When the state was awarded a federal grant of nearly $14 million in September 2005 to revamp its mental-health system, it was just the latest in a series of major mental-health initiatives over the past 40 years.

Moving people out of institutions came first. Then there was the focus on the chronically and seriously mentally ill. Next came a shift in responsibility from state government to counties, the idea being that each region knew best how to use the funds for its particular needs.

Now there is Mental Health Transformation, which promises to let consumers of mental-health services drive the system. Buzzwords include "recovery" and "resilience."

The focus is on outcomes, whereas under the current system, the focus is on the process of doling out services. For example, the state Mental Health Division can tell how many times a consumer has seen his caseworker over the past year, but it can't tell whether his situation has improved as a result.

"The bottom line is, we need to do a better job of looking at whether the services are making a difference," said Ken Stark, who is directing the transformation planning from the Governor's Office.

As part of the initiative, Stark's group held a series of town-hall-style meetings and invited stakeholders to tell them what was working and what wasn't.

They voiced hundreds of complaints — totaling some 6,000 pages of transcripts.

One theme that surfaced among all of the groups was a lack of access to services. Some complained that they couldn't get appointments with counselors quickly, so their symptoms worsened. Others said the acutely ill are given priority at the expense of others.

"Many found they were in an impossible situation of wanting to obtain services because they did not want to become more symptomatic, yet being denied services because they were not showing enough symptoms to qualify for services," a summary of the comments said.

Even the services that are available were deemed insufficient. Treatment seems to focus on low-level stabilization rather than long-term improvement, many said.

And of course, many mentioned the perpetual problem of money and the fact that treatment decisions are based on funding, not on what the consumer really needs.

Few of these things came as a surprise to Stark.

"We know what's not working," Stark said. "The question is how do you want it transformed?"

From the public meetings and other materials, a list of priorities, from better individual therapy to family support, was developed. Over the next few months, the priorities will be turned into a comprehensive mental-health plan — in essence, a strategy that will turn wishes to action. A plan must be submitted to the federal government in September.

"Once that comes out, the state is basically saying these are the things we're going to be working on as top priorities over the next four years," Stark said. "That's not going to happen overnight."

None of the federal grant money can be used for services, he said.

"No one's ever going to want to pay for everything," Stark said. "It's going to have to be incremental change."

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