Substance Abuse and Mental Health Services Administration Reauthorization

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1 Substance Abuse and Mental Health Services Administration Reauthorization 111 th Congress

2 Introduction The American Psychological Association (APA) is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes 152,000 researchers, educators, clinicians, consultants, and students. APA believes that the reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA) provides a critical opportunity to ensure that our nation has the appropriate infrastructure to meet the mental and behavioral health needs of individuals across the lifespan. APA appreciates the opportunity to share the following policy recommendations for the SAMHSA reauthorization.

3 APA Recommendations for the SAMHSA Reauthorization Recommendation 1: Address the professional workforce development needs by: authorizing the existing Minority Fellowship Program (MFP), establishing a new competitive institutional grant program and a loan repayment program, and expanding workforce data collection, analysis, and dissemination activities. a) Authorize the Minority Fellowship Program. APA strongly supports the education and training of mental health professionals to respond effectively to the mental health needs of vulnerable populations, including children and adolescents, older adults, ethnic and racial minorities, and individuals with disabilities. Workforce training on the advanced tools and methods that have been found to be most effective and appropriate for diagnosis and treatment of mental health problems in diverse populations are urgently needed. Training should emphasize sensitivity to family needs, cultural and linguistic differences, and developmentally appropriate interventions. The SAMHSA-funded Minority Fellowship Program promotes diversity among health professionals trained to work with ethnic and racial minorities. Since its inception in 1973, the MFP has helped to support doctoral-level and post-doctoral training of almost 1,000 ethnic and racial minority psychologists, psychiatrists, psychiatric nurses, and social workers. These individuals provide direct services, supervision, services research, training, and administration in the mental health and substance use delivery system. The MFP is the only federal program providing funding for this purpose. b) Establish a competitive institutional grant program for eligible entities (including a graduate education and training program, internship, residency, or fellowship in one of the eligible health professions) for planning, developing, and operating a mental health professional training program that includes student stipends. The goal of this proposal is to prepare the mental health workforce to provide mental and behavioral health services to underserved populations (with particular attention to those with serious mental illness), including children and adolescents, older adults, ethnic minorities, persons with mental and substance abuse disorders, those with chronic illnesses (including HIV/AIDS), and persons living in underserved areas. Priority would be given to programs that emphasize evidence-based practice, cultural competence, and interdisciplinary training, as well as an integrated approach to prevention and treatment services. c) Establish a competitive loan repayment program for licensed or certified mental health professionals. Priority for this program would be given to those who are or will be working with high priority populations in the public sector and who demonstrate financial need, competence in evidence-

4 based practice, and cultural competence. Eligible individuals would either be enrolled in an eligible, accredited health professions graduate program, residency, or fellowship or be licensed in a State to practice an eligible health profession. Eligible individuals would also agree to be employed full-time for at least two years in a designated underserved community as defined by the Office of Shortage Designation. d) Expand workforce data collection, analysis, and dissemination. This initiative to expand workforce data collection and analysis would provide the following information on a bi-annual basis: 1) the number and variety of public and private nonprofit treatment programs; 2) the number and demographic characteristics of individuals receiving treatment through such programs; 3) the type of care received by such individuals; 4) the number, level, field of training, and demographic characteristics of the individuals providing the care; 5) the type of care sorted by specific categories of provider; and 6) such other data as may be appropriate. Recommendation 2: Incorporate the Positive Aging Act (H.R. 3191) into the bill to reauthorize SAMHSA to improve access to quality mental and behavioral health care for older adults by integrating mental health services into primary care and community settings where older adults reside and receive services. While most older adults enjoy good mental health, it is estimated that 20 percent of seniors have a mental disorder. These disorders can have a significant impact on the physical health, functional ability, and emotional well being of older adults. Currently, white males, age 85 and older, have the highest rates of suicide of any age group in the U.S., and depression is its foremost risk factor. Evidence suggests that at least 70 percent of older adults who die by suicide have visited a primary care professional within 30 days of their death. Although effective treatments for mental and behavioral health problems exist, up to two-thirds of older adults with a mental health problem do not receive the services they need. Therefore, new models of care are needed to provide outreach, early identification, treatment and/or referral services for mental disorders in older adults in both traditional health care and other community settings. The President s New Freedom Commission on Mental Health (2003) stressed the need for increased implementation of collaborative models of care to address the mental health needs of older adults, particularly in primary care settings. Integrated interdisciplinary health care involves a high degree of collaboration in assessment, treatment planning and implementation, and outcome evaluation across health professionals. These integrated interdisciplinary models of care are particularly helpful in identifying and addressing the mental health needs of older adults, who often have complex health care needs and may be more likely to present for care in primary care and other traditional health care settings. Recommendation 3: Incorporate the Child and Adolescent Mental Health Resiliency Act (S th Congress) and the Mental Health in Schools Act (H.R. 2531) into the bill to reauthorize SAMHSA to invest in evidence-based programs for mental health promotion, prevention, and early intervention. Despite strong scientific evidence demonstrating the effectiveness of mental health promotion, prevention, and early intervention strategies, and the long-term benefits they bring about to youth, communities, and taxpayers, increased resource allocation in this area is still urgently needed. Within the last decade,

