retardation. "We include measurable targets in our statewide strategic plan and in our contracts with local mental health authorities, and we monitor to determine whether these targets have been met at the state and local levels."

The state's approach to public mental health planning is embodied in its five-year strategic plan, which ties overall goals to specific outcomes and strategies for achieving them. "Planning is intimately linked to our budget," Dr. Ganju says. "Every strategy in the plan becomes a line item in the budget."

The building blocks of the Texas public mental health planning process include: (1) local plans developed by each of the state's 46 local mental health authorities; (2) input from the state mental health planning and advisory committee, other state-level advisory groups and statewide consumer and family organizations; and (3) direction provided by the Board of the Texas Department of Mental Health and Mental Retardation. Based on this input, the department crafts a draft strategic plan for the board's initial approval. The draft plan is then circulated for comment among all of the groups that provided input into the plan. Once comments are incorporated, the plan goes back to the board for final approval.

The strategic plan becomes the basis for the department's budget request to the state legislature. Once funds are appropriated, the department formulates an operating plan and develops contracts with local mental health authorities. Because the elements of the strategic plan are linked so closely to the budget, the final appropriation provides a clear signal concerning planning priorities.

To ensure that consumers and families have a strong voice in the local planning process, the state requires that consumers and family members make up at least 50 percent of the membership of planning advisory committees of local mental health authorities. Several initiatives, some of which are legislatively mandated, are underway to delineate the responsibilities of state and local mental health authorities, incorporate managed care techniques into public mental health services and plan for the development and management of capitated managed care systems. One initiative, referred to as "House Bill 2377," is designed to assess the role of local mental health authorities and, in particular, to determine whether their policymaking and oversight functions conflict with their roles as service providers.

Several sites participating in this initiative are also among a group of pilot sites testing a managed care "carve-in" model for the state Medicaid program. Under this model, the state health department is responsible for all Medicaid-related health services, including those for mental health.

Another pilot project scheduled to begin July 1, 1999, will establish a managed care "carve-out" for Dallas and six surrounding counties. Under the "carve-out," the state mental health and substance abuse agencies will collaborate to ensure that behavioral health services are provided for both Medicaid and non-Medicaid populations.

A key goal of the state's current planning agenda is to redefine the roles of both the state mental health agency and local mental health authorities. The "House Bill 1734 Committee Report" issued in June 1998 by the state mental health agency looks at the issue of which areas of authority and responsibility should remain at the state level and which should be delegated to the local level.

Dr. Ganju likens the state's wide-ranging initiatives to a laboratory for testing different approaches to the provision of mental health services. "These initiatives will help inform our future," he explains. "Hopefully, what develops will be a synthesis of the best that these models have to offer."

For more information about Texas' public mental health planning, please contact Vijay Ganju, Ph.D., at (512) 206-4569.

One of NTAC's primary goals as it launches its new three-year service plan is to help support and strengthen state mental health planning councils through the following collaborative activities:

• Survey of state councils about their technical assistance needs. NTAC will collaborate with the Center for Mental Health Services (CMHS) and the National Association of Mental Health Planning and Advisory Councils (NAMHPAC) to implement a national survey of councils to identify their technical assistance needs. This information will help guide the development of technical assistance services and products during the next several years.

• Hosting of topic-specific teleconference calls for planning council members. NTAC will coordinate quarterly teleconference calls facilitated by expert consultants on topics identified in the survey to promote networking, information sharing and learning.

• Provision of onsite new-member orientation. NTAC will collaborate with selected councils to host training sessions specifically tailored for new council members. Orientation will address topics such as the general role of the planning council, "block grant basics," coordination with other state councils, negotiation and conflict resolution, assessment of unmet needs and development of meaningful performance and outcome standards.

  Additional information may be obtained by contacting John Kotler at 703-739-9333, ext. 31.

The National Technical Assistance Center for State Mental Health Planning (NTAC) and the Nebraska Mental Health Planning and Evaluation Council co-sponsored Recovery...A Guiding Vision for Mental Health Services, a regional conference for midwestern mental health planning councils on April 2-4, 1998. Representatives selected by councils in Colorado, Iowa, Kansas, Missouri and Nebraska convened in Omaha, Neb., to discuss how recovery programs and principles can be incorporated into the public mental health system.

Patricia Deegan, Ph.D., of the National Empowerment Center in Lawrence, Mass., opened the conference with a presentation titled "Hearing Voices that are Distressing," a simulation experience that allowed participants to gain a better understanding of the struggles of people who are voice-hearers.

