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BEHAVIORAL HEALTH 2010BEHAVIORAL HEALTH 2010CHALLENGES AND OPPORTUNITIESCHALLENGES AND OPPORTUNITIES

ACMHA:The College for Behavioral Health

LeadershipMarch 24, 2010

Pamela S. Hyde, J.D.,Pamela S. Hyde, J.D.,Administrator, Substance Abuse and Administrator, Substance Abuse and

Mental Health Services AdministrationMental Health Services AdministrationU.S. Department of Health and Human ServicesU.S. Department of Health and Human Services

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Today It’s Today It’s About….About….

PEOPLE● Making a real & measurable

difference

OPPORTUNITIES● Focusing on what can be

done● Working with available

partners

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People● Stay focused on the goal

Partnership● Cannot do it alone

Performance● Make a measurable difference

Parity● Mental and substance use disorders are

not unlike any other health care condition – acute, chronic or disabling

PRINCIPLESPRINCIPLES

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Behavioral health is an essential part of Behavioral health is an essential part of healthhealth

● Improves health statusImproves health status● Lowers costs for families, businesses and Lowers costs for families, businesses and

governmentsgovernments

Prevention worksPrevention works

Treatment is effectiveTreatment is effective

People recoverPeople recover

KEY MESSAGESKEY MESSAGES

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Key Message:Key Message:Behavioral Health is Part of Behavioral Health is Part of

HealthHealth People with serious mental illness (SMI) are disproportionately overweight or obese & have shortened life-spans

Disproportionate cigarette use by individuals with mental illness (MI) or substance use disorder (SUD)

¼ of adult stays in community hospitals involve MI or SUDs; persons with SUDs have disproportionately high ER use

High proportion of antidepressants prescribed in health care settings

Mood disorders rank 1st in work loss costs, 2nd in total costs & 3rd in health care costs of five highest conditions

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KEY MESSAGE:KEY MESSAGE:Prevention WorksPrevention Works

Cost-benefit ratios for early treatment & prevention for addictions and mental illness programs range from 1:2 to 1:10

Substance abuse prevention programs show:● Decrease in alcohol, tobacco and other drug use (ATOD)● Significant percentage of students using ATOD stopped

using

School prevention programs show reductions in bullying, fighting, verbal abuse, alcohol and cigarette use, and feeling unsafe at school

Preventive intervention for adolescents can reduce the incidence of depressive disorders

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Institute of Medicine Report:Institute of Medicine Report: Preventing Mental, Emotional and Behavioral Preventing Mental, Emotional and Behavioral

Disorders Among Young People – Progress and Disorders Among Young People – Progress and Possibilities (2009)Possibilities (2009)

Positive emotional development, earlier identification Positive emotional development, earlier identification & intervention, multiple interventions sustained over & intervention, multiple interventions sustained over time can prevent disorders such as substance abuse, time can prevent disorders such as substance abuse, conduct disorders, and depression, and reduce conduct disorders, and depression, and reduce symptoms of mental illnessessymptoms of mental illnesses

Addressing families, individuals & specific disorders Addressing families, individuals & specific disorders through schools, health care and community through schools, health care and community programs can develop emotionally healthy adultsprograms can develop emotionally healthy adults

Prevention requires attention to multiple risk factorsPrevention requires attention to multiple risk factors● Biological (family history) Biological (family history) ● Psychosocial (family disruptions)Psychosocial (family disruptions)● Social (poverty, violence, safety in schools, access to health Social (poverty, violence, safety in schools, access to health

care)care)

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KEY MESSAGE: KEY MESSAGE: Treatment is EffectiveTreatment is Effective

$1 invested in substance abuse treatment has a return of $7 in cost savings from social benefits

Treating late-life depression in primary care settings – reduced prevalence and severity of symptoms or complete remission

Long-term treatment of adolescents with major depression is associated with continuous and persistent improvement of symptoms

Federally funded substance abuse treatment programs improved physical and mental health and reduced:

● Illicit drug use ● Alcohol/drug related medical visits● Inpatient mental health visits ● Reduced criminal activity

SBIRT – 50% increase in abstinence at 6-month post intake

RAISE research on-going now to address symptom severity and episode recurrence after first psychotic break in adolescents

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Key Message:Key Message:People RecoverPeople Recover

Early treatment reduces disability/recurrences

Recovering people work, pay taxes, have homes and relationships, volunteer, contribute, vote

Recovery rates w/ treatment and/or medication: ● Bipolar disorder 80%● Major depression 65-80%● Schizophrenia 60%● Addiction 70%

Pathways are highly personal • Focus on lives restored rather than lives managed or

services provided

Self-help and peer supports help the recovery process

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MISSION: To reduce the impact of substance abuse and mental illness on

