We know more than ever about what works -- about effective treatment, service delivery models, sustainable financing strategies -- and how to replicate these innovations. It is widely understood that outcome-driven accountability is essential if adults and children with behavioral health care needs are to learn, work, live and participate fully in their communities.

The establishment, by Executive Order, of a Commission on Behavioral Health Transformation would provide the structure and authority required to draw upon the best thinking of all stakeholders to develop and guide the kind of comprehensive change that no single agency, no one community, no one constituent group can accomplish on its own.

Transformation involves not just reform and isolated innovation, but a wholesale rethinking of the assumptions, principles, relationships, methods, and objectives that form the framework by which we operate. Transformation asks us to 'put it all on the table', engage in divergent thinking, and test every proposal against a set of guiding principles.

Historically, treatment for psychiatric and addictive disorders has been provided apart from the physical health care system. The largely separate system that has evolved is fragmented, with complex funding methodologies which do not meet the needs of the vast majority of New Yorkers. Well-intentioned efforts to reform the system have been equally fragmented.

Uncoordinated initiatives and an outmoded regulatory framework present enormous obstacles to providing timely and effective services to those who urgently need them. Mental health and substance abuse providers struggle with the challenges of offering quality care to individuals and families with many special needs because rarely, if ever, do reimbursement rates reflect the actual cost of providing services in New York State, and there is no mechanism in place to address inflationary costs. Consumers and their families often find that access to best-practice, community-based treatment is limited. The absence of an outcomes-based oversight process has compromised accountability and cost-effectiveness. Collectively, these problems have a negative impact on quality of life and they limit the potential for independence and recovery. Furthermore, the federal government's threatened reduction in Medicaid, the primary source of reimbursement for services is emblematic of a significant structural problem and places our statewide system at significant risk.

There is broad consensus, documented in numerous national and state reports that our current behavioral health care system (public and commercial) is in need of fundamental change. The federal government is backing transformation through grants and technical assistance from the Substance Abuse and Mental Health Services Administration (SAMHSA). According to a survey conducted by the National Association of State Mental Health Directors, in July 2005, 34 other states have already responded with some level of transformation.

While important advances have been made, change has not been sufficiently ambitious or comprehensive. The President's New Freedom Commission Report issued in 2003 recognized this, and recommended "fundamentally transforming how mental health care is delivered in America."

Transformation is Essential

Action must be taken swiftly to develop a comprehensive, forward-thinking course of action. State and national organizations have spoken in unison regarding the need for a fundamental transformation of New York's behavioral health care system of services and supports.

The establishment, by Executive Order, of a Commission on Behavioral Health Transformation would provide the structure and authority required to draw upon the best thinking of all stakeholders to develop and guide the kind of comprehensive change that no single agency, no one community, no one constituent group can accomplish on its own.