advancing the nation’s health: samhsa’s strategic initiatives 2015-2018 charles smith, ph.d....
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Advancing the Nation’s Health: SAMHSA’s Strategic Initiatives
2015-2018
Charles Smith, Ph.D.SAMHSA Regional Administrator
Region VIII (CO, MT, ND, SD, UT, WY)Wyoming Methamphetamine and
Substance Abuse ConferenceCasper, Wyoming
April 15, 2015
Public view of behavioral health conditions
Social consequences rather than health consequenceso Homelessness, gangs, jails, tragedies (e.g., mass
casualty shootings), disability, lost productivity, high government costs
M/SUDs are due to personal will/choice; rather than a preventable and treatable health conditiono Chronic Disease Management
o Heart Disease – more than cholesterol/lipid levels
o Methamphetamine Dependence – more than drug use
o Healthcare Literacy (e.g., CPR/First Aid)
Prevalence Of BH Co-morbidities(Medicaid-only beneficiaries with disabilities)
Hypertension
Diabetes
Coronary Heart Disease
Congestive Heart Failure
Asthma and/or COPD
31.4%
32.1%
26.3%
30.1%
23.8%
68.6%
67.9%
73.7%
69.9%
76.2%
No Behavioral Health Problem With 1 or More Behavioral Health Problem
Boyd, C., Clark, R., Leff, B., Richards, T., Weiss, C., Wolff, J. (2011, August). Clarifying Multimorbidity for Medicaid Programs to Improve Targeting and Delivering Clinical Services. Presented to SAMHSA, Rockville, MD.
Cost of Multiple Health Conditions
$-
$1,000
$2,000
$3,000
$4,000
$5,000
$751
$1,999 $2,739
$4,032
$680
$1,601
$2,627
$4,717
$212
$1,382 $2,052
$3,233
Mental Health Service Users Substance Abuse Service UsersAll Other Medicaid Beneficiaries
SAMHSA. (2010). Mental health and substance abuse services in Medicaid, 2003: Charts and state tables. HHS Publication No. (SMA) 10-4608.
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Access to Care Disparities
Mental Illness45.9 million
Substance Use Disorder
23.1 million
Diabetes 25.8 million
Heart Disease81.1 million
Hypertension 74.5 million
39.2% receiving treatment
11.2% receiving treatment
84% receiving treatment
74.6% receiving
screenings
70.4% receiving treatment
SUD & Primary Care
1 in 6 adults report that a health professional has ever talked with them about alcohol use
o 1 in 4 patients who binge drink report their primary care provider inquiring about alcohol use
CDC, Vital Signs Report (January 2014)
SAMHSA: A Public Health Agency
Mission
Reduce the impact of substance abuse and mental illness on America’s communities
Behavioral Health Is Essential To Health
Treatment Is Effective
Prevention Works
People Recover
Leading Change 2.0: Advancing the Behavioral Health of the Nation 2015–2018
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Purpose: Guide SAMHSA Delivers its mission and realizes the vision sets budget and policy priorities; manages key investments (e.g., grants, contracts, technical
assistance, internal resources) engages public and private partners at every level; and tracks and disseminates information about its progress.
Strategic Initiatives1. Prevention of Substance Abuse and Mental Illness2. Health Care and Health Systems Integration3. Trauma and Justice4. Recovery Support5. Health Information Technology6. Workforce Development
SI #1: Prevention of Substance Abuse & Mental Illness
Goals: Promote emotional health and wellness, prevent or delay the
onset of and complications from substance abuse and mental illness, and identify and respond to emerging behavioral health issues.
Prevent and reduce underage drinking and young adult problem drinking.
Prevent and reduce attempted suicides and deaths by suicide among populations at high risk.
Prevent and reduce prescription drug and illicit opioid misuse and abuse. 14
SI #2: Health Care &Health Systems Integration
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Goals: Integration between behavioral health and health
care, social support, and prevention systems. Support federal, state, territorial, and tribal efforts
to develop and implement new provisions under Medicaid and Medicare.
Support federal, state, territorial, and tribal efforts to influence and support financing models and mechanisms to address behavioral health services.
Finalize and implement the parity provisions in the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act,
Implement quality indicators to advance behavioral health outcomes in the health care.
SI 3#: Trauma and Justice
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Goals: Implement and study a trauma-
informed approach throughout health, behavioral health, and related systems.
Create capacity and systems change in the behavioral health and justice systems.
Reduce the impact of disasters on the behavioral health of individuals, families, and communities.
SI #4: Recovery Support
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Goals: Improve the physical and behavioral health of individuals with
mental illness and/or substance use disorders and their families.
Increase access to permanent housing for individuals with mental illness and/ or substance use disorders and their families. Increase competitive employment and educational attainment for individuals with mental illness and/or substance use disorders.
Promote community living for individuals with mental and/or substance use disorders and their families.