America’s communities

ROLES: ● Voice & Leadership● Funding● Information● Standard Setting/Guidance● Practice Improvement

10 STRATEGIC INITIATIVES

SAMHSA’S SAMHSA’S DIRECTIONDIRECTION

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10 Strategic 10 Strategic InitiativesInitiatives

1. Prevention of Substance Abuse and Mental Illness

2. Violence and Trauma

3. Military Families – Active, Guard, Reserve, and Veteran

4. Health Insurance Reform Implementation

5. Housing and Homelessness

6. Jobs and Economy

7. Health Information Technology for Behavioral Health Providers

8. Behavioral Health Workforce – In Primary and Specialty Care Settings

9. Data and Outcomes – Demonstrating Results

10. Public Awareness and Support

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Impact of Strategic Impact of Strategic InitiativesInitiatives

1. Requests for Applications (RFAs) beginning in FY2010 – block grants and grant programs

2. Public messages; communications; materials

3. Budget requests – FY2012 forward

4. Current fiscal resources – FY2010 and FY2011

5. Human resources – staff time

6. Contracts & technical assistance centers

7. Public forums; meeting time

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Strategic Initiatives Next Strategic Initiatives Next StepsSteps1. Draft narrative sometime in April or early May for

public review/input (including posting on website)

2. Public meeting in DC to discuss with key stakeholders

3. SAMHSA’s National Advisory Council (NAC) meeting in May

4. FY2012 budget planning continues in summer 2010

5. Revise and finalize strategic initiatives document/strategic plan – summer or fall 2010

6. Incorporation of initiatives into SAMHSA’s work – now and on-going

NOTE: Dates are tentative.

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No. 1 Prevention of No. 1 Prevention of Substance Abuse and Substance Abuse and

Mental IllnessMental Illness Reduce/prevent substance abuse & mental

illness through prevention prepared communities• President Obama’s National Drug Control

Strategy, with ONDCP• Prescription drug abuse• Emotional health per IOM report

Suicides – especially youth, military, tribes

Underage drinking

Tobacco use among persons with serious mental illness and substance use disorders

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Prevention Highlights Prevention Highlights in FY 2011 Budgetin FY 2011 Budget

Project LAUNCH (Kids 0-8)↑ $12 million to $37 million

Prevention Prepared Communities (Young people 9-25) $23 million for this new initiative

Strategic Prevention Framework/Partners for Success ↓$7 million to $103.5 million

Preventing Suicide ↑$6 million to $54 million

SBIRT ↑$8 million to $37 million

Prescription Drug Monitoring $2 million

Stop Act (Sober Truth on Preventing Underage Drinking) $8 million

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No. 2 Trauma & No. 2 Trauma & JusticeJustice

Trauma-informed screening and care in behavioral health, health and justice settings

Youth & adults with behavioral health needs in juvenile and criminal justice systems – diversion and prevention

Impacts of violence and trauma on youth

Incidence of community violence Prevalence data Helping communities reduce violence

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Trauma & JusticeTrauma & Justice FY 2011 Budget FY 2011 Budget

HighlightsHighlights Children’s Mental

Health Initiative (CMHI) ↑$5 million to $126 million

Transformation grants

Safe Schools/Healthy Students $95 million

Drug Courts ↑$13 million to $56 million

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No. 3 Military Families - No. 3 Military Families - Active, Guard, Reserve, & Active, Guard, Reserve, & VeteranVeteran

Suicide Homelessness Prevention for families Access to treatment in civilian service settings in partnership with states and VA, DOD,

Guard FY 2011 Budget highlights which could

focus on military families:● Prevention, Housing, Children’s MH, Suicide

Prevention, Block Grant Increases ATR ↑ $10 million to $109 million

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No. 4 Health Insurance No. 4 Health Insurance ReformReform

Health Insurance Reform implementation

Medicaid & Medicare policies and opportunities

Parity regulation – implementation of interim final rule• Effective April 4th; comments through May 4th

• Comments & research on scope of services, non-quantitative treatment limitations, common deductibles, etc.

• Medicaid parity regulation still to come

Block grants – consideration of future use and implications

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WHY CARE ABOUT HEALTH WHY CARE ABOUT HEALTH INSURANCE REFORM?INSURANCE REFORM?

