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SAMHSA’s Eighth Strategic Initiatives Paper Open for Comment

6 October 2010 35 Comments

By SAMHSA Administrator Pamela S. Hyde, J.D.

As I have traveled around the country I have said that behavioral health is essential to health – for individuals, families, and communities, as well as for the Nation’s health delivery systems, and I truly believe this.  SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.  SAMHSA, together with many partners, has demonstrated that prevention works, treatment is effective, and people recover from mental and substance use disorders.

SAMHSA cannot achieve its desires, its goals, its mission alone.  We need the help of partners and collaborators within the Federal government, at state, tribal, and local levels, and in the business and non-profit worlds.  These partnerships enable SAMHSA to focus on far-reaching initiatives of its own in a changing health care environment, while identifying specific actions within larger national agendas to assure healthy communities throughout the country.

SAMHSA must address these needs with limited financial and human resources.  To guide its work through 2012, SAMHSA has identified Eight Strategic Initiatives on which to concentrate its efforts.  The Initiatives are:

  1. Prevention of Substance Abuse and Mental Illness;
  2. Trauma and Justice;
  3. Military families;
  4. Health Reform;
  5. Housing and Homelessness;
  6. Health Information Technology;
  7. Data, Outcomes and Quality; and
  8. Public Awareness and Support

To outline the direction and priorities SAMHSA will take over the next few years, a paper has been drafted to detail goals, priorities and action steps for forming the basis of SAMHSA’s Strategic Plan.  The paper was developed based on discussions with Federal, state and local leaders, constituency groups, advisory council members, members of Congress, people in recovery and family members.

At this time the SAMHSA Draft Strategic Initiatives Paper is open for public comment and will remain so until October 22, 2010.  If you feel a certain way about the paper, want to comment on ideas that have the greatest merit, or think that a specific issue or topic should be included or taken out, please let us know by commenting.  Also, if you have questions please feel free to ask; we will do our best to answer your questions.  We look forward to your feedback on a critical document that will guide SAMHSA during these historic times and the nation’s changing health care environment.

35 Comments »

  • Fran said:

    Hello,
    I am interested and concerned for a Complimentary or an Alternative Health /Wellbeing System for person’s with Disabilities. Is the possibility for Bodywork, Nutrition, Self-care addressed under Prevention or Health Reform? What would it take to make Complimentary Healthcare available to person’s dealing with Substance Abuse or Mental Illness.

  • Nancy Young said:

    I believe that trauma, housing and homelessness and public awareness are interconnected. Any type of trauma–sexual abuse, domestic violence, bullying, etc.—can create PTSD,Anxiety and/or Panic Disorders, among the many disorders, signs and symptoms that the health care field and mental health professionals need to look closely for. Many homeless people have mental illnesses and never get the help they deserve, maybe due to the paranoia of trusting anyone enough to open up to them or maybe due to not having any mental health center to go to, but it seems to be the general opinion that all homeless people are mentally ill, which increases the need for public awareness and public education. People who have housing can just as easily be traumatized by landlords or neighbors and need public support and awareness. I see this on a regular basis and nobody seems to care enough to do anything about it.

  • mgen josepht phillips md said:

    As a top flight surgeon usaf, forensic psychiatrist ,I fing that substance abuse is a continuing concern and is problematic.

    thanks

    MGEN J T PHILLIP,MD

  • Jennifer Martin said:

    I am saddened to not see Fighting Stigma as one of the initiatives. Thanks

  • Marian E. Jones said:

    From my recent experience: I have read information on many Veterans Affairs bulletins, Veterans Service Organization Websites and so forth and so on. I have come to the conclusion that there is no serious effort to assist military personnel and veterans who are victims of sexual assault and subsequent trauma. I went to a very prominent Veterans Service Organization to represent me in a claim for MST and PTSD, you would think I had the palgue and was crazy as a lune!

    Even my therapist at the VA thought I had not been traumatized. And this is just the mental and emotional trauma. As for the physical trauma to my body.

    I use to enjoy running now my body is so broke down I can’t even enjoy that any longer. Try running in combat boots for 10 years and tell me it has no affect on your body as you grow older.