5 reports by the Institute of Medicine (IoM), the U. S. Surgeon General, and the President s New Freedom Commission on Mental Health have highlighted the critical individual-level and public health imperatives in addressing children s mental health needs. In its 2009 report, Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, the IOM stated that between 14 and 20 percent of children and youth annually experience a mental, emotional, or behavioral (MEB) disorder, at a cost of $247 billion per year. Mental health in childhood and adolescence is critical to healthy, overall development, and MEB disorders can lead to tragic consequences, including suicide, substance abuse, inability to live independently, involvement with the correctional system, and lack of vocational success. Furthermore, in the 2001 National Action Agenda for Children s Mental Health, former U.S. Surgeon General David Satcher also warned that the nation is facing a public health crisis in this critical area, and noted that families of low socioeconomic status, that are of color, or have children with disabilities or health concerns have a particularly difficult time receiving services that would identify, prevent, or treat mental health problems. Last year, the IOM also stated that existing and emerging practices have the ability to promote mental health in children and address problems before they develop into full, diagnosable disorders. The Child and Adolescent Mental Health Resiliency Act would provide for States and local governments to further leverage evidence-based and promising practices to address the mental health needs of youth and, ultimately, save money on treatment and intervention. Furthermore, the Mental Health in Schools Act expands the existing, exemplary Safe Schools/Health Students program by increasing the capacity of schools to offer evidence-based and culturally and linguistically appropriate services to students. Schools represent the one social service system that is mandated to be in contact with all young people and, as such, stand as a critical front in meeting the mental health needs of our nation s youth. Recommendation 4: Renew the Garrett Lee Smith Memorial Act (GLSMA) in the bill to reauthorize SAMHSA and include an authorization for the Mental Health on Campus Improvement Act (S. 682/H.R. 1704). Inclusion of both of these programs will ensure access to a wider range of mental and behavioral health services in an effort to better meet the documented and growing needs of college students. The President s New Freedom Commission on Mental Health (2003) identified that Suicide is a serious public health challenge that has not received the attention and degree of national priority it deserves. In 2003, suicide was the 11 th leading cause of death in the United States. Of particular concern, suicide rates for young and older adults, African American males, and the American Indian/Alaska Native populations continue to increase. Suicide is now the third leading cause of death for 15 to 24-year-olds. For Americans under age 20, the suicide rate climbed 18 percent from 2003 to In addition, mental and behavioral health concerns, if not addressed, can significantly impact a student s ability to succeed in postsecondary study. In fact, research indicates that students with depression are twice as likely as their classmates to drop out of school The GLSMA authorized a variety of critical programs to address the issue of suicide including the Campus Suicide Prevention program which makes funds available to centers on campus that provide mental and behavioral health services for education and outreach related to suicide prevention. The GLSMA also includes a Youth Suicide Early Intervention and Prevention Strategies program and a Technical Assistance Center. The Mental Health on Campus Improvement Act establishes a program to provide direct support to students and includes services to students; outreach; hiring of appropriately trained staff; expansion of mental health training through internship, post-doctorate and residency programs; and program evaluation and dissemination. It also includes the authority for a national public education campaign and an interagency working group on college mental health. In addition, the Suicide

