The aim of FN-10 was to help people (mostly managers then) make better decisions about mental health care. None of that has changed. What has changed makes a big difference though. There are more decisions to be made, there are more people making decisions, there are more people involved in defining standards, and there are more areas for which standards are needed.

Many of those changes are reflected in the evolution of MHSIP values that has occurred over the last eight to 10 years. Following are values and principles stated in FN-10 and MHSIP documents that have been published since then. It is interesting to note that FN-10 gave lip service to serving a broader audience, but was focused primarily on adult clients and the individual organizations serving them. The Children's Data Task Force report recognized the need to involve families and to look across organizations to integrate data, and used the term "person-based" to describe a preferred data system. Then the Performance Indicator report and the MHSIP Consumer-Oriented Mental Health Report Card document clearly supported the notions of "consumer orientation" and "consumer involvement." Throughout has been the basic call for a common language--i.e., for data standards--so valid comparisons and other data-based decisions can be made.

Values from FN-10:

• "Improvements occur mainly because decision makers elect to make rational changes based on good, data-based information about the operation of their programs."
• Information is "good" if it is "objective, reliable and comparable."
• "The adoption of standards permits communication, judgments and comparisons."
• Comparisons are important, because "organizational performance must be understood in a context."
• Elements of the MHSIP approach are rationality and deliberation, combined with action-taking; collaboration; inclusion of multiple perspectives; and reliance on volunteerism.

Values from the MHSIP Ad Hoc Group Task Force on Enhancing MHSIP to Meet the Needs of Children:

Generally, "services and data to support children's mental health care (should) be forward thinking and flexible enough to accommodate the changes that continue to occur at an accelerated pace." Key principles are:

• 1. The data system coverage should be inclusive (of the full range of services children receive across a multi-agency service system)
• 2. Data should be shared across agencies
• 3. The data should have a clear and agreed-upon utility
• 4. Participants, especially the families of children who have mental disorders, should be invested in the data collection process
• 5. Every effort should be made to avoid demeaning terms and minimize the negative effect of collecting the data
• 6. The data should be easily accessible to potential users who have an authorized need and right to know
• 7. The data system should promote effective and efficient service delivery
• 8. The data system should support communication, advocacy and marketing
• 9. Data elements, their definitions and data networking protocols should be standardized and compatible.

Values from the MHSIP Ad Hoc Group Task Force on the Design of Performance Indicators Derived from the MHSIP Content:

• "Performance Indicators should ensure flexibility and the ability to shift to measures that reflect the most important issues and policies at a given time."
• "Performance Indicators should be ratios and rates--not raw numbers--and should not be merely descriptive statistics; rather Performance Indicators should help show the degree to which service systems perform as intended."
• "Performance Indicators should 'provide systems managers with leverage for shaping the performance of individual organizations' to support consumer-centered systems of care."
• Performance is multi-faceted; focus on "only one aspect of performance (e.g., efficiency) could be at the expense of another aspect (e.g., effectiveness) and, therefore, should be avoided.
• The ideal environment for the development of a system of Performance Indicators is one in which
  • Intents of all stakeholders are articulated.
  • There is a culture of respect for and constructive use of data.
  • Changes are accomplished through participatory development.
  • Resistance is reduced through an open discussion of any misgivings about the Performance Indicators and implementation of safeguards that address those misgivings.

Values from the MHSIP Task Force on a Consumer-Oriented Mental Health Report Card:

A mental health care report card should be consumer oriented-- consumers were involved in every aspect of developing the MHSIP Report Card, and major areas of concern to consumers were addressed: access, appropriateness, outcomes and prevention.

A report card should be based on research and explicit values-- literature reviews of performance indicator systems and what people with serious mental illness want from services were conducted, a focus group of consumers was held, and the Task Force explicitly stated the concerns or values the group wanted addressed by the domains of access, appropriateness, outcomes and prevention (see the full task force report for those values).

A mental health report card should focus on, but not be limited to, serious mental illness--adults with serious mental illnesses are a major focus of the MHSIP Consumer-Oriented Mental Health Report Card, and many of the indicators and measures have been designed with these individuals in mind.

A report card should emphasize the outcomes of treatment--the ask Force acknowledged difficulties with current outcome measures, but "developed the report card based on considerations of what should be measured and not what is conveniently available or easy to measure. Members believe that outcome data will become more accurate as organizations are held accountable for reporting it. In addition, they feel that by defining more clearly the goals and values of the public mental health system, consumers will receive better quality of care, and the broader healthcare community will recognize the effectiveness of mental health and substance abuse treatment."

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