    Stop writing about it and do something positive to assist Veterans and Active Duty men and women heal and live a postive life. Many of us feel used and then after you drained our body, soul and spirit you toss us away and look for new youg men and women to drain them as well. Mean what you say by action! When you plan an assault on an enemy you don’t spend years writing about it, you develop a stategy and move to action. I loved my time in the military and I am proud to be a Veteran having served 10 years as an enlisted soldier as well as a commissioned officer. I come from a long line of family members of active duty and veterans from WWI to Afghanistan and more than likey prior to WWI. A lot of you bureaucrats who say you care about us are just like another enemy. P.S. “Put your money where your mouth is.” Many of you Veterans Service Organization need to “Step Up and be serious about assisting veterans with sexual trauma cases. You know who you are because I have written and spoke to you on the phone only to be left feeling more ashamed and alone prior to expecting at least, at the minimum your understanding. Every opportunity I get I will voice my opinion regarding the shame I feel at the betrayal and treatment of military veterans. You should feel shame! However, I remain a loyal and proud Veteran of the US Army 1979 -1989. That’s one thing you haven’t taken away ….yet.

  • Linda Stella-Dean said:

    The new housing assistance now available and offered to non-elderly Americans with Disabilities through HUD along with other community resources-I have sent my request to register for immediate urgent assistance here, in South Florida’s Palm B each and/or Broward County and I have not received a response. If resources have been funded, where and from whom must I seek assistance from in my area here in Palm Beach County or Broward County, Florida?

  • Debra Girard said:

    In the state of California, fewer and fewer psychiatrists and psychologists are accepting medi-cal and medicare patients. What, if anything,is being done about this? I find it to be discriminatory.

  • Dr. Joy Wigfall said:

    Schizophrenia and Bi-Polar Disorder are genetic illnesses and can be treated, but reoccurrences can be expected even though not predictable. They need different management than other types of
    Substance abuse, including overeating, is directly related to Depression.
    Elementary school teachers are the first line of defense, along with Pediatricians. Both groups need better preparation in recognizing early childhood emotional difficulties-I had two young girls referred for possible ADHD. One was gifted and the other was close to completely deaf. Students who have difficulty keeping up with the class frequently become trouble makers.
    The current funding for mental health providers is horrible. Seeing patients for 15 minutes every two months is TOTALLY inadequate. Well trained Community Workers in addition to better trained Social Workers who DO social work will greatly improve patient success.
    More satellite clinics, staffed by neighborhood residents, will improve access and use. Keep the clinic simple but nice and clean.
    The Obstetrician’s office can be a useful site for teaching early childhood parenting. Much of the groundwork for developing substance abuse begins before the person has words.
    Beauty Parlors and Barbershops are useful sites for teaching about Prevention in all areas of Health.
    On-site Case Managers are useful in large homes and Apartment Complexes that house people with a variety of mental illnesses. However, they must be well trained in recognizing the various aspects of the mental illnesses they will see.

  • Dr. Joy Wigfall said:

    That sentence should have ended with than other mental illnesses.

  • eloria said:

    Start with children, we need observers in school looking for signs of behavior and grades change. also parent need counseling on dealing and copeing with these problems.

  • Mitchell Klein said:

    The first item, “Prevention of Substance Abuse and Mental Illness”, is all wrong! Mental illness AND substance abuse (in most cases) are illnesses that need to be TREATED, not PREVENTED. Yes, prevention is important too. But proper treatment is very important. Too often, people who suffer from these two illnesses aretreated as criminals. They are jailed, not helped the way we would help someone with cancer or a broken leg. The wording is very important. Please focus on BOTH treatment and prevention.
    Thank you.

    Mitchell Klein
    CEO
    CHEEERS INC.
    Phoenix, AZ…

  • Joyce said:

    I believe children of substance absuse and mentally ill parents need early intervention..When a man or a woman is being treated, it should be mandatory that their children go through screening and treatment by a concerned counsellor to assess the damage their parents substance abuse and mental illness has had on thier children. This type of screening and treatment may help further generations to prevent the same fate as their parents.

  • Lance Cardaro said:

    A recent study by the Partnership For A Drug Free America found that children/teens are spending 53 hours a week, engaged in some form of electronic media… i.e. internet, social networks, electronic games, etc… Seems like an excellent component of our young peoples time, to integrate substance abuse education/advertising with…

  • Christopher Coon said:

    Substance abuse is a public health issue. When we consider drunk driving deaths, unwanted pregnancy, sexually-transmitted disease, child abuse and other issues directly related to chemical dependency, it is clear that more must be done to adress these issues. More prevention-based programs, fewer government cuts to programs, and more education for the public are needed.

    Chris Coon CADCI

  • Melanie Hamilton said:

    Mental Health sucks ! I think that people focus on intellectuals and doctors instead of the person with the mental illness. When will our voices be heard!
    Children and adults with mental health issues are discriminated against and clinicians, doctors and others need to be more compassionate and caring.Substance abuse and mental health often go hand in hand but think about it, if your mental health isn’t right of course you are going to do something to soothe you. Take of your blinders!

