The current discretionary grant review process is not transparent and is very subjective. There is no internal check to assure that reviewers are not biased against particular applicants, and there are no protections to assure that application contents remain confidential. Under the current system, there seems to be a lot of smoke and mirrors after the reviewers complete their reviews --- little is known about how final award decisions are made, as this decision process is not articulated to the public.

Many consumers are interested in reducing medication usage. Also the impact of the pharmaceutical industry on medication research is starting to question the effectiveness of medications. Reducing medication usage would pay for peer support and other consumer run alternatives.

Thank you for reading this, smile. Since the 1950's the single determinant of recovery that is repeatedly cited is employment. "Meaning" is insufficient as one of top four priorities. Living wage employment plus full healthcare coverage will prevent and facilitate recovery from "The Great Depression" and obsession with "stinking thinking" which is foundational to Substance Abuse and Mental Health crisis. Please substitute employment for "meaning" as one of your top four determinants of prevention and recovery.

For ex, Open Dialogue (cf. Jaakko Seikkula) has reduced the incidence of new diagnosis of schizophrenia by 80% with minimal use of medication. Child maltreatment is implicated in the large majority of psychiatric disorders; is effective child protection or abuse prevention included in SAMHSA plan?

While I applaud SAMHSA's emphasis on the employment of people in recovery in the "Introductory" section of the plan, I feel that in many of the specific sections- Prevention of SA and MI, Trauma Services, Service to Military Families and Housing and Homlessness the "Action Steps should specifically state that people in recovery/peer support must be used as vehicles to address the identified issues and be part of the continmuum of services. SAMHSA must continue its prior commitment to the development and use of peer services in a more affirmative manner than is currently stated in this document.

SAMHSA has been at the forefront of Cultural Competence in the funding/non-profit world. The new material LACKS Cultural Competence specificity. Without it, we may lose what we have gained by not emphasizing that Cultural Competence standards be met in order for non-profits to receive funding. If you don't tell people what you want, they won't do it. Plain and simple.
Jimi Kelley, FSS, FSST
Native American Outreach
NAMI

Unlike the President's Freedom Commission Report (2003) where consumer, survivor and family inclusion, voice and leadership was stated as a goal, the SAMHSA strategic initiatives are void of this important perspective. Let's not marginalize this very important group of experts and include them into the SAMHSA strategic initiatives. Make this a stated affirmation!

integrate trauma-informed care into programs and services for survivors (beyond perpetrators!)