tribal behavioral health: growing healthy communities and healthy people charles h. smith, phd...
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Tribal Behavioral Health: Growing Healthy Communities and
Healthy People
Charles H. Smith, PhDRegional Administrator – Region VIII
Substance Abuse and Mental Health Administration
Pathways to Respecting American IndianCivil Rights Conference
August 8, 2012
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Behavioral Health: A National Priority
SAMHSA’s Mission: Reduce the impact of substance abuse and mental illness on America’s communities
www.samhsa.gov
Behavioral health is essential to health
Treatment is effective
Prevention works
People recover
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SAMHSA’s Principles
www.samhsa.gov
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SAMHSA’s New Regional Presence
• Represent SAMHSA leadership in the Regions• Provide SAMHSA with regional feedback• Establish working relationships with:
– Regional representatives of OpDivs (HRSA, ACF, CMS, AoA) and internal staff divisions
– State authorities for mental health and substance abuse, providers, advocates, and groups, state and local health departments.
• Coordinate support for State implementation of health reform.
• Coordinate, as needed, implementation of SAMHSA Strategic Initiatives and resources across SAMHSA to address emerging needs
• Consultation and technical assistance within the regions.
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Behavioral Health: Public Health Or Social Problem?
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Tribal Behavioral Health:Scope of the Problem
Congress: Substance abuse “most severe health and social problem” for Indian tribes Costs of consequences Risk factor for other problems Cause of death and disability
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Tribal Communities andBehavioral Health Challenges
21.6 % of American Indians or Alaska Natives (AI/AN) experienced mental illness in the past year (vs. 19.9 % overall pop)
The rate of past month binge alcohol use was ↑ among AI/AN adults than the national average (30.6 vs. 24.5%)
The rate of past month illicit drug use was ↑ among AI/AN adults than the national average (11.2 vs. 7.9%)
Only 1 in 8 (12.6%) of AI/AN adults (24,000 people) in need of alcohol or illicit drug use treatment in the past year received treatment at a specialty treatment facility
American Indians are overrepresented in incarceration and arrests rates; in one Minnesota county, American Indians account for 50% of the arrests, but only 11.5% of the county population is American Indian.
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Health Disparities: A Snapshot
Indian Country Rates Nationally*• 72 % higher suicide rate• 92 % higher homicide rate• 149 % higher unintentional injury rate
(includes motor vehicle crashes)
• 195 % higher diabetes rate• 500 % higher tuberculosis rate• 519 % higher alcoholism rate
*Retrieved from www.ihs.gov/Disparities.asp
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Health Disparities: A Snapshot
Urban Indian Rates Nationally*• 38% higher accident mortality• 54% higher diabetes mortality• 126% higher chronic liver disease mortality• 178% higher alcohol-related mortality• Urban Indian youth are nearly 5 times more likely
to attempt suicide requiring hospitalization than all other urban youth combined
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*Urban Indian Health Institute (2004) The Health Status of Urban American Indian and Alaska Natives; (2010) Visibility Through Data: Health information for Urban American Indian and Alaska Native Communities, retrieved from www.uihi.org
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Suicide Among American Indian and Alaskan Natives
Suicide among AI/NA populations• Higher risk: young and middle-aged AI/AN
• Ages 15 – 24: Rates of 31.59 per 100,000• Ages 40 – 59: Rates of 19.43 per 100,000
• Suicide is the second leading cause of death for AI/AN youth in the 15-24 age group, 2.5x the national rate for this age group
Suicidal thoughts and plans among AI/AN adults age 18 and older• 54,000 (5.0%) had serious thoughts of suicide in the past year vs.
3.7% overall population• 26,000 (2.4%) made a suicide plan vs. 1.0% of overall population
Suicide attempts among AI/AN adults age 18 and older• 16,000 (1.4%) made a suicide attempt vs. 0.05% of overall population
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Current, Binge, and Heavy Alcohol Use among Persons
Aged 12 & Older, by Race/Ethnicity: 2010
2010 NSDUH – Summary of National Findings
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Substance Dependence or Abuse in the Past Year by Race/Ethnicity: 2010
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Indian Country at a Glance
Challenges in AI/AN Communities:• Higher adolescent death rates• Higher youth suicide rates• Higher past month binge alcohol use• Higher past month illicit drug use• Higher sexual assault rates against females• Higher homicide rates against women • Higher rates of intimate partner violence• Higher rates of historical trauma
AND……...