  • Dr. Diane Rogers said:

    I was disappointed to find out that to find employment was dropped as one of SAMHSA’s top priorities.

  • Beth Wilson said:

    It is great to see that the Health Care Reform included a provision of 30 Centers of Excellence for Bipolar and Depression. However, the funding was not approved so now we have to fight for this yearly with Congress. There is no advocating for these funds or making the mental health community aware that these Centers are a possibility so they can write their Senators and Represenatives letters requesting funding for the maximum level for these hospitals for the next 10 years.

    The appropriations just took place in July and out of a possibility of 100 million dollars total appropriated only 10 million dollars was. The maximum for a Center for funding is 5 million dollars. So Congress approved enough for 2 hospitals.

    It is important to have these hospitals treat with altenative treatments and use peer supports in additional to traditional medications

    Please find a way to advertise this provision of Obama’s Health Care Plan. We have to fight for this funding every year,but who can fight for it if they do not even know about it.

  • Eliza K said:

    Hospitals are a place for the sick and noone wants to be ill. Peer Warm lines need to be available and funded as a preventive measure to keep people from needing further support services.

    If a warm line is not enough support for someone during an emotional crisis then
    a Peer Run Respite Center could be available to a person for a short term stay to assist them to regain balance in their life until they can go back into the community. Only until these options are utilized would one reach out to a specialized hospital or Center of Excellence.

    Please fund the 30 Centers of Excellence for Bipolar and Depression with the maximum funding called for 100 million dollars for the first 20 Centers for 5 years then 150 million dollars for the last 10 Centers for the last 5 years. Congress needs to appropriate these funds yearly, the media needs to make this possiblity known to the community and the community needs to contact their legislators with letters before every July to ask for the maximum funding for these Centers for treatment and research.

    The mental health community wants to make sure if money is spent on these hospitals that they ensure the humane rights of patients such as being able to use telephones, having access to fresh air and other basic rights. Include consumers and family members on advisory boards for these treatment centers. Only consumers can provide the insight of effective missing links in treatment settings that health care professionals do not see. The families need to be there to protect their family members rights when they are not capable of doing that themselves.

    These Centers need to provide alternative treatments, psychological treatments and
    medication therapy. There are people that feel strongly against the use of medications in the mental health community and those that have been helped by medications although the side effects of somnolence and weight gain can greatly decrease quality of life.

    Peer supports would need to be included in these treatment Centers as this movement has become effective. This does not displace therapy or psychiatry, but enhances it.
    Other enhancements of treatment such as Psychiatric service dogs should also be included at these treatment Centers.

    Then when patients transfer back into the community they need the supports that will enable them to successfully integrate themselves back into their world. The least restrictive enviornmet will make patients the most self reliant. But at the same time that does not mean that there be inadequate community supports and no psychiatric hospital beds for patients to be able to use when and if they need it. The community has not found that balance between community supports and available hospital
    support.

    I strongly believe that these Centers of Excellence for Bipolar and Depression are an important link to this safety net for psychiatric patients. In my state now, psychiatric beds are being lost continually. Patients have to wait for an admission. This is part of why we need these Centers in addition to the fact it will allow the discovery of new and better treatments.

    If the mental health community does not step up and support this initiative they will be losing out on millions of dollars on treatment and research. You do not hear about treatment and research possibilities, it is usually talkining about cuts. Please focus on this tremendous positive opportunity and all the differing fractions of the mental health community, promedication, proalternative treatments come together and utilize all the
    possible treatments that have been effective for each individual. Support appropriate treatment of each individual and not whether medications or alternative treatments are the ultimate answer. What may be effective for one individual may not be for somone else.

    .

  • lynne wolfe said:

    Homelessness is a huge issue. In my county alone this year there were 1500 homeless people. 368 of them were under 18 and 169 were under the age of 5. A lot of these homless have been displaced due to economic stress. There is inadequate housing and shelter options. We have foster care in place for children. Why can’t we have foster care for homeless families who are trying to transition back in to society? I think transitioning from a stable home would have more success than while moving from shelter to shelter.

  • Dude said:

    “# Prevention of Substance Abuse and Mental Illness;”
    A lot of that sounds like brainwashing to me. You people are talking about “getting to the children” two to four years BEFORE they “might” use drugs, that sounds like the Tom Cruise movie ” Minority Report” where the law would pre-empt a crime …..Bizzaro world !.
    How about instead of you filling our childrens minds with your lies , you just go away.

