[NYAPRS Enews] Curie: The Need for a Strong SAMHSA

Tue Apr 28 07:28:09 EDT 2009

NYAPRS Note: The following piece by former SAMHSA Administrator Charles
Curie provides powerful testimony to the importance of preserving a
strong separate lead agency within the Obama administration dedicated to
the needs of Americans with psychiatric and substance abuse conditions.
The Substance Abuse Mental Health Services Administration and its Center
for Mental Health Services have provided powerful leadership in
advancing most of the major national mental health recovery,
rehabilitation and rights reforms of the past decades. Far from being
subsumed within other federal agencies like the Health Resources and
Services Administration (as has been rumored), SAMHSA must be
strengthened. 

SAMHSA can help make efficiencies and economies within the federal
government at the same time that it takes its appropriate role in
providing expertise and representation for our community to a host of
other federal agencies including the Centers for Medicare and Medicaid
Services, the Department of Labor, the Rehabilitation Services
Administration, the Department of Housing and Urban Development, the
Social Security Administration and the Department of Education.

In helping those agencies to re-shape current policies that unwittingly
favor costly institutional approaches over more dignified and productive
community integration centered ones, SAMHSA help greatly enrich lives
while saving dollars. 

In New York, we've seen the major benefits of having a strong Office of
Mental Health lead many major collaborative reforms with our Medicaid,
housing and employment related agencies. As we approach the era of major
health care reform, Americans faced with mental health and substance
abuse challenges deserve no less! 

The Need for a Strong SAMHSA

Charles Curie
<http://www.behavioral.net/ME2/Apps/CPBlog/PrintTopic.asp?id=E01653A7DF4
7482CA7E673D863A1AB47>  Behavioral Healthcare  March 22, 2009

As the Obama Administration appoints a new HHS Secretary and other
officials within HHS, they are also, apparently, reviewing what the
operating divisions should look like within HHS (this is to be expected
with a new Administration).  Where substance use treatment, prevention
and mental health services reside within HHS is a question that has been
raised in some forums and by some Administration officials.  This is a
particularly pertinent process in light of the President's commitment to
streamline the bureaucracy.  Is it tempting to move and merge the
Centers within SAMHSA elsewhere to achieve this streamlining goal? 

...Below I have outlined some thoughts about the need for a strong
SAMHSA and a clear, visible presence for SU and MH services within HHS
and the Executive Branch.  I welcome all the substance use treatment,
prevention and mental health services advocacy groups within the
"Beltway" and behavioral health advocates across the country to "weigh
in" on this issue.  There is much at stake!

*      The need for a strong SAMHSA and strong state authorities for
substance use treatment and prevention and mental health services may
not be clear in the current political environment in Washington.

*      With all the discussions and advocacy around the issues of the
need for integration of behavioral health services into physical health
services and with the parity legislation finally passing, there is a
danger that policy makers and members of Congress will think that the
mental health and substance use treatment fields are now "taken care of"
and do not need focused consideration or separate funding.  This risks
not doing integration right and further marginalizing people with mental
illnesses and addictive disorders, as well as children and youth with
serious emotional disturbances and at risk of the adverse consequences
of substance use.   

*      If the components of SAMHSA are merged into other federal
agencies, it sets the stage for the same consideration to be given at
the State level for Mental Health Authorities and Single State Drug and
Alcohol Services Authorities.

*      SAMHSA is a leader in bringing evidence based practices to the
behavioral health fields, providing a strategic prevention framework for
substance abuse, facilitating a process to transform mental health
services, developing national outcome measures to demonstrate services
effectiveness, establishing financing models that include consumer
driven approaches, disseminating the most up to date information on
substance use prevention  and collaborating with other federal agencies
and the health care provider community in deriving effective ways of
integrating a behavioral health focus in primary health care. These
efforts are not only essential to moving substance use treatment,
prevention and mental health services ahead, but SAMHSA's role must be
strengthened in these areas and broadened in other areas if behavioral
health is to have a relevant , key place in the health care reform
agenda.

*      SAMHSA and its many partners, including people in recovery,
consumers, and families, providers, states and other federal agencies
have laid a strong foundation through many initiatives upon which to
build strong and innovative service delivery approaches that effectively
serves the American people and people with addictives disorders,
individuals with serious mental illnesses, children with serious
emotional disturbances and high risk youth.  

*      The SAMHSA Administrator is a Presidential Appointee who is also
Senate-confirmed (PAS).  This position is the head of an operating
division within the United States Department of Health and Human
Services and reports directly to the Secretary of HHS and politically
has access to the White House, including OMB, DPC, ONDCP and a range of
other offices representing special needs and programs (i. e. HIV/AIDS,
Homelessness, Faith based and Community Initiatives, etc)

*      The high level executive and political access that is afforded
the SAMHSA Administrator on a daily basis gives the ongoing opportunity
to educate and inform the Secretary and the White House on issues
relevant to the fields of substance use treatment, prevention and mental
health services.  This has been critical when "fighting" for the budget
(both gaining increases and preventing cuts), shaping and forming
various commissions and new initiatives, addressing disaster and
terrorist attack response and in general, assuring that mental health
services and substance use treatment and prevention are prioritized at
the "table" of health policy. 

*      It will be ever more imperative that a PAS within HHS represents
the SU/MH services fields be present in the deliberations shaping health
care reform.  Those processes can move quickly and decisions and how
approaches are framed are many times decided by the Secretary or a White
House Director in meetings where only PAS level or Operating Division
Heads are present.  If SAMHSA is merged or split up, then it is likely
the three Centers in SAMHSA will be bureaus or divisions within bureaus
several layers down from having any access to the Secretary or White
House.   We cannot underestimate the political access and credibility a
PAS has in influencing policy and being in a position to at least be a
direct participant in the debates.  The personal relationships that can
develop at the high policy levels many times make the difference as to
whether a key element is included in policy or, at times, assuring a key
element is not included in policy.

*      SAMHSA reauthorization is a great opportunity for the advocacy
community to shape the expectations of what SAMHSA should do.
Accountability can be clarified for SAMHSA, the states, local
authorities and the provider community.  It can be clarified that SAMHSA
is to inform and influence CMS policy, collaborate with other divisions
and be a resource and policy guide to all the Departments of the
Executive Branch. 

*      There is too much work that still needs to be accomplished to
assure that behavioral health will be delivered effectively in a new
healthcare system to not have a SAMHSA or PAS Administrator.  When
stigma is eradicated, when people are no longer held in institutions who
can live in the community, when people with addictive disorders are no
longer in and out of the criminal justice system, when financing for all
treatment, rehab and prevention services is in place and when once and
for all SU/ MH is considered consistently in all appropriate medical
settings, then maybe it would be time to consider an integration of
SAMHSA and State authorities into broader health agencies...But, until
then we need a strong SAMHSA! 

http://www.behavioral.net/ME2/dirmod.asp?sid=45D4F1BC1C2F41E6A754ED831BD
98648&nm=&type=Blog&mod=BlogTopics&mid=66A53481AC7B4A13B45D7CDA7A9B920B&
tier=7&id=E01653A7DF47482CA7E673D863A1AB47
<http://www.behavioral.net/ME2/dirmod.asp?sid=45D4F1BC1C2F41E6A754ED831B
D98648&nm=&type=Blog&mod=BlogTopics&mid=66A53481AC7B4A13B45D7CDA7A9B920B
&tier=7&id=E01653A7DF47482CA7E673D863A1AB47>  

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