Pamela S Hyde, JD
Substance Abuse and Mental Health Services Administrator, United States Department of Health and Human Services

The Substance Abuse and Mental Health Services Administration (SAMHSA), together with many partners, has shown that:

• behavioral health is essential to health,
• prevention works,
• treatment is effective, and
• people recover from mental and substance use disorders.

In 2011 and beyond, SAMHSA will build on these results through eight strategic initiatives.¹ SAMHSA will work with private and public partners at all levels to reduce the impact of substance abuse and mental illness on America’s communities.

Public Health Burden

Substance use disorders, poor emotional health, and mental illnesses take a toll on individuals, families, and communities. They cost money and lives. Their presence results in some of the highest disability burdens in the world for individuals, families, businesses, and governments.²

The impact on America’s children, adults, and communities is enormous. For example:

• The annual total estimated societal cost of substance abuse in the United States is $510.8 billion.³

• By 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide.⁴

• In 2008, an estimated 9.8 million adults aged 18 years and older in the United States had a serious mental illness. Two million youth ages 12 to 17 years had a major depressive episode during the past year.⁵

Highlights of Strategic Initiatives

Each initiative has a specific purpose, goals, and actions as well as measures for determining success. The initiatives will focus SAMHSA’s efforts in:

• setting budget and policy priorities,
• managing grants, contracts, technical assistance, agency staff, and interagency efforts,
• engaging partners at every level, and
• measuring and communicating progress.

Prevention of Substance Abuse and Mental Illness

Mental and substance use disorders affect the health of individuals and the nation’s social and economic well-being. Compared with other health conditions, they are among the top causes of disability, disease burden, and cost for families, employers, and publicly funded health systems.

The Health Care and Education Reconciliation Act of 2010 (Affordable Care Act) reflects an increasing commitment to prevention. SAMHSA will capitalize on this opportunity by supporting communities in using a comprehensive mix of prevention strategies. The agency will work to build emotional health, prevent or delay onset of, and reduce symptoms and problems from substance abuse and mental illness. The initiative will target underage drinking and adult problem drinking, tobacco cessation, prevention of suicide and suicide attempts, and misuse and abuse of prescription drugs. SAMHSA will focus its efforts on American Indian and Alaska Native communities and other populations that have higher levels of substance use disorders and suicide rates than the general population.

Trauma and Justice

Psychological trauma occurs as a result of violence, abuse, neglect, disaster, war, and other emotionally damaging experiences and has no boundaries by age, gender, socioeconomic status, race and ethnicity, geography, or sexual orientation. Addressing trauma is a fundamental obligation of behavioral health services. SAMHSA supports a public health approach to trauma, identifying screening tools and a continuum of interventions. Efforts though this initiative will develop trauma-informed systems through SAMHSA’s grant programs and partnerships with other service systems.

SAMHSA also will work to address the needs of persons with mental and substance use disorders within the criminal and juvenile justice systems. For example, SAMHSA will offer training on trauma-related behavioral health issues for state and territorial chief judges and presiding judges, continue to support innovations in drug and other problem solving courts, and work to get people with behavioral health problems into treatment instead of correctional settings when it is appropriate.

Military Families

Since 9/11, more than 2 million US troops have deployed to Iraq and Afghanistan. A significant proportion of returning service men and women suffer from post traumatic stress disorder, depression, traumatic brain injury, and substance abuse. Military suicides exceed the national average.

SAMHSA will support the presidential call for action and the development of a seamless behavioral health service system for military families. Its emphasis will be on coordination of policies and resources across federal, national, state, territorial, local, and tribal organizations. The agency’s efforts will include improving access to community-based behavioral healthcare, providing technical assistance to behavioral healthcare providers, and promoting evidence-based practices. SAMHSA will strengthen partnerships to build a full-spectrum behavioral health service system for military families.

Healthcare Reform

The Affordable Care Act (ACA) affirms that prevention, early intervention, and treatment of mental and substance use disorders are an integral part of improving and maintaining overall health. The act calls for mental health and substance use services for newly covered individuals at parity and consistent with the 2008 Mental Health
Parity and Addiction Equity Act (MHPEA). SAMHSA will also support states to use block grant funds in coordination with the system improvements resulting from MHPEA and ACA.

SAMHSA will ensure that behavioral health is included in healthcare reform. Furthermore, the agency will support states, territories, tribes, primary care and behavioral health providers, and individuals and families to understand and participate actively in healthcare reform efforts. SAMHSA will undertake a variety of virtual and in-person communications and education efforts—from webinars to blogs to meetings—across diverse target audiences, including agency staff as well as consumers and providers. SAMHSA will provide technical assistance and training geared to the integration of primary and behavioral healthcare.

