HHS FY26 bill holds funds, adds small boosts for MH programs

Removing the stigma of medication for opioid use disorder

Understanding Trauma-Informed Care in the PALTC Setting

Back to table of contents Previous article Next article ProfessionalFull AccessDEA, SAMHSA Release Temporary Rule Extending Telemedicine FlexibilitiesTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:11 May 2023https://doi.org/10.1176/appi.pn.2023.06.6.2AbstractThe rule extends the full set of telemedicine flexibilities adopted during the COVID-19 PHE through November 11. Additional flexibilities will extend to established patients until November 11, 2024.The U.S. Drug Enforcement Administration (DEA) and Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary rule on May 10 that extends telemedicine flexibilities adopted during the COVID-19 Public Health Emergency (PHE). The temporary rule is effective today, May 11, and extends the full set of telemedicine flexibilities adopted during the COVID-19 PHE for six months (through November 11). Additional flexibilities will extend to established patients until November 11, 2024.“Access to evidence-based treatment is a pillar of the HHS Overdose Prevention Strategy,” said Miriam E. Delphin-Rittmon, Ph.D., the Health and Human Services (HHS) assistant secretary for mental health and substance use and the leader of SAMHSA, in a press release issued by SAMHSA. “We strongly support policies that promote access to effective and safe treatment for opioid use disorder, including through telemedicine platforms, and ensuring continued access to necessary controlled medications past the COVID-PHE.”This development is the latest in a story that began back in February, when the DEA announced two proposed rules (Docket No. DEA–407 and Docket No. DEA–948) for the prescribing of controlled medications via telemedicine. There was a 30-day public comment period for the proposed rules, which ended on March 31.The nation cannot afford policies that make it more difficult for patients to get the medications they need, says APA CEO and Medical Director Saul Levin, M.D., M.P.A.APA filed two letters with the DEA in response to the proposed rules during this time, recommending that the DEA “focus on balancing common-sense safeguards for DEA enforcement without decreasing access to lifesaving treatment” and consider ways to extend flexibilities made during the COVID-19 PHE. These comments were just two of the tens of thousands of comments that the agency received.DEA Administrator Anne Milgram on May 3 announced that the agency had received “a record 38,000 comments on its proposed telemedicine rules” and would delay releasing the two permanent rules that were set to go into effect when the COVID-19 PHE ends. “We take those [38,000] comments seriously and are considering them carefully,” Milgram said.The SAMHSA release noted: “For any practitioner-patient telemedicine relationships that have been or will be established up to November 11, 2023, the full set of telemedicine flexibilities regarding prescription of controlled medications established during the COVID-19 PHE will be extended for one year—through November 11, 2024.”“We recognize the importance of telemedicine in providing Americans with access to needed medications, and we have decided to extend the current flexibilities while we work to find a way forward to give Americans that access with appropriate safeguards,” Milgram said.“We are pleased that the DEA is taking the time to consider carefully the impact the proposed rules would have on patients, many of whom rely on telehealth as a means of accessing care,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “At a time when the nation faces both a mental health crisis and an opioid crisis, we cannot afford policies that make it harder for patients to get the medications they need.” ■ResourcesThe temporary DEA rule “Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications”Proposed DEA rule “Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation”Proposed DEA rule “Expansion of Induction of Buprenorphine via Telemedicine Encounter”Statement from the DEA Administrator Anne Milgram on COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications ISSUES NewArchived