SI #5: Health Information Technology
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Goals: Promote development of technologies and standards to enable
interoperable exchange of behavioral health data Promote the adoption of EHRs and other HIT tools by health
care providers, patients, consumers, states, and tribes. Enhance capacity for the secure collection and use of data in
EHRs and other technologies by continuing to develop behavioral health national data standards, which support quality improvement and effective outcome tracking.
Promote the broad dissemination of technologies for improving behavioral health care, prevention, and wellness.
SI #6: Workforce Development
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Goals:Develop and disseminate workforce
training and education tools and core competencies to address behavioral health issues.
Develop and support deployment of peer providers in all public health and health care delivery settings.
Develop consistent data collection methods to identify and track behavioral health workforce needs.
Influence and support funding for the behavioral health workforce.
SAMHSA’s Theory of Change
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SAMHSA Budget
Budget (Proposed FY 2016): $3.7 B ($44.6 M from FY 2015 Enacted Level)
State Block Grants (MHS & SAPT) Discretionary/Competitive Grants
2016 Behavioral Health Budget Priorities Crisis Systems Prescription Drug & Opioid Use/Misuse Behavioral Health Workforce Tribal Behavioral Health
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2015 SAMHSA Funding Opportunities
Statewide Family Network Program CMHS 02/02/15
Statewide Consumer Network Program CMHS 02/02/15
State Youth Suicide Prevention & Early Intervention CMHS 06/02/15
Primary and Behavioral Health Care Integration (PBHCI) CMHS 02/27/15
Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health)
CMHS 03/30/15
2015 Campus Suicide Prevention Grant
CMHS 04/20/15
Comprehensive Community Mental Health Services for Children with SED
CMHS 04/10/15
Cooperative Agreement to Benefit Homeless Individuals for States (CABHI-S)
CMHS 04/09/15
“Now is the Time” Project AWARE-Community Grants
CMHS 05/01/15
Statewide Peer Networks for Recovery and Resiliency CMHS 06/23/15
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2015 SAMHSA Funding Opportunities
Drug-Free Communities Mentoring Program
CSAP 04/14/15
Strategic Prevention Framework Partnerships for Success
CSAP 03/16/15
Minority Serving Partnerships with Community-Based Orgs CSAP 05/26/15
SBIRT Health Professions Student Training
CSAT 03/27/15
Expand Substance Abuse Treatment Capacity in Adult & Family Drug Courts
CSAT 04/10/15
Cooperative Agreements to Benefit Homeless for States (CABHI-S)
CSAT 04/09/15
Cooperative Agreements for State Adolescent and Transitional Aged Youth
CSAT 04/02/15
SUD Treatment for Minority Populations at High-Risk for HIV/AIDS CSAT 05/14/15
Medication Assisted Treatment:Prescription Drug & Opioid Addiction
CSAT 05/08/15
Joint Adult Drug Court: Services, Coordination, & Treatment
CSAT 06/01/15
Offender Reentry Program (ORP) CSAT 05/26/15
Region I: BostonCT, ME, MA, NH, RI, VTKathryn Power, MEdJFK Federal BuildingBoston, MA 02203
Region II: New YorkNJ, NY, PR, VIDennis O. Romero26 Federal PlazaNew York, NY 10278
Region III: PhiladelphiaDE, DC, MD, PA, VA, WVJean Bennett, PhD150 S. Independence Mall WestPhiladelphia, PA 19106
Region IV: AtlantaAL, FL, GA, KY, MS, NC, SC, TNStephanie McCladdie61 Forsyth Street, SWAtlanta, GA 30303
Region VI: DallasAR, LA, NM, OK, TXMichael Duffy, RN, BSN1301 Young St, Dallas, Texas 75202
Region IX: San FranciscoAZ, CA, HI, GU, NV, AS,CNMI, FSM, MH, PWJon Perez, PhD90 7th Street, 8th FloorSan Francisco, CA 94103
Region V: ChicagoIL, IN, MI, MN, OH, WIJeffrey Coady, PsyD233 N Michigan AveChicago, IL 60601
Region VII: Kansas CityIA, KS, NE, MOVacant601 East 12th StKansas City, MO 64106
Region VIII: DenverCO, MT, ND, SD, UT, WYCharles Smith, PhD1961 Stout StreetDenver, CO 80294
Region X: SeattleAK, ID, OR, WADavid Dickinson2201 6th Ave,MS RX-02Seattle, WA 98121
Region VIII
State Capital Population1 Pop. Density2
SUD Prevalence3
SMI Prevalence4
Suicide Rate5
Colorado Denver 5,029,196 48.5 10.11 4.22 16.8
Montana Helena 989,415 6.8 10.35 5.08 21.8
North Dakota Bismarck 672,591 9.7 9.69 3.93 15.6
South Dakota Pierre 814,180 10.7 10.13 4.17 17.5
Utah Salt Lake City 2,763,885 33.6 6.37 5.00 18.3
Wyoming Cheyenne 563,626 5.8 8.48 4.27 22.4
United StatesWashington,
DC 308,745,538 87.4 8.5 3.9 12.1