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Indian Country at a Glance
AND………• Lower mental / substance use disorder
treatment rates in non-IHS/specialty treatment settings
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SAMHSA Programs Serving AI/AN Communities
• 17 Strategic Prevention Framework Tribal Incentive Grants• 54 Drug Free Communities Support grants• 29 Garrett Lee Smith Tribal Youth Suicide Prevention grants• 65 Native communities served by Native Aspirations
(bullying, violence, and suicide prevention) • 7 Circles of Care Infrastructure grants for Children’s Mental
Health Systems • 1 Project LAUNCH grantee• Native American Center for Excellence (provides technical
assistance to native communities)
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SAMHSA Block Grants
• Currently, 2/3 of SAMHSA’s budget goes to State Block Grants.– Mental Health Services Block Grant– Substance Abuse Prevention & Treatment Block Grant
• 2011 & 2012 Uniform Block Grant– States must show evidence they consulted with the
Federally recognized Tribes within borders– Current analysis of Section G –Tribal Consultation
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Behavioral Health – Tribal Prevention Grant (BH-TPG)
A proposed non-competitive, multi-year grant included in SAMHSA’s FY 2013 budget request.
•$40 million from ACA Prevention Fund•“Basic” award for every Federally recognized Tribe that submits a plan to prevent substance abuse and suicide.•On-going Tribal Consultations on distribution formula and program design.
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Health Care Reform
• More people will have insurance coverage
• ↑ Demand for qualified and well-trained BH professionals
• Medicaid (and States) will play a bigger role in M/SUDs
• Focus on primary care & coordination w/ specialty care
• Major emphasis on home & community-based services; less reliance on institutional and residential care
• Priority on prevention of diseases & promoting wellness
• Focus on quality rather than quantity of care
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Tribal Law and Order Act (TLOA)
TLOA was signed into law on July 29, 2009. It reauthorized and amends the Indian Alcohol and Substance Abuse Prevention and Treatment Act (IASA) of 1986.
TLOA Section 241: SAMHSA Shall…Lead interagency coordination of efforts, resources and services.
Seek Tribal Leader input (consultation)
Develop a Memorandum of Agreement with Justice, Interior and HHS.
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Tribal Law and Order Act of 2010
Signed into law July 29, 2010
Reauthorizes and amends: Indian Alcohol and SubstanceAbuse Prevention and Treatment Act (IASA)
of 1986
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Tribal Law and Order Act of 2010
Key Features:• Three (plus) federal Departments– U.S. Dept of Health and Human Services– U.S. Dept of the Interior– U.S. Dept of Justice– Plus… U.S.D.A., Dept of Ed, DOL, ONDCP
• Establish objectives/goals• Encourage development of “Tribal Action Plans” (TAPs)• Respect for Tribal sovereignty• No additional $$
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Tribal Law and Order Act of 2010
Key Features:
• Three main goals(1) Determine scope of the problems faced by Tribes
(2) Identify relevant resources and programs of each partner agency
(3) Coordinate existing agency programs with those established under the Act
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Tribal Law and Order Act of 2010
Key Features:• Encourage development of “TAPs”
Tribal Action Plan coordinate resources and programs to combat substance abuse in the tribe
Federal cooperation at the tribe’s request, federal partner agencies help develop a TAP
Implementation federal area representatives enter into agreement with tribe to implement TAP
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Tribal Law and Order Act of 2010
Key Features:
• Respect for Tribal sovereignty Unique historical, legal, moral responsibility
Tribal sovereignty to determine what’s best for their people
Together, these are the basis of:
Government-to-government relationship
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TLOA also requires SAMHSA to…
Create and staff a SAMHSA Office of Indian Alcohol and Substance Abuse (OIASA):
Secure operating framework for a Tribal Action Plan (TAP).
Establish Inventory/Resource Workgroup.
Establish Newsletter Workgroup.
Establish an Education Services Workgroup. Launch OIASA website: http://www.samhsa.gov/tloa/
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OIASA Quarterly Newsletter
Publish quarterly
Include reviews of exemplary AI/AN programs
Provide contact and follow-up information about the programs
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Raising Awareness about Behavioral Health in Tribal Communities
http://store.samhsa.gov/homehttp://blog.samhsa.gov/
http://actionallianceforsuicideprevention.org/
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National Network to Eliminate Disparities in Behavioral Health (NNED)
http://nned.net/index-nned.php/
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Multicultural Public Awareness Campaign Raising Awareness about Mental Health Problems in Tribal Communities
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http://www.whatadifference.samhsa.gov/native/
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Thank You
Charles H. Smith, PhD
Regional Administrator – Region VIII(CO, MT, ND, SD, UT, WY)
Substance Abuse and Mental Health Services Administration
(303) 844-7873
www.samhsa.gov