Behavioral health care, which addresses mental health and substance use, has been neglected by our health care system. People with severe mental illnesses and other chronic conditions such as diabetes, asthma, heart disease, and obesity, die earlier than do people without such conditions. Behavioral health conditions may not be properly addressed because of a lack of community resources and poor health insurance coverage for such conditions. The federal government — in partnership with states, communities, consumers, families, and the private sector — has responded with proposals for health care reform that include mental health care. In 2009, federal agency partners helped frame the agenda for health care reform. Their focus was on creating a holistic, person-centered health care system, achieved through a public health model that addresses the broad determinants of health and mental health. In particular, they focused on prevention, early intervention, and the use of technology to increase access to and quality of health and mental health services. The federal response to behavioral health care reform has been guided by 3 seminal documents that have influenced and reflected change in mental health systems and services. Reports by the Surgeon General (1), New Freedom Commission on Mental Health (2), and Institute of Medicine (3) made all of the following clear: Mental health is essential to overall health. Mental illnesses are real disorders and treatment is effective. Recovery is the expected outcome of treatment and services. Services must be consumer- and family-driven and evidence-based. Soon after the release of the New Freedom Commission's final report in 2003, the US Department of Health and Human Services (HHS) charged its Substance Abuse and Mental Health Services Administration (SAMHSA) with leading efforts to transform the mental health system in this country. SAMHSA organized a collaborative effort among more than 20 federal agencies and offices to ensure that people with mental and substance use disorders have every opportunity for recovery. Along with other agencies and offices in HHS, the federal partners include the US departments of agriculture, defense, education, housing and urban development, justice, labor, transportation, and veterans affairs, as well as the Social Security Administration and the Equal Employment Opportunity Commission. The federal partners are guided in their work by the Federal Executive Steering Committee, a group of assistant secretary-level professionals who ensure that resources will be available and promised actions will occur. Efforts to improve systems of care for people with mental illnesses have been extensive. Together, SAMHSA and its federal partners developed a specific agenda to create consumer-centered, recovery-focused, evidence-based, quality-driven systems of care for people with mental health problems. Transforming Mental Health Care in America: The Federal Action Agenda: First Steps (4), released in 2005, and Transforming Mental Health Care in America: The Federal Action Agenda: A Living Agenda (5), published in 2008, chart a vision for a transformed mental health system, delineate specific objectives to achieve this vision, and highlight progress made. The Federal Executive Steering Committee has focused on critical issues to ensure both full community integration for people with mental health problems and broad recognition of the role of mental health in overall health. Some of these issues are countering the social exclusion of people with mental illnesses through public education, preventing suicide, and increasing employment opportunities for people with psychiatric disabilities, mental illnesses, and emotional disturbances. Efforts to expand the reach of care include collaborating with the criminal and juvenile justice systems to provide access to mental health care, addressing the mental health needs of marginalized groups such as refugees and homeless people, and improving mental health care services for children and adolescents. Research is needed to understand concurrent mental and physical disorders, develop new medications, promote evidence-based mental health best practices, and put research findings into practice. The committee's accomplishments include a collection of federal resources on disaster behavioral health, a compendium of primary care and mental health integration initiatives across participating federal agencies, and a research study on evidence-based programs that integrate primary care and mental health. Meeting the needs of people with existing mental illnesses is a challenge. Countering discrimination, undoing the fragmentation of services for physical and mental illnesses, and managing costs and limited resources are first steps toward a transformed mental health system. Wisely investing in the future while making the best use of limited resources will enable us to share the hope of recovery.

Personal Accounts: "Doctor's Standing Orders"

In a July 29 Dear Colleague letter, the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency with the federal Department of Health and Human Services (HHS), strongly supports the use of opioid overdose reversal medications (OORMs) – naloxone and nalmefene – and explains that these are not par of “an ideological concept of harm reduction.”

It is only recently that health providers, policy makers, researchers, and the public have begun to focus on the importance of the mental health needs of children, youth, and young adults. There is a growing understanding that children’s mental health issues must be addressed early to improve behavioral health outcomes for children and decrease or prevent problems later in life for the child, his or her family, and the community as a whole. The Caring for Every Child’s Mental Health Campaign (Campaign) is a social marketing program funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), a federal agency within the U.S. Department of Health and Human Services that improves the nation’s behavioral health, with a mission of reducing the impact of substance abuse and mental illness in communities across the country. The Campaign’s goals are to increase awareness of children’s mental health issues and promote the development, expansion, and sustainability of innovative approaches to delivering community mental health services for children and youth with mental disorders. The Campaign addresses these goals by providing social marketing training and technical assistance to federally funded grantees in local communities. The Campaign and the grantees are funded through SAMHSA’s Comprehensive Community Mental Health Services for Children and Their Families Program. The purpose of this article is to inform professionals in the field of social marketing about how a program at the national level provides support to local, state, tribal, and territorial grantees to facilitate grassroots systems change using a social marketing approach.

