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Suicide prevention: Effective advocacy and collaboration. A case in point (Charles Curie)

August 23, 2008
by ccurie
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Advocacy is hard work. Collaboration is perhaps even harder work. Advocacy for and collaboration on efforts to promote effective approaches to suicide prevention can be particularly challenging in light of the stigma that surrounds the issue and the difficulty in finding resources (money) to meet the demands of competing public health priorities. It may seem as if, more often than not, we make little to no progress in advancing the priorities of the mental health and substance use treatment fields. The good news is there are many examples of the well-informed and prepared individual making a difference, when the opportunity presents itself, to advocate for the right thing. The profound impact of one such advocacy success for suicide prevention made the national news in recent weeks. TheUSA TODAY newspaper (otherwise known as the road warrior journal), in its July 29th issue on page 4A, reported on a federal government program that is jointly administered by the VA and SAMHSA. The article stated, “More than 22,000 veterans have sought help from a special hotline in its first year, and 1,221 suicides had been averted”. It went on to point out that a RAND Corp. study has “found that about 20% of soldiers returning from Iraq and Afghanistan display symptoms of PSTD, which raises the suicide risk”. There are several reasons this short article is significant. One obvious reason is it reports on quantifiable outcomes and demonstrates that access to the right supports, in this case a qualified hotline, helps people and saves lives. Also, it serves to educate the public about risk factors for suicide and brings the conversation to an open forum.

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Doug, you make an important point. What is an effective way to "transcend turf" and realize an alignment of activities of the federal agencies that impact behavioral health services positively? The notion of a czar that will force collaboration seems appealing. However, of the many attempts to establish a czar, (most recently an intelligence czar) collaboration and coordination between agencies still is illusive. I have heard some advocate that HHS should add an "Under Secretary of Health" to force coordination of all the public health agencies within HHS. This would be a step backwards. Before the Clinton Administration streamlined the structure in HHS, agencies such as SAMHSA, HRSA, CDC, IHS, etc., reported to an Assistant Secretary of Health and coordination and collaboration still was not realized. That old structure also operationally removed those agencies one further step away from the Secretary of HHS and adds an additional step to someone like the SAMHSA Adminstrator trying to move an item before the Secretary or White House. Another danger in having a "czar-like" position is that the person appointed to such an office, may have a philosophy contrary to concepts like a recovery orientation to services and might even be an obstacle to progress. In actuality, the Secretary of HHS is in a position to hold agency heads accountable for collaboration and the advocacy community and constituents should expect it.

One structure currently in place that established an aligned mental health agenda is the Mental Health Federal Executive Steering Committee. This committee developed and released a Federal Action Agenda that outlines 70 action steps related to the President's New Freedom Commission on Mental Health. These action steps were agreed to by over 22 federal agencies. The hard work in developing this agenda was accomplished by dedicated senior career officials who still will be working and managing within the government under future administrations. The action steps are data based and reflect what many in the field have wanted to realize for years. I encourage advocates, "inside the beltway" associations, consumers, families and the behavioral health constituency groups to use these existing structures to hold government officials accountable to do what they say they will do. I know for a fact, there are many times, government employees appreciate it when constituents press for the right thing to be done, because it actually empowers the employees in helping them accomplish their work.

Just like Jerry Reed advocated for using a hotline already being funded by the federal government, advocates can be most effective in asking the government to do what the government has already committed itself to do.

Doug, you make an important point. What is an effective way to "transcend turf" and realize an alignment of activities of the federal agencies that impact behavioral health services positively? The notion of a czar that will force collaboration seems appealing. However, of the many attempts to establish a czar, (most recently an intelligence czar) collaboration and coordination between agencies still is illusive. I have heard some advocate that HHS should add an "Under Secretary of Health" to force coordination of all the public health agencies within HHS. This would be a step backwards. Before the Clinton Administration streamlined the structure in HHS, agencies such as SAMHSA, HRSA, CDC, IHS, etc., reported to an Assistant Secretary of Health and coordination and collaboration still was not realized. That old structure also operationally removed those agencies one further step away from the Secretary of HHS and adds an additional step to someone like the SAMHSA Adminstrator trying to move an item before the Secretary or White House. Another danger in having a "czar-like" position is that the person appointed to such an office, may have a philosophy contrary to concepts like a recovery orientation to services and might even be an obstacle to progress. In actuality, the Secretary of HHS is in a position to hold agency heads accountable for collaboration and the advocacy community and constituents should expect it.

One structure currently in place that established an aligned mental health agenda is the Mental Health Federal Executive Steering Committee. This committee developed and released a Federal Action Agenda that outlines 70 action steps related to the President's New Freedom Commission on Mental Health. These action steps were agreed to by over 22 federal agencies. The hard work in developing this agenda was accomplished by dedicated senior career officials who still will be working and managing within the government under future administrations. The action steps are data based and reflect what many in the field have wanted to realize for years. I encourage advocates, "inside the beltway" associations, consumers, families and the behavioral health constituency groups to use these existing structures to hold government officials accountable to do what they say they will do. I know for a fact, there are many times, government employees appreciate it when constituents press for the right thing to be done, because it actually empowers the employees in helping them accomplish their work.

Just like Jerry Reed advocated for using a hotline already being funded by the federal government, advocates can be most effective in asking the government to do what the government has already committed itself to do.

That is some great insight, Charles. It's encouraging to see these two agencies work together. I wonder if the federal government combined all of its agencies that are involved in behavioral healthcare, or at least appointed some sort of czar to coordinate their efforts, if some of these turf issues might be transcended. After all, in addition to the VA and SAMHSA, there's NIDA, NIAAA, NIMH, ONDCP, DEA, DOE, CDC, CMS, and more.

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