Recovery Support

SAMHSA remains committed to the recovery of people with substance use and mental disorders. Recovery is more than abstinence from substance use or a reduction in symptoms, true recovery includes a life that includes opportunities for:

• health—a physically and emotionally healthy lifestyle;
• home—a stable, safe, and supportive place to live;
• purpose—meaningful daily activities such as a job, school, volunteerism, family caretaking, or creative endeavors and the independence, income, and resources to participate in society; and
• community—relationships and social networks that provide support, friendship, love, and hope.

Through the Recovery Support Initiative, SAMHSA will promote individual, program, and system approaches to building recovery and resilience. This includes the development of services, information, and partnerships to increase permanent supportive housing, supported employment, and other recovery support services for persons with mental and substance use disorders. SAMHSA will also work to reduce barriers to recovery for individuals with mental and substance use disorders.

Health Information Technology

Health information technology (HIT) can enhance healthcare quality, prevent medical errors, increase administrative efficiencies, decrease paperwork, and improve individual health. Yet, research shows that IT spending and use are below average among behavioral healthcare and human services organizations, compared with general healthcare services. Comprehensive, secure, consumer-oriented electronic health records (EHRs) must include data related to all key components of health, including behavioral health.

SAMHSA is already working on several HIT initiatives with HHS agencies as well as the Departments of Defense and Veterans Affairs. The agency will host national forums on HIT strategies for state and territorial behavioral health authorities, providers, consumers, families, and other stakeholder groups. These forums will foster the adoption and use of EHRs and access to information on behavioral health privacy and confidentiality. The agency also plans to promote cooperation among substance abuse, mental health, and Medicaid agencies within states and territories.

Data Outcomes and Quality

In order to make informed decisions in the development of their behavioral health systems, states, territories, and communities need data on evidence-based interventions and services. This data can help policymakers at all levels develop policies and programs that promote better health and behavioral health outcomes.

Since 2006, SAMHSA has worked successfully to advance data systems and the uptake of EHRs. SAMHSA will take advantage of a revitalized national interest in data activities and new technologies by forming a more robust behavioral health information infrastructure for the nation. The agency will work with partners and stakeholders to develop a coordinated set of systems and quality and performance indicators for grant programs. The agency will set standards for defining and measuring resilience and recovery for substance abuse and mental health. Finally, SAMHSA will improve the quality and access to surveillance, outcome and performance, and evaluation information for staff, stakeholders, funders, and policymakers.

Public Awareness and Support

According to SAMHSA’s National Survey on Drug Use and Health, millions of people are not receiving needed services for substance use and mental disorders.⁸ In addition to the service improvements outlined in SAMHSA’s other strategic initiatives, decreasing the gap between people needing and receiving treatment services requires public education. If people recognize mental and substance use disorders and seek help with the same urgency as any other health condition, recovery becomes the expectation. SAMHSA aims to increase understanding about mental and substance use disorders and ensure that the public knows that effective treatment and prevention programs exist.

SAMHSA will coordinate with public and private partners to increase access to evidence-based behavior health information. The agency will streamline and coordinate its Web presence, using emerging technology and social media to engage and inform the public. SAMHSA will also create a research-based strategic communications plan for each of these eight initiatives.

2011 and Beyond

SAMHSA has a unique opportunity and responsibility to focus the nation’s healthcare and social agendas on these preventable and treatable problems. By focusing on prevention, addressingtrauma, supporting military families, increasing access to appropriate care, developing community and family supports, building information systems and by working with health, justice, social services, educational, and other systems, SAMHSA will continue to support our nation’s behavioral health.

References

1. The full document describing SAMHSA’s strategic initiatives is available at www.samhsa.gov.
2. World Health Organization (2004). Prevention of mental disorders: Effective interventions and policy options. Summary Report.
3. Miller, T. and Hendrie, D. Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis. DHHS Pub. No. (SMA) 07-4298. Rockville, MD: Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, 2009.
4. Mental Health: Concepts, Emerging Evidence, Practice (summary report). Geneva (CH): World Health Organization; 2004; www.who.int/mental_health/evidence/en/promoting_mhh.pdf.
5. Substance Abuse and Mental Health Services Administration (2009). Results from the 2008 National Survey on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-36, HHS Publication No. SMA 09-4434). Rockville, MD.

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