Ethics of Prescription Drug Monitoring Programs

Tribally Based Suicide Prevention ProgramsA Review of Current Approaches Puneet Chawla Sahota (bio) and Sarah Kastelic (bio) INTRODUCTION Suicide is a major health challenge in American Indian/Alaska Native (AI/AN) communities, particularly among the youth. In 2004, suicide was the second leading cause of death for AI/ANs of all age groups. Among individuals between ten and fourteen years old, 13.5% of deaths were from suicide, which is nearly twice the national rate of 7.2%.1 Many factors contribute to the high prevalence of suicide in AI/AN communities, including individual factors (mental illness, substance abuse, feelings of hopelessness or isolation, impulsive behavior, and a history of violence, substance abuse, or family history of mental illness) and group factors (historical trauma, poverty, unemployment, and geographic isolation).2 Actions are needed at both the federal and tribal levels to prevent suicide, and some initial important steps have been taken. To address the challenges of youth suicide in Indian Country, a bill titled 7th Generation Promise: Indian Youth Suicide Prevention Act of 2009 was incorporated into health care reform legislation enacted in March 2010 (Patient Protection and Affordable Care Act, 2010).3 This legislation authorizes two demonstration projects aimed at preventing youth suicide in AI/AN communities. To assist tribes in preventing youth suicide, the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS) published [End Page 77] a detailed guide in 2010.4 The guide, To Live to See the Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults, is an excellent resource. Below, we present fifteen policy and practice recommendations for further supporting tribally based suicide prevention efforts. By “tribally based” we mean efforts that are tailored to the unique contexts of individual tribes and Native communities, which may include adaptations of mainstream programs or newly designed local suicide prevention programs, such as those based on spiritual or cultural traditions. The aim of this project was to review the range of approaches being used in tribally based suicide prevention programs and make recommendations about how policy makers, tribal communities, health care providers, and other service providers might better support locally tailored efforts to prevent suicide. As we describe in the next section, our goal in this paper was not to capture an exhaustive list of strategies being used in tribally based suicide prevention programs. Rather, we reviewed existing literature and consulted a select group of key informants in order to broadly describe the landscape—the commonalities and distinctive elements of these strategies—at a level of detail necessary to identify practice and policy change recommendations for a tribal leader and program staff audience. While these recommendations are targeted to supporting suicide prevention efforts in AI/AN communities, we also believe they have broader relevance for other community-based suicide prevention programs. PAPER DEVELOPMENT AND RESEARCH METHODS We developed this paper in collaboration with expert, key informant interviewees. For a list of the organizations and individuals who were interviewed or consulted by e-mail, please see Figure 1. This paper was originally intended to be a white paper for tribal leaders, not an academic research paper. Our initial goal was to write a paper for tribal communities that would review existing academic literature on suicide prevention and develop resulting recommendations about best practices and policies specifically for tribal governments. However, the initial literature review and conversations with experts in the field revealed that many successful tribal suicide prevention programs were not included in published academic articles, and that there was a need for publications about culturally appropriate tribal strategies. For this reason, we sought to review the landscape of tribally based suicide prevention programs. We conducted this broad review by reading published academic literature and “gray” literature (i.e., policy reports, white papers, program brochures, Web sites) as well as interviewing and corresponding with key informants working in the field of tribal suicide prevention. [End Page 78] In reflecting on key informants’ comments, we felt that there was a great deal of important information shared which was not already available in the academic literature. We also felt that this information...

: This document summarizes the proceedings of a meeting of cost analysis experts held August 1-2, 2000, convened by RAND on behalf of the Casey Family Programs and the Office of Early Childhood, Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of the meeting was to address the potential for cost-benefit and related analyses of subsequent demonstration studies of the Starting Early Starting Smart (SESS) program, which is a public/private initiative funded and directed through SAMHSA and the Casey Family Programs. Participants at the meeting included four national experts in cost analysis with backgrounds in mental health and substance abuse, as well as several RAND staff with experience in cost analysis. Also participating were staff from SAMHSA, the Casey Family Programs, the SESS Data Coordinating Center, and two of the SESS program sites.

Patients seeking treatment for opioid use disorder face more challenges during pandemic

The Substance Abuse and Mental Health Services Administration (SAMHSA) last month released its Interim Strategic Plan. “This is an unprecedented time in history,” SAMHSA officials stated. “The federal government, state and local governments, communities, providers, families, and people with lived experience are coming together to help address the mental health and substance use crises. SAMHSA's updated mission, vision, and priorities are informed by the events of the past several years and the innovative ideas and suggestions communicated by our many stakeholders.” This Interim Strategic Plan keeps the promotion, prevention, and treatment continuum at its core; and prioritizes equity, trauma‐informed approaches, recovery, and a commitment to data and evidence. The priorities focus on five key areas: (1) preventing overdose; (2) enhancing access to suicide prevention and crisis care; (3) promoting resilience and emotional health for children, youth, and families; (4) integrating behavioral and physical health care; and (5) strengthening the behavioral health workforce. For a copy of the plan, visit https://www.samhsa.gov/sites/default/files/samhsa‐interim‐strategic‐plan.pdf.

If you are in recovery from a substance use disorder (SUD), a peer would be another person in recovery from a SUD. At least, that's the purist way of thinking, before the word “peer” came into common usage. For years, the Substance Abuse and Mental Health Services Administration (SAMHSA) has endeavored in various ways to promote the blending of SUDs and mental illnesses, mainly in terms of the recovery workforce. Most recently, SAMHSA's publication, Peer Support Specialists: A Growing Mental Health and Addictions Workforce, adds further confusion to the issue. We asked experts in the field to comment.

After 988’s Launch, Experts Emphasize More Work Needed

The Department of Health and Human Services (HHS) announced proposed changes to 42 CFR Part 2, referred to as Part 2, last year (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33628). These rules regard the confidentiality of substance use disorder (SUD) patient records, and the American Society of Addiction Medicine (ASAM) has a history of opposing the requirement that patients give consent to have their records released when it comes to physicians treating them. According to ASAM, it's important for doctors to know about a patient's past (or present) SUD treatment. The federal government under the Substance Abuse and Mental Health Services Administration (SAMHSA) began efforts to eliminate the consent requirement, and other aspects of the decades‐old regulation, in 2010, largely due to the prevalence of electronic health records (EHRs) and the difficulty of incorporating individual patient consent for records release.