  • Laura Dawson said:

    My chief concern is in misdiagnosis and treatment of mental illness. As a trauma survivor, that information is not validated or included in my SSDI data files, when I personally requested to investigate. Due to the lack of insurance provision for single women in the past years, particularly with any pre-existing conditions, certain diagnosis were used as a ‘blanket’ in order to prescribe drugs and treatment. Now that our medical community has become more sophisicated in the treatment of brain trauma, some of these diagnosis need to be re-evaluated. Personally, the occaisional headaches and pain in my legs, is more likely cause by the trauma than bipolar disorder. Yet, I can’t seem to get any providers to look past the mental illness screen to my body, which will need more help as time progresses.

  • Laura Dawson said:

    Item 6, Health Information Technology, is progressing rapidly in legislative areas, but still has not reach enough providers in our area, where I have applied to assist in the implementation process. This is discouraging since there are more changes coming down the pike, including the mandatory conversion from ICD-9 to ICD-10 which the WHO has been updating for at least a decade. Then there is the SNOMED nomenclature usage conversion. We need to help our health care providers to meet the demands of acurate record keeping in order to reduce the cost to patients and make services more affordable.

  • Laura Dawson said:

    Item 8, Public Awareness and Support: Having participated in the regulation and meeting processes for implementation of accredited Electronic Health Records, all online, I expect that SAMHSA will benefit from using public platforms to collect ideas and trends, while monitoring services. As a stakeholder for the Codex Alimentarius Global Food Standards, and the Supplemental Nutrition Assistance Program (SNAP) Ourtreach, I have participated in meetings online and attempted to keep abreast of the subject within my realm of expertise, health care-particular as it related to the use of nutrition to benefit wellbeing and education to empower people willing to be pro-active in their own health and wellness.

  • fil said:

    Prevention of Substance Abuse and Mental Illness; why are these lumped together..maybe prevention of prescription medicine or the effects of prescription medicine leading to mental illness.

  • Ken Thompson said:

