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What is SAMHSA’s role in today’s healthcare system?

May 29, 2014
by Elinore McCance-Katz, MD. PhD, FAAAP
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Guest Blog

The mission of the Substance Abuse and Mental Health Services Administration (SAMHSA) is to reduce the impact of substance abuse and mental illness on America’s communities. The Affordable Care Act and new parity protections are expanding mental and substance use disorder benefits to over 60 million Americans. This historic expansion of insurance coverage presents a unique moment in history to address the long standing barriers to treatment for people with mental illness.

The history of the treatment of mental disorders in the United States is marked by inhumane and questionable interventions that did not recognize individual rights or even the humanity of those affected. We must remain cognizant of this history while offering the best, research-based interventions available today.  

As a result of investments by the National Institutes of Health (NIH) and SAMHSA in research, testing, and evaluation of prevention, treatment, and recovery support services, there have been many advances in the field over the past 50 years. Medications development research has produced pharmacotherapies that can ease the distress of auditory and visual hallucinations, improve the disordered and disorganized thinking of some mental conditions, and assist in the resolution of depression and anxiety.

A wide array of therapies has been shown to improve the ability to cope with symptoms of mental disorders. Investments in infrastructure to assist families and treatment providers working with young people with serious emotional disturbances have produced models to improve outcomes for individuals, families, and systems. New interventions to assist with aspects of everyday life so important to a sense of purpose and meaning – stable housing, the ability to obtain an education, getting and keeping a job – are now part of the services available to assist those living with serious mental disorders, including depression, schizophrenia, bipolar disorder and schizoaffective disorder.

SAMHSA embraces these advances and, using its Congressionally appropriated funding, works to help implement these approaches across the country. In fact, the biggest percentage of SAMHSA’s Congressionally appropriated mental health funding is directed toward services and supports for those with the most serious illnesses.

Clinical Support System

SAMHSA works closely with the NIH’s National Institute of Mental Health (NIMH) to help disseminate new and promising practices and advances in the treatment of serious mental disorders. SAMHSA supports national training efforts that provide clinicians and the public with information on these developments and will soon be launching a new clinical support system that will provide training opportunities for clinicians on evidence-based treatments specifically aimed at serious mental illness including the treatment of psychotic, depressive/manic-depressive, and anxiety disorders. SAMHSA also works with researchers, academics, and its grantees to test new models and emerging promising practices to advance the field and the behavioral health of the nation.

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Pardon my bluntness, but I'm not sure the question posed in the headline was answered. What this piece projects is a sense of support from SAMHSA and NIH for organizations and providers who have existed in and are attempting to survive in a silo'd landscape almost wholly separated from the health care system. Today's health care system is all about the integration of mental/behavioral health care with primary care. Today's health care system needs to partner with community organizations that provide long-term addiction management and/or recovery supports. It must do this because total patient wellness will be the goal. Health care systems will strive to keep the patient out of the clinics, hospitals and ERs and in their communities living healthy, productive and meaningful lives. This goal can only be accomplished with community resources actively engaged in the health care system's process of continued care and wellness.

The current transformation of today's health care system is being built on a foundation of (1) Integrated Delivery of Primary/Mental/Behavioral Care; (2) Continuums of Care; (3) Chronic Disease Management; (4) Team-based Medical Home Models; (5) Population Health Management; and (6) Data Analytics.

If SAMHSA's mission is to "reduce the impact of [addiction] and mental illness on American communities" and to view a "whole-person approach" to better mental health outcomes, then SAMHSA must focus less on "program support" and more on system change.

Today's health care system is moving away from a fee-based reimbursement platform but to a value-driven, outcomes-based reimbursement approach. Integrated health care systems will be required to view the whole patient and to bring in both clinicians and peers to address the addiction and mental illness issues. SAMHSA knows, just as well as everyone else in health care, that increased health care costs are driven by patients suffering from co-morbid and co-occurring disorders. To get these complex patients well, the right teams of care-givers must come together and the right community resources must be plugged in at the right times -- creating a seamless and holistic continuum of care across a broad spectrum of services.

Total health wellness should be the goal. Focusing on the notion of "recovery" being the goal unfortunately keeps the addiction and mental health fields separated within the changing health care landscape.

You are absolutely right, Dr. McCance-Katz, this is an historic moment. If addressed properly, for the first time in the history of addiction and mental illness treatment, individuals who suffer from these conditions will no longer be sent out of the health care system for care, but welcomed with the dignity, respect, and care that all patients deserve.

David Whitesock, J.D./M.A.
Addiction Informatics Officer
Face It TOGETHER
www.wefaceittogether.org

Yes, integration continues to be a key goal that all in the industry must support.

Bringing about the kind of transformative changes that will be necessary to deliver care to the 'whole person' is a huge challenge. Thinking and talking about it are the easy steps.
We know where we want to go, but not how to get there. Many, significant changes will be required and overcoming the natural resistance to change is but one of the many challenges.

The problems at SAMHSA are well known. They include ignoring the most seriously ill, certifying programs that have no evidence to improve a meaningful outcome in people with SMI, funding antipsychiatry, pretending they know how to prevent serious mental illness, and encouraging states to abandon the medical model in favor of SAMHSA's "Recovery Model". If you are unaware of SAMHSA's shortcomings visit http://mentalillnesspolicy.org/samhsa.html
DJ Jaffe
Mental Illness Policy Org
http://mentalillnesspolicy.org

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