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Hyde: "We've got to think differently about funding"

January 5, 2010
by Dennis Grantham, Senior Editor
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Improve integration, collaboration, and creativity to address funding changes, says new SAMHSA chief

Pamela Hyde was nominated by President Barack Obama and confirmed by the U.S. Senate in November 2009 as Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). She leads SAMHSA's staff of approximately 550 public health professionals and manages a budget of approximately $3.5 billion with responsibility for improving the accountability, capacity, and effectiveness of the nation’s substance abuse prevention, addictions treatment, and mental health services delivery system.

Hyde comes to SAMHSA with more than 30 years experience in management and consulting for public healthcare and human services agencies. She has served as a state mental health director, state human services director, city housing and human services director, as well as CEO of a private non-profit managed behavioral healthcare firm. In 2003 she was appointed cabinet secretary of the New Mexico Human Services Department by Gov. Bill Richardson.

In this, her first published interview, Hyde answered our questions about the role of the agency in driving the integration of behavioral healthcare and primary care, delivering evidence-based practices to the field, supporting parity and healthcare reform legislation, and helping cash-strapped states and providers make the most of anticipated changes in funding for substance abuse and mental health services.

Q. As a former state official in New Mexico, what were your perceptions of SAMHSA’s work and where would you like to see it continued or changed with regard to states in the future?

A. With regard to states, I think that SAMHSA does a terrific job managing with the dollars they are provided by Congress and getting those dollars out to states and helping the states make the most of those dollars. I certainly expect that to continue. SAMHSA has a great track record in doing that and in getting great results from all of those dollars and grant programs.

My hope is beyond the relationship with the states, we can have SAMHSA play a significant role in the amazing number of issues that are merging on the federal level—including healthcare reform and the commitment to prevention and wellness. As a leader in mental health and substance abuse issues, we can have a huge impact on healthcare costs—costs to communities and businesses. If we can help people understand how they can make a difference in those areas through strong prevention and other interventions, that would be a great role. That’s what we’re going to try to work on.

Q. Given your experience in the New Mexico Behavioral Health Collaborative, are you seeking more integration among the various agencies and providers that are delivering mental health and substance abuse services?

A. The short answer is yes, but I’m not the first person who’s bringing that to the fore. This administration is committed to cross-agency and cross-government collaborations. You can look in the many areas just within the HHS department and see the many places where behavioral health issues play out. Whether through Medicaid, Medicare, HRSA (Health Resources and Services Administration) and its work with the primary care workforce, or other places, behavioral health is involved. We want to work inside HHS to bring all of those together.

Across government, we also want to work outside HHS, through relationships to the Departments of Defense, Veterans’ Affairs, Education, and Justice. There are so many places where behavioral health issues are being dealt with and are impacting service delivery systems. I believe that my experience in New Mexico and other states is going to help me here. The commitment is high and the need is great.

Q. Do you plan to work out in the field, and in what ways, to encourage more integrated care models that combine primary healthcare services with behavioral health and substance abuse services?

A. That’s a great question. This will get played out in many ways. Here are a few examples:

The behavioral health/primary care interface is where lots of SAMHSA people are working to make sure we’re getting SBIRTs (Screening-Brief Intervention-Referral to Treatment) provided. These are brief screening programs that providers can use in primary care settings to help identify people with mental health or substance abuse needs and get them referred quickly.

Another example is the medical home approach, where we’re trying to get medical homes into primary care settings and community health centers and ensure that they take on the issue of mental health and substance abuse screening. And vice versa, people who receive specialty mental health and substance abuse care really need to be screened for health problems because we know that the co-occurrence of diabetes and chronic diseases is high. So there are lots of opportunities for that interface.

Q. Any more particulars on those programs—perhaps for primary care or emergency settings?

A. As we work on all of these issues—there’s no either/or—it’s going to be a matter of integrating behavioral health issues into the healthcare arena and looking at where specialty care delivery systems can help identify people’s healthcare needs. We have a lot of people getting specialty mental health or substance abuse care and we forget to look at their diabetes or their heart disease, hypertension, or the issues that we know drive costs and drive morbidity in the wrong direction.

So, there’s not an either/or. We’re going to be looking at all of the programs in SAMHSA and across HHS and other agencies to keep those issues at the forefront.

Q. What initiatives will you be undertaking to address the tremendous gap between the discovery of new information and the introduction of best practices related to that research in the field—currently about 12 years?