The Future of Prevention: Our Challenges and

Opportunities

Frances M. Harding, DirectorSAMHSA’s Center for Substance Abuse Prevention

2011 NCADD Conference of AffiliatesArlington, VA • September 7, 2011

Behavioral health is essential for health Prevention works Treatment is effective People recover from mental and substance use

disorders

SAMHSA’s Key Messages

Role of Prevention in Substance Use and Mental Health Disorders

Behavioral health is essential for health Addiction as a complex and chronic disease Recovery as a process rather than an event Ongoing contact and support to complement treatment Natural supports such as friends, peers, and family Evidence-based, multi-component prevention programs

Assessing Public Knowledge and Attitudes: What Americans Believe

66 percent believe

treatment and support can help people with mental illness lead

normal lives

20 percent feel persons with mental illness are dangerous

to others

Two thirds believe

addiction can be prevented

75 percent believe recovery from addiction

is possible

20 percent say they would

think less of a friend/relative if they discovered that person is in recovery from an addiction

30 percent say they would

think less of a person with a

current addiction

Health Reform

State Budget

Declines

Federal Domestic Spending

EMERGING SCIENCE

Drivers of Change

Health Reform

More people will have insurance coverage. Theme: prevent diseases, promote wellness Integrated care: new thinking—recovery, wellness, role of

peers, response to whole health needs New opportunities for behavioral health:

• Parity: Mental Health Parity and Addiction Equality Act and within Affordable Care Act

• Tribal Law and Order Act• National Action Alliance for Suicide Prevention

Medicare and Medicaid changes

Beginning in 2014: 32 Million More Americans Eligible to be Covered

4-6 mil

Commercial Insurance

Medicaid

6–10 Million With M/SUDs

Challenges—State Leadership

Individuals Served by SSAs

Uninsured61%

Insured39%

Individuals Served by MHAs

Insured61%

Uninsured39%

• 90–95 percent will have the opportunity to be covered by Medicaid or through insurance exchanges.

Federal Domestic Spending

Focusing on the Strategic Initiatives Revised Approach to Grant-Making Prevention Funding for 2012:

• Substance Abuse-State Prevention Grant ($395 million).• Mental Health-State Prevention Grant ($90 million).• Behavioral Health-Tribal Prevention Grant ($50 million).

Staying Focused During Change

SAMHSA’S Strategic Initiatives

AIM: Improving the Nation’s Behavioral Health (1–4)

AIM: Transforming Health Care in America (5–6)AIM: Achieving Excellence in Operations (7–8)

1. Prevention

2. Trauma

and Justice

3. Military Families

4. Recover

y Support

5. Health Reform

6. Health Informati

on Technolo

gy

7. Data, Outcom

es & Quality

8. Public Awaren

ess & Support

Strategic Initiative 1: Prevention of Substance Abuse and Mental Illness

Goal 1.1

With primary prevention as the focus, build emotional health, prevent or delay onset of, and mitigate symptoms and complications from substance abuse and mental illness.

Goal 1.2

Prevent or reduce consequences of underage drinking and adult problem drinking.

Goal 1.3

Prevent suicides and attempted suicides among populations at high risk, especially military families, LGBTQ youth, and American Indians and Alaska Natives.

Goal 1.4

Reduce prescription drug misuse and abuse.

Work Ahead—SAMHSA

Revised Block Grant application and reporting Implementation of Tribal Law and Order Act—Office of

Indian Alcohol and Substance Abuse Decisions and implementation of prevention funds Evidence of good and modern services:

• Benefit decisions, practice protocols, research agenda

Current Federal Partners

• Administration for Children and Families

• Administration on Aging• Centers for Disease Control and

Prevention• Centers for Medicare and

Medicaid Services• Food and Drug Administration• Health Resources and Services

Administration• Indian Health Service• National Institutes of Health

• Office of Minority Health• Office of National Drug Control

Policy• Office of the Surgeon General• Department of Education• Department of Defense• Department of the Interior• Department of Justice

New Roles—State SA and MH Leadership

Take key role in design and execution of health reform. Develop or enhance strategic partnerships for prevention. Think beyond traditional Block Grant populations. Focus on recovery support—help people get and stay

well.

We’ve Been Here Before

Risk and protective factors—Commonalities between mental health and substance abuse.

Chronic disease indicators—Substance use represents a spectrum of conditions and risk factors as well as social context.

Links with physical health care providers—Prevent problems related to mental illnesses and substance abuse.

SAMHSA’s PRINCIPLES

www.samhsa.gov