Dr. Deegan also spoke eloquently of her own recovery journey, beginning with her diagnosis of schizophrenia at age 17. Recalling the dramatic shift in the way others perceived her as a result of this diagnosis, she emphasized how such changes in attitudes and behavior can undermine an individual's efforts to recover and lead a full and healthy life.

Conference participants identified the following four elements as critical for promoting recovery:

Consumer-run services. A delegation of Ohio mental health researchers and services providers who received state grants to promote recovery-oriented services and evaluate their outcomes presented program profiles and preliminary research findings from several recovery-oriented programs. Among them were the "Consumer Leadership Education Program" of Toledo, which assists consumers to become more effective advocates and spokespersons; a program in Fairfield County that promotes employment as well as social and peer support; and Recovery Initative, a day center with five consumer staff members. Each of these programs seeks to create a unique bond and social network among consumers that reduces the sense of isolation and enhances recovery.

Consumer-driven evaluation. Ruth Ralph, Ph.D., of the University of Southern Maine underscored the need to involve consumers at every stage of mental health research. She discussed her work on developing recovery indicators as identified by consumers, including: (1) having the ability to hope, (2) trusting one's own thoughts, (3) enjoying one's environment and (4) feeling alert and alive.

Another example of consumer-driven evaluation efforts, presented by Larry Fricks of the Office of Consumer Affairs of the Georgia Department of Mental Health, was the Georgia Evaluation and Satisfactions Teams, Inc., (GEST), a quality assurance initiative that employs consumers to survey other consumers about their satisfaction with the state mental health system. Mr. Fricks noted that the GEST program creates a "continuous quality improvement loop" by obtaining peer-provided information that is then used to improve the system.

Employment. Mr. Fricks discussed Georgia's "20 To Work by 2000" program, through which each of the state's mental health regions has made a commitment to ensure that 20 percent of mental health consumers participating in day programs are employed by the year 2000. He also pointed out that the Georgia public mental health system employs more than 400 consumers as peer counselors and consumer specialists.

Advocacy. Advocacy, described by some participants as "the best therapy," was viewed as a primary mechanism for helping consumers develop a clear sense of purpose and increasing their opportunities. Participants noted several potential areas for consumer advocacy including the media, fund raising and state and national legislation.

Steven J. Kopecky, M.S., of Boston University's Center for Psychiatric Rehabilitation offered strategies for prompting managed care organizations to incorporate recovery principles and practices into their services while noting several obstacles to achieving this goal, including a lack of widely accepted definitions for terms such as recovery, rehabilitation and psychiatric disability and the absence of an established and comprehensive array of services to promote recovery.

At the conference's conclusion, participants discussed strategies for incorporating recovery principles and practices into state mental health systems. Faculty provided feedback on their initial plans and referred participants to additional resources. In summing up what they gained from the conference, participants expressed the belief that consumers must be involved in all aspects of the mental health system. Their final rallying cry was this: "Nothing about us without us."

Cioffari, A., and Carling, P. (1992). Creating a Competent Mental Health Workforce for the 21st Century. Burlington, VT: Center for Community Change Through Housing and Supports. (Cost: $18 plus shipping and handling; contact Staci Visco at 802-658-0000.)

Drucker, P., Dyson, E., et al. (1997)."Looking Ahead: Implications of the Present," Harvard Business Review, September-October, 18-32. (Cost: $5; call 800-998-0886; reprint 97503.)

Emery, B., Glover, R., and Mazade, N. (1998). "The Environmental Trends Facing State Mental Health Agencies," Administration and Policy in Mental Health 25(3). (Contact Andrea Sheerin at NTAC at 703-739-9333, ext. 22.)

Herzlinger, R. (1997). Market-Driven Health Care: Who Wins, Who Loses in the Transformation of America's Largest Service Industry. Reading, MA: Addison-Wesley. (Cost: $34; call 800-387-8028.)

Hogan, M. (1994). Community Care and Inpatient Treatment: Solutions for the Next Century. Columbus, OH: Ohio Department of Mental Health. (Call 614-466-2297.)

Kaplan, R., and Norton, D. (1996). The Balanced Scorecard: Translating Strategies into Action. Boston, MA: Harvard Business School Press. (Cost: $29.95; call 800-998-0886.)

Reinhardt, U. (1994). "Planning the Nation's Health Workforce: Let the Market In," Inquiry: The Journal of Health Care Organization, Provision, and Financing 31(3): 250-263; call 847-724-9280.)

Robins, L., and Regier, D. (Eds.) (1990). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press. (Cost: $60 plus shipping and handling; call 800-323-7445.)

