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Lassoing collaboration to spur change

December 1, 2007
by Ronald W. Manderscheid, PhD
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Texas explores the possibilities of community collaboratives

Texas is in the early phases of a very interesting community experiment. One of nine recipients of Mental Health Transformation State Incentive Grants from the federal Substance Abuse and Mental Health Services Administration, the state has turned to the Texas Health Institute to develop eight local community collaboratives that will transform local mental health services.

Community collaboratives identify local health problems, build local consensus about solutions, and implement these solutions. The Institute of Medicine recognizes collaboratives as a powerful tool to bring about transformation and quality improvement in local health services. This strategy recognizes that like politics, all healthcare occurs at the local level, and that solutions to problems must begin at this level. Texas is the only state developing local community collaboratives as part of its mental health transformation process.

The eight Texas collaboratives range from the urban Dallas County Initiative to the Coastal Bend Rural Health Partnership, which covers Brooks, Jim Wells, and Kleberg Counties. This range is intended to reflect the different mental health needs and problems in the urban, rural, frontier, and border communities of Texas. Generally, urban communities have more problems with service coordination across different care systems; rural areas have more problems with service availability and implementation.

The Texas Health Institute recently hosted the first meeting of the eight community collaboratives. The symposium's purpose was to share plans and information among the collaboratives as a first step in creating a “quality circle,” as well as to receive feedback from an advisory group composed of key leaders from the mental health field.

The meeting was hosted jointly by Camille Miller, CEO and president of the Texas Health Institute, and Dr. Nancy Speck, a member of the President's New Freedom Commission on Mental Health. Dr. David Lakey, commissioner of the Texas Department of State Health Services, opened the meeting, and Kathryn Power, director of SAMHSA's Center for Mental Health Services, closed it.

From the opening session to the final good-byes, all participants expressed a high level of enthusiasm and commitment. Consumers and family members figure prominently into the structure of each collaborative, and they were well-represented in the audience and conversation for both days of the symposium. Even more important, the collaboratives have provided a venue for the creation of local recovery-oriented service systems that are consumer-and family-directed.

An obvious need of all of the collaboratives, whether urban or rural, is additional financial resources. Several collaboratives have shown a high degree of creativity in identifying and seeking new funding sources, especially local foundations. Another obvious need is for broader health insurance coverage for all Texans. More than one-quarter of the population is without health insurance. As is well known in our field, this percentage is even higher among persons with mental illness. The collaboratives are committed to expanding services and reaching out to the uninsured, a very innovative way of “covering” this population.

Hallway discussions with members of the consumer community indicated a deeply felt need for the creation of a statewide consumer organization to guide aspirations and efforts. Following the symposium, the Texas Health Institute held a second meeting to explore this idea.

As we continue to seek ways to implement the IOM's report on Improving the Quality of Health Care for Mental and Substance-Use Conditions, community collaboratives hold considerable promise. They will allow us to transcend traditional bureaucratic boundaries and identify new partners to forge needed linkages among mental health, substance use, and primary care. They also will provide strong support for fostering new values and actions that can lead to a transformed system that is consumer- and family-directed. Each of these possibilities is both exciting and energizing.

With all of this potentiality, one has to question why Texas is the only state implementing community collaboratives to transform public mental healthcare. I suspect that the concept is yet too new to our field. Although recommended by the IOM for almost a decade and employed for at least the same period in the public health field, community collaboratives are new to us.

I salute the Lone Star State, the Texas Health Institute, Camille Miller, Dr. Nancy Speck, and especially the eight Texas mental health community collaboratives for the vision, heart, and courage to move into an uncharted territory that holds such promise.

Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm Constella Group, LLC, worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board.

To contact Dr. Manderscheid, e-mail