6 Hotline and the Suicide Resource Center at SAMHSA s Center for Mental Health Services are essential initiatives to addressing this important public health problem. Recommendation 5: Reauthorize the National Child Traumatic Stress Initiative (originally authorized within the 2000 Children s Health Act), as part of the bill to reauthorize SAMHSA. Increase support for the National Child Traumatic Stress Network (NCTSN) and prioritize the inclusion of experienced child trauma professionals in the Network, to broaden the national impact of this important program and increase attention to the needs of children and families affected by trauma, and those who are working to support their recovery in all child-serving systems. Traumatic events can have a significant impact on the physical, mental, emotional, and behavioral health of children and families. In particular, such events can lead to developmental disability, cognitive impairment, mental disorders and substance abuse, severely affecting family and social relationships and school productivity. Left untreated, child traumatic stress can have long-lasting consequences affecting adult health and mental health. The NCTSN program within the Emergency Mental Health and Traumatic Stress Services Branch at SAMHSA provides outstanding and effective child trauma services, training, and support for children, families, and providers in all child-serving systems. The NCTSN includes programs to support the recovery of children, families and communities impacted by a wide range of traumatic experiences, including physical and sexual abuse, violence in families and communities, natural disasters and terrorism, accidental or violent death of a loved one, life-threatening injury and illness, and refugee and war experience (including the impact of war on active duty, guard, and reserve military families). Recommendation 6: Ensure an integrated approach to addressing the needs of individuals living with HIV/AIDS that includes mental health and substance use services. a) Increase screening for HIV and risk behavior in mental health and substance use treatment settings. Mental disorders and substance use or dependence are common among people with HIV. However, HIV screening is uncommon in settings where mental health and substance use services are provided. In 2000, the Center for Substance Abuse Treatment recommended that substance use treatment centers screen for HIV. As such, it is critical that HIV screening also occurs in mental health settings. In addition, HIV-positive individuals who have co-occurring mental health and substance use disorders rarely receive a coordinated treatment plan for all three disorders. b) Include funding for direct mental health services in the Rapid HIV Testing Initiative. SAMHSA was awarded $4.8 million to implement a Rapid HIV Testing Initiative in 2004 to provide tool kits and training for eligible providers in rapid HIV testing, prevention counseling, and related data collection. However, the current program does not include funding for direct mental health services. Mental and behavioral health services are essential components of rapid HIV testing. Knowing one's HIV status is essential to preventing the spread of HIV, including accessing mental health counseling and receiving medical care. Mental and behavioral health services can help

7 individuals who are infected with HIV cope with testing positive for HIV and develop the skills to prevent HIV transmission to others. For those not infected with HIV, mental and behavioral health services can provide the knowledge and skills needed to reduce their risk of acquiring HIV. Recommendation 7: Incorporate the Public Mental Health Emergency Preparedness Act (S th Congress) into the bill to reauthorize SAMHSA to enhance our nation s public mental health preparedness and response efforts in the event of a public health emergency. Both human-made and natural disasters can have significant effects on the mental health and well-being of individuals, families, and communities. Among the most common mental health problems encountered by disaster survivors are posttraumatic stress disorder (PTSD), depression, anxiety, and increased alcohol, tobacco, and substance use. For many, the psychological effects of disasters may be temporary, while others may require more long-term mental health assistance. While disasters are distressing to all who are affected, evidence suggests that several subgroups within the population may be at greater risk of negative physical and mental health effects of disasters, including children, people of low socioeconomic status, individuals with physical and mental disabilities, older adults, and caregivers.

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