    The eight SAMHSA’s strategic initiatives and their associated proposed actions advance the national interst, but only partially and haltingly. In themselves, there is not much to say except, of course, that we must address homelessness, veterans and military families, trauma and justice and pursue prevention. No doubt too we must wrestle with implementing health care reform, develop health information technology, and improve the quality of the data we work with. And when has public awareness not been an issue we must address?
    Part of the problem with the Initiative effort is that it would be easy to make a list of other critical initiatives that could be but are not included. Admittedly some were actively excluded now for possible consideration later- the issue of employment and behavioral health is treated this way. Other themes, like workforce development and health equity, are presented as being weaved into the 8 initiatives (in a weave so tight they almost vanish). Still more- such as ensuring continued progress in bringing persons in recovery and families into the process of modernizing services; promoting recovery; developing, implementing and improving the clinical and social elements of recovery support services; supporting public service; addressing co-morbid substance abuse and mental illness and tackling the pressing needs of children, older adults, migrants/refugees and rural populations, etc.- are left somewhere on the cutting room floor. The logic behind these decisions is presented as being purely pragmatic. SAMHSA is noted to be a small agency with limited resources and the claim is that it needs to focus. Its hard to argue with this- except to note that the reasons to dismiss some efforts over others are not mentioned and to observe that 2-3 new full blown initiatives would seem to be more then enough for any organization. In this regard, just carrying out the actions required by health care reform seems daunting. Equally problematic, from the other direction, is the idea that carrying out the named 8 initiatives are all that SAMHSA can handle. As though persons in recovery, families, children and older adults no longer require attention. As though we have actually gotten to the point where we claim with certainty that “treatment is effective”, instead of noting that in reality, its effectiveness is very uncertain (if it can be accessed), that we need to keep improving quality and accessibility and that we have been doing this.
    Its interesting to note that somehow or other, much of the work that was being done by SAMHSA no longer seems to worth noting or pursuing- not even being raised, dismissed by neglect without explanation. Only a few of the 8 initiatives describes how they tie to and build on any of SAMHSA’s past work (trauma, HIT and data/quality stand out in this regard). There no sense of a trajectory- no where are SAMHSA’s important accomplishments of the past decade noted (Is some somehow related to partisan politics and dismissal of work done in prior administrations? One would hope not. Yet the path the country has been walking is obscured by this document). The new Strategic Initiatives appear to have been created de novo- as though a new mental health commission convened and issued them with little consideration of current ongoing activities. This seems especially strange, given the expressed desire to be efficient and husband scarce resources- why start 8 entirely new initiatives- and why not clearly build on previous work? Was the prior work of the Agency entirely off track? Even when continuities are present- take homelessness for example- there is no mention of past milestones leading to new work. This lack of historical perspective is extremely hard to understand and leaves the 8 initiatives floating in mid-air conceptually.
    In short- these 8 initiatives seem random. They don’t seem connected. Its not clear how they really build on each other or on previous work- and even less clear how they move the whole field forward except in these specific areas. Its unclear what they mean as priorities. What is the relationship between the issues that made the cut and those left behind- when none of them can be left behind?
    Beneath all this is the question, what is the underlying approach to behavioral health that is being pursued? Are we building for the future across all fronts (which seems the only way to go)- or are we truly being asked to put aside all other efforts as distractions? To take some examples, do we really drop community support program development unless its tied to trauma or homelessness? Does the focus on HIV and mental illness/substance abuse vanish? Where do efforts to create shared decision making tools fit? What of SAMHSA’s global health initiatives and exchanges? What of our leadership development efforts? What are the roles of psychiatric expertise and psychiatrists in behavioral health? Etc etc.
    If the answer is that there is room for these in the 8 initiatives- what is the meaning of having 8 initiatives? Why bother with them if everything is included?
    It is not hard to imagine a way to create an all fronts approach that would be clearer in its implications. Of course SAMHSA personnel can not be everywhere- but they doesn’t need to be. An overall plan and functioning partnerships with our multiple partners can cover what must be done. That plan can flow out of a true comprehensive population health approach to addressing issues of mental health and addiction. For an example, I would highly recommend examining the work of the Foresight group on promoting and protecting “mental capital” commissioned by the UK Office of Science.
    One element of the Initiatives- which this very act of making comments raises- is how the Initiatives were constructed and how firmly planted they are now. Are these comments and those of others to focus only on the specifics of the pursuit of each Initiative- or are wider comments being sought? Are we to ask how high we need to jump or can we suggest that we move in other directions? It seems late in the game for the latter, but there was no prior opportunity. How are we to understand this?
    This is a problem of communication- how to get everyone pulling in the same direction? But it should not be understood as the problem of communicating THE message. The problem is constructing the message. The current message appears to be a dictat from on high, a message with no room for real interaction. All the decisions seem to be made. SAMHSA appears to now simply be seeking foot soldiers to move those decisions forward.
    Perhaps this is a false perception. It would be good to know if it is and see evidence to the contrary. However, if it is not, the communication back to SAMHSA needs to indicate a desire to rethink the approach, design a practical yet comprehensive population health approach to behavioral health, figure out how to connect it with SAMHSA’s past and present efforts and those of our partners and engage all of us in pursuing a healthy nation. This is not a critique of the intentions behind the initiatives. They are clearly well meaning and good. Rather, it is a plea to see all of us in behavioral health as participants in a lively dialogue built on a shared desire to be public servants.

  • parental guide said:

    Getting sober and receiving the proper mental health assistance was paramount in me turning my life around. Nice to know there are some programs focused on providing help in these areas.

  • Mike said:

    Lets hope that many more people can get the help they need and turn things around.

  • Dana said:

    I think this is great! I know I’m almost 1 year late (as always) to make my comment count. But I especially want to emphasize the need for addressing Trauma and Justice. However much we talk about it, I feel that there isn’t enough being done. For example, even yesterday’s Seal Beach Salon shooting could have been avoided if this was handled properly (the guy had had a history of traumatic experiences).

    So I am really for this, especially the ‘trauma handling’ portion!
    Dana

  • Meth Center said:

    As a recovering meth addict, I can say that anything and everything that can be done to help those with a drug addiction or drug dependance will be a beneficial, not only to those individuals but to society as a whole.

  • Homestar Mortgage said:

    I love that one of the initiatives is public awareness and support. I think most people don’t realize how many people are affect by substance abuse, and when they find out who has a problem, they are much too quick to judge the person instead of being supportive and encouraging them to get help.

  • linda said:

    Adolescent treatment in this country is in very poor. We need treatment funding to develope and staff treatment programs for adolescents. More and more this population is being swallowed up by the juvenile justice system where treatment is provided in prison and by the mental health system where addiction related behavior is diagnosed under the DSM diagnosis of Conduct Disorder. Adolescents need access to secure alochol and drug treatment facilities. Funding is needed for treatment!

  • food in train said:

    From these eight Strategic Initiatives for me the most important is health reform, because without this we can not make the country a better place to live.

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