Rising cost for families, businesses and government

Health care quality

Disproportionate impact on persons with mental illness and substance use disorders

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WHAT REFORM GETS US: 32 million Americans covered

(95%)

$2,000 projected reduction in premiums for American families

4,000,000 jobs created as health costs decline

$1 trillion+ reduction in federal deficit in next decade

$36 billion reduced spending on uninsured over next decade

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WHAT’S IN REFORM WHAT’S IN REFORM FOR BEHAVIORAL FOR BEHAVIORAL

HEALTH – 1 HEALTH – 1 COVERAGECOVERAGE● Expands Medicaid to 133% FPL – an estimated 16 Expands Medicaid to 133% FPL – an estimated 16

million new enrollees of which 1/3 are likely to million new enrollees of which 1/3 are likely to have MI/SUD service needshave MI/SUD service needs

● Focus grant dollars for recovery support services Focus grant dollars for recovery support services not paid for through insurance benefit plansnot paid for through insurance benefit plans

● Changes in Medicaid to assist youth to maintain Changes in Medicaid to assist youth to maintain coverage in times of transitioncoverage in times of transition

● Allows dependent coverage to age 26Allows dependent coverage to age 26● Elimination of pre-existing condition exclusions & Elimination of pre-existing condition exclusions &

policy terminations; guaranteed renewabilitypolicy terminations; guaranteed renewability● Expands possibility of home and community-Expands possibility of home and community-

based services for individuals with mental health based services for individuals with mental health and substance use disorders and substance use disorders

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WHAT’S IN REFORM WHAT’S IN REFORM FOR BEHAVIORAL FOR BEHAVIORAL

HEALTH – 2 HEALTH – 2 SERVICES SERVICES

● New home visiting programs for young children—with a focus on New home visiting programs for young children—with a focus on families with substance use disordersfamilies with substance use disorders

● Programs to expand “medical homes” to include behavioral Programs to expand “medical homes” to include behavioral healthhealth

● School-based health clinics to provide mental health and School-based health clinics to provide mental health and substance use disorder assessments, crisis intervention, substance use disorder assessments, crisis intervention, counseling, treatmentcounseling, treatment

● Begin closing Medicare “doughnut hole” for prescription drugs for Begin closing Medicare “doughnut hole” for prescription drugs for seniors and disabled individualsseniors and disabled individuals

● Establishes a “Medicaid Emergency Psychiatric Demonstration” Establishes a “Medicaid Emergency Psychiatric Demonstration”

PARITY PARITY ● Parity required in essential benefits plans offered through Parity required in essential benefits plans offered through

exchangesexchanges● Employer mandate requires parity in private health plansEmployer mandate requires parity in private health plans

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WHAT’S IN REFORM WHAT’S IN REFORM FOR BEHAVIORAL FOR BEHAVIORAL

HEALTH – 3 HEALTH – 3 PREVENTION PREVENTION ● Prevention research programs and national Prevention research programs and national

prevention plansprevention plans● Coverage of preventive services in benefits Coverage of preventive services in benefits

packages, including SBIRT, without cost-sharingpackages, including SBIRT, without cost-sharing● Allowing states to cover prevention services Allowing states to cover prevention services

under Medicaidunder Medicaid● Prevention Trust FundPrevention Trust Fund

TRAINING & RESEARCHTRAINING & RESEARCH● Increased patient-centered health researchIncreased patient-centered health research● Training grants for behavioral health workforceTraining grants for behavioral health workforce● Training on MH/SUD for Primary Care Extender Training on MH/SUD for Primary Care Extender

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WHAT’S IN REFORM WHAT’S IN REFORM FOR BEHAVIORAL FOR BEHAVIORAL

HEALTH – 4 HEALTH – 4 COSTS & FUNDINGCOSTS & FUNDING

● Tax credits for businesses offering coverageTax credits for businesses offering coverage● Tax credits for individuals purchasing Tax credits for individuals purchasing

insuranceinsurance● Vouchers for low-income individuals not Vouchers for low-income individuals not

eligible for Medicaid to purchase insurance eligible for Medicaid to purchase insurance through exchangesthrough exchanges

● Increased Medicaid and commercial Increased Medicaid and commercial insurance funding of mental health and insurance funding of mental health and substance abuse servicessubstance abuse services

● Allows SAMHSA block grant and grant dollars Allows SAMHSA block grant and grant dollars to be focused on recovery support services to be focused on recovery support services not paid for through insurance benefit plansnot paid for through insurance benefit plans

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WHAT’S IN REFORM WHAT’S IN REFORM FOR BEHAVIORAL FOR BEHAVIORAL

HEALTH – 4 HEALTH – 4 INVOLVEMENTINVOLVEMENT

● SAMHSA consultation on regulations, SAMHSA consultation on regulations, demonstrations, implementationdemonstrations, implementation

● States that develop health homes must States that develop health homes must “consult and coordinate” with SAMHSA “consult and coordinate” with SAMHSA regarding the prevention and treatment of regarding the prevention and treatment of MH/SUDMH/SUD