1U.S. Census 2010 resident population, all ages2U.S. Census 20103SAMHSA, NSDUH 2010-2011, Table 19. Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 18 or Older (Substance Use Disorder). 4SAMHSA, NSDUH 2010-2011, Table 22. Serious Mental Illness in Past Year among Persons Aged 18 or Older (revised October 2013). 5CDC, National Vital Statistics System-Mortality (NVSS-M) 2010, per 100,000
Behavioral Health Barometer(SAMHSA 2014)
Adolescent Cigarette Use
Slide 27
Adolescent Binge Alcohol Use
Slide 28
Adult Alcohol - Heavy Use
Slide 29
Adolescent/Adult Alcohol Use Disorders
Slide 30
Adolescent Drug Use
Slide 31
Adolescent/Adult Drug Use Disorders
Slide 32
Adolescent Perceived No Risk - Alcohol
Slide 33
Adolescent Perceived No Risk-Marijuana
Slide 34
Adolescent/Adult Alcohol Use Treatment
Slide 35
Adolescent/Adult Drug Use Treatment
Slide 36
Substance Use Disorders – Treatment
Slide 37
Mental Health Treatment
Slide 38
Serious Mental Illness - Prevalence
Slide 39
Adult Mental Health Treatment
Slide 40
Adult Mental Health Treatment
Slide 41
Hot Issue: Health Care System is Changing
Comprehensive health care
Prevention/Wellness rather than illness
Quality rather than Quantity
Increased access to health insurance
Public payers’ roles changing
Implications for the behavioral health workforce
Hot Issue: Accessing Health Care
HRSA Treatment Locator
IHS Treatment Locator
VA Program Locator
SAMHSA Treatment Locators
Hot Issue:Prescription Drug Use
Most Prevalent Illicit Drug Problem After
Marijuanao 1 in 22 reported misuse/abuse of prescription
meds (2010, 2011)o US consumes 99 % of world’s hydrocodone
Emergency Room Visitso Non-medical use of ADHD stimulant medications
nearly tripled from 5,212 to 15,585 visits (2005 –
2010)
Treatment Admissions o 569.7% increase Benzodiazepine & pain med use
(2000-2010)
National Prescription Drug Abuse Prevention Strategy
Consumer and Prescriber education.
Enhanced use of prescription drug monitoring programs.
Safe disposal of unused medicines.
Enforcement to eliminate improper prescribing practices and to stop pill mills.
Tobacco Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health ProvidersTobacco cessation is a key component of many individuals’ recovery, and should be a priority health issue for every health provider.
Community ConversationsThe “Toolkit for Community Conversations About Mental Health” is designed to help communities hold community dialogue about mental health and violence.
Million HeartsMillion Hearts is a national initiative to prevent 1 million heart attacks and strokes over five years.
ChooseMyPlate.gov USDA Food and Nutrition Service campaign to promote appropriate food balance and portions
Hot Issue: Health & Wellness
National Prevention Strategy
SAMHSA Technical Assistance Centers
ATTC Regional Centers www.attcnetwork.org o Central Rockies ATTC (University of Utah)
ATTC National Focus Centerso National Frontier and Rural ATTC (University of Nevada-Reno)o Hispanic/Latino Health Disparities ATTC (Universidad Central del Caribe)o ATTC-SBIRT (IRETA, University of Pittsburgh)o American Indian Alaskan Native ATTC (University of Iowa)
Center for the Application of Prevention Technologies (CAPT) www.captus.samhsa.gov
Tribal Training &Technical Assistance Center www.samhsa.gov/tribal-ttac
Suicide Prevention Resource Center www.sprc.org
Center for Integrated Health Solutions www.integration.samhsa.gov
Center for Integrated Health Solutions
www.integration.samhsa.gov
CIHS promotes the development of integrated primary and behavioral health services to better address the needs of individuals with M/SUD, whether seen in behavioral health or primary care settings
Practicing Comprehensive Community Health Care: PBHCI
Health care providers (both PH & BH) assess and monitoro Blood pressure, body mass
index, vaccineso Depression/suicide,
drug/alcohol/tobacco use
Community/School initiatives focus on:o Physical health, substance use,
and emotional healtho Academic success and health
Community Partnerships = Coordinated System of Care
Imagine a generation …
without a death by suicide,
without one young person being bullied because they are LGBT,
of youth who do not see using alcohol and drugs as a right of passage,
in which no one in recovery struggles to find a job,
where our jails and prisons are not the largest psychiatric institutions,
… in which behavioral health is truly an essential part of health care.
Ripple…
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Thank You
Charles H. Smith, PhDRegional Administrator - Region VIII
(Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming)
Substance Abuse and Mental Health Services AdministrationU.S. Department of Health and Human Services
999 18th Street, South Tower, Room 4-342Denver, CO 80202
303-844-7873 (office)720-441-9995 (cell)