Senge, P. (1990). The Fifth Discipline: The Art & Practice of the Learning Organization. New York: Doubleday/Currency. (Cost: $32.50; call 800-323-9872.)

Wheatley, M. (1992). Leadership and the New Science: Learning about Organization from an Orderly Universe. San Francisco: Berrett-Koehler Publishers. (Cost: $24.95; call 800-929-2929.)

More than 300 state mental health planners, mental health planning council members and other mental health stakeholders participated in the Center for Mental Health Service's (CMHS) Performance Outcomes Technical Assistance Workshop held May 2-5, 1998, in McLean, Virginia.

Joyce T. Berry Ph.D., J.D., Director of CMHS's Division of State and Community Systems Development, welcomed participants and called on stakeholders to develop partnerships to improve mental health services for children and adults. Dr. Berry said that she is particularly concerned about the nation's "unmet mental health needs" and expressed hope that federal mental health block grant funds would be used to help state mental health systems identify and respond to these unmet needs. "We have to gather information and collect data to draw attention to these issues," she said.

Bruce D. Emery, M.S.W., Director of the National Technical Assistance Center for State Mental Health Planning (NTAC), urged participants to strike a "critical balance" between addressing the day-to-day needs of the mental health system and planning for its future. "We are often in a crisis mode, but we also have a responsibility to look ahead," he said.

In his keynote address on performance indicators and outcome measures, Thomas Barrett, Ph.D., Director of Colorado Mental Health Services, emphasized that state mental health agencies "need to show the benefits" of mental health services to gain increases in federal and state funding. Dr. Barrett said that state mental health agencies must collect and evaluate information about mental health services, provide this information to state legislatures and use the information to improve the public mental health system. At the same time, he said, states need to be able to compare their performance in areas such as access, quality of services and consumer outcomes and to "adopt and adapt" the best practices.

Presentations on the Mental Health Statistics Improvement Program (MHSIP) and the federal Government Performance Results Act (GPRA) were followed by regional workshops on monitoring and evaluation of state mental health systems and a presentation on the new federal mental health block grant application guidelines. [See related article beginning on page 1.]

For the first time, the conference included four workshops on children's mental health issues that resulted from a collaboration between CMHS, NTAC and the Federation of Families for Children's Mental Health. Workshop topics included federal initiatives such as the new Children's Health Insurance Program (CHIP), planning for children's services in a managed care environment and ensuring that children's and family issues are included in state mental health planning efforts.

Federation Director Barbara Huff praised Mr. Emery and the Federation's Trina Osher for their collaboration in developing the workshops. "Their combined efforts were critical to successful family involvement in this meeting," she said. Ms. Huff said that family members who participated in the workshops were enthusiastic about their experience. NTAC also provided funding to pay the expenses of 20 family members to participate in the meeting.

July 19-23: National Association of State Mental Health Program Directors (NASMHPD). NASMHPD 1998 Summer Commissioners' Meeting and Adult Services Division Meeting. Portland, OR. Call 703-739-9333.

August 3-8: International Association for Cross-Cultural Psychology. Fourteenth International Congress. Bellingham, WA. Contact Walter Lonner at 360-650-3574.

August 9-11: National Academy for State Health Policy. State Health Policy Conference. San Diego, CA. Call 207- 874-6524.

August 14-18: American Psychological Association. 106th Annual Convention. San Francisco, CA. Call 800-374-2721.

September 16-20: Institute for Behavioral Healthcare. Tenth Annual National Dialogue Conference: Mental Health Benefits and Practice in the Era of Managed Care. Chicago, IL. Call 650-851-8411.

October 4-10: Mental Illness Awareness Week. Contact Claudia Barnett at the American Psychiatric Association at 202-682-6000.

October 14-16: Washington Business Group on Health. Twelfth Annual National Disability Management Conference and Exhibit. Washington, DC. Contact Ann Makowski at 202-408-9320.

November 19-23: International Society for Traumatic Stress Studies. Fourteenth Annual Conference—Ending Cycles of Violence: Integrating Research, Practice and Social Policy. Washington, DC. Contact Andrea Blood at 847- 480-9028, ext. 233.

In response to Dr. Joyce T. Berry's recent call for more information on unmet mental health services needs, more than 30 states have responded to NTAC's survey on state efforts relating to unmet needs. Information is being analyzed regarding:

• How state mental health agencies (SMHAs) identify and respond to the unmet public mental health needs of children with serious emotional disturbances and adults with serious mental illness;

• What "best practices" in needs identification are employed by SMHAs and other organizations in the state; and

• What resource materials are available to SMHAs that outline effective strategies for identifying and responding to unmet public mental health needs.