Peer Support Specialists: SAMHSA's designation raises confusion

Inertia Mires Bills to Fix Biased Medicare Copay

Understanding Trauma-Informed Care in the PALTC Setting

After 988’s Launch, Experts Emphasize More Work Needed

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"

The Substance Abuse and Mental Health Services Administration (SAMHSA) has taken another step toward merging mental illness and substance use disorder (SUD) with its new Office of Recovery that blends both. Peers (differentiated from professionals) with “lived experience” of having either SUDs, mental illness, or both in the SAMHSA‐preferred terminology of “co‐occurring” will be key to this new office, which was announced last fall (see Advocates hold hope that SAMHSA office will deliver for recovery support, ADAW Oct. 11, 2021; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33218).

The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced the availability of more than $10 million in grant funding to expand treatment capacity for substance use disorders in family treatment drug courts. The Funding Opportunity Announcement, posted Nov. 5, states that the application due date is Jan. 4, 2019. “The purpose of this program is to expand substance use disorder (SUD) treatment services in existing family treatment drug courts, which use the family treatment drug court model in order to provide alcohol and drug treatment (including recovery support services, screening, assessment, case management, and program coordination) to parents with a SUD and/or co‐occurring SUD and mental disorders who have had a dependency petition filed against them or are at risk of such filing,” according to the announcement. “Services must address the needs of the family as a whole and include direct service provision to children (18 and under) of individuals served by this project.” Grant recipients must provide an approach that combines the “sanctioning power” of treatment drug courts with treatment services that promote successful family preservation and reunification. “Priority funding should address gaps in the treatment continuum for court involved individuals who need treatment for a SUD and/or co‐occurring SUD and mental disorders while simultaneously addressing the needs of their children,” according to the announcement. The funding is to help participants reduce substance misuse, reduce SUD and co‐occurring disorder severity and decrease out‐of‐home placements for children, according to the announcement, which goes on to say that this “should also decrease the number of parents or guardians whose parental rights have been or will be terminated.” Eligible applicants include state governments and territories, counties, cities or towns, as well as federally recognized tribal organizations and consortia. Family treatment drug courts that received an award for FY 2017 or FY 2018 under this program are not eligible to apply. An anticipated 25 awards will be given, with award amounts of up to $425,000 a year for up to five years. No cost sharing is required. For more information, contact Jon.Berg@samhsa.hhs.gov

Ethics of Prescription Drug Monitoring Programs

Back to table of contents Previous article Next article Government NewsFull AccessSenate Committee Solicits Input on State of MH SystemLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:15 Mar 2013https://doi.org/10.1176/appi.pn.2013.3b13AbstractExperts tell a Senate committee that the mental health system is overburdened, many patients don’t get needed help, and earlier and improved detection could change that reality.The Senate Health, Education, Labor, and Pensions (HELP) Committee, convened a meeting January 24 to discuss—for the first time in six years—the mental health of Americans. Prompted by the Newtown, Conn., school shooting and in anticipation of the changes the Affordable Care Act will bring about, committee members solicited input at the hearing they dubbed “Assessing the State of America’s Mental Health System.”“It seems to me that the questions before us are ‘who needs help’ and ‘who’s there to provide the help’,” said Sen. Lamar Alexander (R-Tenn.), the committee’s ranking member.Pamela Hyde, J.D., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), was the first to provide testimony. “Behavioral health is a public-health issue, not a social issue, and it can be tackled and addressed with an effective public-health approach,” she said, while noting that SAMHSA’s National Survey on Drug Use and Health indicates that only 38 percent of adults with diagnosable mental health problems and only 11 percent of those with diagnosable substance use disorders receive treatment.“Prevention works, treatment is effective, and people do, in fact, recover,” she stressed, but obstacles including cost, access, and recognition of mental health disorders are the primary reasons treatment is not received by many who need it. Hyde pointed to upcoming changes associated with the Affordable Care Act that will extend the reach of mental health treatment to more Americans, saying “Medicaid is already the largest payer of mental health services, and the Affordable Care Act will extend Medicaid coverage to as many as 17 million hardworking Americans.”Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH), also presented testimony and emphasized that most mental disorders begin early in life, yet patients often wait years for diagnosis and treatment. “The lesson we have learned from cancer and heart disease, diabetes and AIDS, is that the secret to having the best outcomes is early detection and early intervention…yet we don’t do that.” Moving forward, NIMH will support research on earlier diagnosis and quicker delivery of appropriate treatment, be it behavioral or pharmacological, he said. Medical Director James H. Scully Jr., M.D., submitted testimony on behalf of APA. “This hearing comes at a critical time when our leaders in government are faced with difficult choices about where to allocate limited resources,” he noted. “Nevertheless, I believe the current state of our nation’s mental health system is weak and demands immediate and significant attention by Congress and the administration.” Scully’s testimony presented five key areas through which the mental health system could be strengthened to ensure the mental health and well-being of all Americans:Mental Health Parity. APA urges issuance of a final rule on the Mental Health Parity and Addiction Equity Act of 2008. In the absence of a final rule, APA is concerned that access to critical mental health services will be jeopardized for millions of Americans. APA also supports reintroduction of the Medicare Mental Health Inpatient Equity Act, which would increase access to coverage for the most seriously mentally ill people. A Commission on Mental Health. APA supports the idea of a new commission—either presidential or congressional—to conceptualize how the nation’s mental health system can meet the needs of all Americans. Investing in Existing Mental Health System Components. APA supports investment in biomedical research, initiatives to develop and implement new treatments for addiction, and state block grants for mental health and substance use activities, suicide prevention, and jail-diversion programs for people with mental illness. Support for Graduate Medical Education. The ability of the U.S. mental health system to deliver high-quality care in a coordinated and cost-effective manner is dependent upon an appropriately trained workforce. As a physician specialty society, APA strongly supports the preservation of funding for both direct graduate medical education and indirect graduate medical education, programs that support 16,000 residencies each year. Early Intervention and Prevention Services for Youth. As a vulnerable population, children and adolescents are especially in need of early intervention and prevention services.Scully also brought to the committee’s attention the initiative APA launched through the American Psychiatric Foundation, called “Typical or Troubled?,” to train school personnel to make the distinction between students who are “just being adolescents” and students who demonstrate early signs of mental illness, saying “this program represents the type of early intervention and prevention strategy that could serve as a national model.” ■A video of the committee hearing as well as written testimony are posted at http://www.help.senate.gov/hearings/hearing/?id=b2048a10-5056-a032-529c-340d7ae5f237. Scully’s testimony is posted at http://www.psychiatry.org/advocacy--newsroom/advocacy/apa-submits-testimony-to-congress-on-the-state-of-americas-mental-health-system. ISSUES NewArchived

