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Substance use treatment/prevention and mental health services: Critical elements to successful healthcare reform

February 27, 2009
by ccurie
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It is with great interest and tremendous concern to observe how little attention has been given to addressing the needs of people with addictive disorders or mental illnesses in any of the initiatives coming out of the new U. S. Congress or the Obama Administration. Granted, there are grave issues facing our nation with an economy in crisis and instability in international affairs. The new President and Congress have their “hands full” in addressing overwhelming challenges. However, whether considering the Baucus health care plan (proposed in the Fall of ’08 by Senator Max Baucus of Montana, Chairman of the Senate Finance Committee), the Economic Stimulus Package or the information being released by the Obama Administration thus far, there is little evidence that meeting the treatment and recovery needs of people with addictive diseases, adults with serious mental illnesses, children with serious emotional disturbances and youth at risk for substance use are being addressed in any direct or meaningful way. The Baucus plan (which very much aligns with the health reform plan outlined by the Obama Campaign) has no consideration of addictive disorders or the toll substance abuse takes on our society and in the lives of individuals trapped in addiction and their families. Mental illness also is not mentioned and the term mental health is mentioned twice, once in a footnote and once in the context that a community health team should have a mental health worker. While the Economic Stimulus package was initially written by the Democratic Leadership of the House included money for the Department of Interior for providing drug and alcohol treatment in American Indian and Alaskan Native communities and perhaps dollars elsewhere for treatment of addictive disorders for adults and youth; there was no money for the Substance Abuse and Mental Health Services Administration (SAMHSA) and yet there were billions of dollars proposed for other operating divisions within the U. S. Department of Health and Human Services. I give much credit to advocates such as Paul Samuels of the Legal Action Center for pulling together the substance use and mental health services advocacy communities to influence the final bill to give behavioral health providers an opportunity to apply for services funding and HIT dollars for drug and alcohol and mental health services. However, it is still disturbing that addiction treatment services and mental health interventions seem to be invisible in the current Administration’s deliberations. This concern is further highlighted by the apparent decision of the Obama Administration to “demote” the position of Director Office of National Drug Control Policy (ONDCP) from a Cabinet ranking position to being in charge of an office within the White House. Those within the Administration may say that they will address substance use disorders and mental illnesses within the greater health care system. However, it is essential to note that whenever there has not been a deliberate focus on people with the most serious mental illnesses or with people with addictive disorders or with youth at risk for substance use problems or children with serious emotional disturbances, those individuals lose in terms of resource allocation and increased stigma. People who already are living on the margins of society are further marginalized. Let us not forget that these conditions and disorders are very serious, as they not only profoundly diminish a person’s health and quality of life, but also can result in death.

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Your comments are right on the mark. The next question to ponder is "what would a reformed behavioral health system look like?"

The Obama administration's apparent lack of interest in mental health and substance use policy is striking. Maybe we need to give them more time (Obama's only been in the White House a month), but this field knows all too well that if you aren't on the radar at the very beginning, it's easy to be left behind. Let's hope the HHS secretary nominee (What is taking so long? We've had three commerce secretary nominees already!) will have the behavioral healthcare field on his/her mind.

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Charles G. Curie is the Principal and founder of The...