Built from the former Alcohol, Drug Abuse, and Mental Health Administration, the Substance Abuse and Mental Health Services Administration (SAMHSA) was formed in 1992 when ADAMHA's research institutes (the National Institutes on Mental Health, on Alcohol Abuse and Alcoholism, and on Drug Abuse) were transferred to the National Institutes of Health. It wasn't an easy fresh start for the agency.
To begin with, the institutes enjoy a high level of respect and prestige in the behavioral health field. The institutes have clearly defined functions as well as strong constituencies within academia and healthcare. In contrast, the activities that remained with SAMHSA have struggled to define their collective contribution to behavioral health. Most SAMHSA funds are devoted to block grants to state governments calculated on formulas based on state population; much of the remaining funding has been distributed among diverse, often short-lived “demonstration grant” programs.
The block grants and demonstration grants, in turn, are supervised by three entities: the Center for Mental Health Services (CMHS), the Center for Substance Abuse Treatment (CSAT), and the Center for Substance Abuse Prevention (CSAP). SAMHSA thus was born as a patchwork of programs with neither a coherent sense of mission nor a well-defined constituency.
Also troubling the young agency were leadership problems. In 1994, the Clinton administration named Nelba Chavez, PhD, then director of juvenile probation services for San Francisco, as SAMHSA's first appointed administrator. It was not a well-received appointment: Dr. Chavez's few years of experience in city office did not provide a background to credibly run a federal agency with a budget of more than $800 million. SAMHSA veterans add that her acerbic and domineering style alienated career federal officials and contributed to an exodus of well-known experts from the agency. At the same time, congressional staff found Dr. Chavez consistently unprepared to answer questions on behavioral health issues. Predictably, during her final years as administrator, rumors frequently circulated that Congress was preparing to dissolve SAMHSA as an independent agency.
Despite the reports of SAMHSA's imminent demise, nearly a year elapsed between Dr. Chavez's resignation in December 2000 and the appointment of Charles G. Curie, MA, ACSW, as SAMHSA administrator. Curie had more than 20 years of professional background in behavioral health. At the time of his federal appointment, Curie was deputy secretary for mental health and substance abuse services for the Pennsylvania Department of Public Welfare. In this position, he implemented the state's Medicaid managed behavioral healthcare program. He also is credited with eliminating the use of seclusion and restraint practices in the Pennsylvania state hospital system.
Charles G. Curie, MA, ACSW
Articulate, urbane, and knowledgeable in managing both public- and private-sector mental health services, Curie clearly enjoyed several advantages over the previous appointee. The question remained whether he could overcome the institutional barriers to defining a single mission for SAMHSA.
As Curie prepared to step down from his post this summer, he gave Behavioral Healthcare the opportunity to talk with him about his five years as SAMHSA administrator.
What are your greatest accomplishments…the things you're most proud of in terms of your tenure?
Curie: The President's New Freedom Commission on Mental Health succeeded in coming out with a report that consumer-family groups, the provider community, and the academic community have embraced. I feel very good that we've been a part of the process that has brought the issues out that need to be addressed. We've built on a knowledge base as well as begun to set the stage for an action plan.
That leads me to another accomplishment: the federal action agenda formed out of the results of the commission. There are now over 20 federal agencies aligned to take concrete steps to assure that the federal government can begin speaking with one voice on mental health issues. That's never happened before. I think the stage has been set to give a clear focus to mental health policy on the federal level.
On the substance abuse side, I would point to two areas. I'm pleased that we have been able to implement the Access to Recovery Program. This basically was a new approach using mechanisms that allow consumers choice of the best pathways to recovery. We're garnering data from 14 states and one tribal organization. We're learning a lot from that process. One of the major things we've learned is how important recovery support services are to recovery. That can have an impact in shaping what services should be funded.
The Strategic Prevention Framework is another accomplishment that I'm proud of. The Strategic Prevention Framework is putting into place in 40 states a risk and protective factor approach to prevention that will help continue to reduce substance abuse and build resilience in our young people.
Within SAMHSA, we have a clear agenda around children's issues. Sybil Goldman, initially the senior advisor on children's issues to the administrator, set the bar high and moved ahead with an agenda in which all three centers [CMHS, CSAT, and CSAP] are aligned. Now that agenda is moving throughout the federal government, engaging the Department of Education and the Office of Juvenile Justice and Delinquency Prevention.
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