● Demonstration initiatives within HHS at Demonstration initiatives within HHS at discretion of HHS Secretary allow for discretion of HHS Secretary allow for MH/SA inclusionMH/SA inclusion

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Behavioral Health must be at the table to participate in, inform and influence the future of the Nation’s health care

system

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No. 5 Jobs and No. 5 Jobs and EconomyEconomy

Place-based approach to impacting increasing behavioral health needs of communities with significant effects from the current economic conditions

Employers – role in supporting employees behavioral health while positively impacting their costs

Employment – for persons with histories of mental illness or substance abuse diagnoses or treatment Policy, legal, capacity, and knowledge barriers

FY 2011 Budget:● Community Mental Health Block Grant at $421 million● Substance Abuse Prevention & Treatment Block Grant at $1.8

billion● Community Resilience & Recovery Initiative (CRRI) $5 million

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No. 6 Housing & No. 6 Housing & HomelessnessHomelessness

Moving from services for homeless persons to permanent supportive housing for persons who experience chronic homelessness due to substance abuse and/or mental illness

• Policy barriers• Financing barriers• Capacity and knowledge barriers

Interagency Council to End Homelessness – Report to Congress, Spring 2010

• Families• Youth• Veterans• Adults experiencing chronic homelessness

FY 2011 Budget: ● PATH ↑$5 million to $70 million● HUD/HHS demo – ↑ $16 million provision of 10,000 new homeless and

special needs vouchers, 4,000 of which are targeted for persons with mental illness/substance abuse disorders eligible for Medicaid through creative state waivers or other programs

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No. 7 Health Information Technology No. 7 Health Information Technology (HIT) (HIT)

& Electronic Health Records (EHR)& Electronic Health Records (EHR) SA/MH provider capacity to utilize electronic health

records, including access to federal assistance (meaningful use; ARRA)

Behavioral health outcomes and data using health information technology – standards

Privacy/confidentiality of mental health and substance abuse treatment information while supporting integration of health and behavioral health care

April 15, 2010 public meeting with ONC and ASPE, in DC

FY 2011 Budget:● $4 million new in the Office of the National Coordinator (ONC) for

Behavioral Health HIT

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No. 8 No. 8 WorkforceWorkforce

Numbers and distribution of practitioners with aging workforce

Behavioral health/primary care integration

Support for recovery coaches peer and paraprofessional or non-traditional workers

Evidence-based thinking; evidence-based practices adoption

Recovery in core competencies and curriculum for education of all practitioners and workers

FY2011 Budget: $25 million to HRSA for BH in FQHCs

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No. 9 Data and Outcomes – No. 9 Data and Outcomes – Demonstrating ResultsDemonstrating Results

Consolidation of fragmented and multiple SAMHSA data systems

Consistent data requirements for states and grantees – block grants and grant programs

Common National Outcome Measures (NOMS) across funding streams for state mental health, substance abuse, and Medicaid agencies

Common approach to evaluation and services research

FY 2011 Budget:● National data collection ↑ $33 million to $136 million – DAWN &

New C-EMS● Internal work regarding common data elements and approaches

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No. 10 Public Awareness No. 10 Public Awareness and Supportand Support

Consistent messages, focusing on key messages, principles and 10 strategic initiatives

Redesign and consolidation of websites

Utilization of social marketing mechanisms

Increase understanding of where and how to seek help

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Behavioral health is an essential part of Behavioral health is an essential part of healthhealth

● Improves health statusImproves health status● Lowers costs for families, businesses and Lowers costs for families, businesses and

governmentsgovernments

Prevention worksPrevention works

Treatment is effectiveTreatment is effective

People recoverPeople recover

KEY MESSAGESKEY MESSAGES

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People● Stay focused on the goal

Partnership● Cannot do it alone

Performance● Make a measurable difference

Parity● Mental and substance use disorders are not

unlikeany other health care condition – acute, chronic or disabling

PRINCIPLESPRINCIPLES

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Partnership:Partnership:Cannot do it aloneCannot do it alone

Faith & Community-based

Providers

States, Territories & Tribes

Consumers & Recovery

Community

Substance Use

Treatment Providers

Mental Health

Treatment Providers

Individuals, Families &

Communities

Medical Communit

y

Criminal Justice

Community

Practitioners

Researchers

Advocates

Educators

Service Agency

Administrators

Policy Makers

Media

Military

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THE ONLY FAILURE THE ONLY FAILURE IS FAILURE TO AIM IS FAILURE TO AIM

HIGHHIGH

““Not failure, but low aim is sin.”Not failure, but low aim is sin.”

– – Benjamin E. Mays Benjamin E. Mays

““Not failure, but low aim, is crime.”Not failure, but low aim, is crime.”

– – James Russell LowellJames Russell Lowell