The National Association of State Alcohol and Drug Abuse Directors (NASADAD) has issued practice guidance to adolescent substance use disorder (SUD) treatment services. The purpose of the document is to better inform SUD services for adolescents across the states. NASADAD expects that language in the document can be incorporated into contracts with treatment providers to ensure that evidence‐based, high‐quality treatment is delivered to adolescents ages 12 to 18. The project, which was funded under a subcontract to JBS International, under a Substance Abuse and Mental Health Services Administration (SAMHSA) contract, originated in the states themselves, said Henrick Harwood, NASADAD's director of research, in an interview with CPU. “Many of the states had been putting together their own documents,” he said. “Each state was inventing their own guidelines, their own practices, on how to manage and purchase youth services,” he said. “SAMHSA said, ‘We can help to resource this,’ and gave us a grant to work with the states.”

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessPeople With Dual Diagnoses Going UntreatedEve BenderEve BenderPublished Online:20 Aug 2004https://doi.org/10.1176/pn.39.16.0390022bLess than half of the 4 million adults estimated to have serious mental illness and a co-occurring substance use disorder in 2002 received treatment for either problem, according to a June report from the Substance Abuse and Mental Health Services Administration (SAMHSA).The data, which come from the 2002 National Survey on Drug Use and Health, a household survey of 44,481 randomly selected adults in the United States, found that an estimated 17.5 million adults aged 18 or older had a serious mental illness during the preceding year, or about 8 percent of all adults in the country.Furthermore, about 4 million, or 23 percent, of adults with mental illness in 2002 were also dependent on or had abused illicit drugs and/or alcohol.In contrast, among adults without a serious mental illness, only about 8 percent acknowledged dependence on or abuse of drugs or alcohol.The researchers defined serious mental illness as a "diagnosable mental, behavioral, or emotional disorder that met DSM-IV criteria during the previous year that resulted in functional impairment that substantially interfered with one or more major life activities." (They separated substance use from other mental disorders for the purposes of this study.)One striking finding was that a little over half (52 percent) of those with mental illness and a co-occurring substance use disorder received neither mental health nor specialty addiction treatment during the year prior to the survey.These were among the findings on the 4 million adults with co-occurring disorders:34 percent received mental illness treatment only.2 percent received specialty substance use treatment only.12 percent received both mental illness and substance use treatment during the prior year.These were among the findings on the 2 million adults with co-occurring mental illness and a substance use disorder who had not received treatment:24 percent perceived an unmet need for mental illness treatment.6 percent perceived an unmet need for substance use treatment.9 percent perceived an unmet need for both mental illness and substance use treatment.61 percent perceived no unmet need for either substance use treatment or mental health treatment.Findings from the 2002 National Survey on Drug Use and Health are posted online at<www.oas.samhsa.gov>.▪ ISSUES NewArchived

In an interview last week with Mental Health Weekly, former Substance Abuse and Mental Health Services Administration (SAMHSA) Assistant Secretary for Mental Health and Substance Use Elinore McCance‐Katz, M.D., Ph.D., who announced her resignation last month, reflected on SAMHSA's achievements and national priorities, especially amid COVID‐19, and the need for increased funding to address the mental health and substance use disorder needs of Americans.

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.

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

Mental health care for Latinos: introduction to the special section.