McCance-Katz to Reduce Recovery, Wellness, Peer Focus at SAMHSA; More Hospital Beds, AOT

NYAPRS Note: For quite some time, the E. Fuller Torrey-DJ Jaffe wing has promoted the false narrative that recovery, rehab and peer support providers and advocates have wanted to exclude those with the greatest behavioral health needs and that our motivation in supporting hospital bed downsizing is simply to capture public dollars for our own purposes. In contrast, their solutions have only offered one approach that can be characterized as more meds, more beds and more coercion.
Along the way, these groups have promoted beliefs that a recovery and rehab focus only applies to the ‘worried well’ and excludes the most distressed….that peer support is inevitably against treatment and medication and that rights advocates are only interested in helping people to avoid such treatment.

In recent years, subscribers to these beliefs have succeeded in capturing the attention and support of conservative Republicans and think tanks and the tabloids, have heavily informed the efforts of self-styled mental health ‘reformer’ Rep. Tim Murphy and are apparently poised to see the appointment of an apparently like-minded first HHS Assistant Secretary for Mental Health Services.

Advocates across our spectrum must join together to educate the Senate and the public that the truth is that millions of Americans with the most serious behavioral health conditions would indeed be homeless, incarcerated or dead by suicide or from other tragic circumstances if we weren’t there, advancing hope and support for recovery, crisis support, homeless outreach and essential health, wellness, housing and rehabilitative and social supports.

We must be very clear that the greatest contribution of our respective movements has been to raise the bar for what is possible for people with behavioral health conditions and what should be expected from our services, social conditions and public policies. Where would people and families be had we not done come forward to do so over the last few decades!

There are extremes on both sides of the continuum…bluntly put, those who believe that recovery approaches abandon the ‘sickest’ and those who argue that there is no such thing as ‘mental illness.’ Re-balancing federal policy need not have to choose between one extreme or the other.

And that’s not where the vast majority of our field and our movements have been or are today. We must join forces in the coming months and years to fight to ensure that the regressive views, mean-spirited tactics and falsehoods of the Torrey/Jaffe wing do not undo decades of progress and, in doing so, deny hope, wellness, recovery and peer support for Americans in the greatest need. They need us to stand up for them now.

Trump's Nominee for Mental Health Chief Wants to Shake Up the Agency
By Brianna Ehley Politico April 28, 2017

Elinore McCance-Katz quit her job at the federal agency in charge of mental health programs two years ago over staunch disagreements with top officials about what she considered to be a flawed mission that neglected people with serious mental illness.

Two years later, the Trump administration hopes to bring her back to the agency to shake things up.

McCance-Katz, who currently serves as the chief medical officer for the Rhode Island Department of Behavioral Health, was tapped to serve as the first assistant secretary for mental health, a position created by legislation signed into law last year by President Barack Obama. The job elevates the Substance Abuse and Mental Health Administration by giving it a seat at the table at HHS at a time when suicide rates are at a record high, opioid addiction is epidemic and there's a severe nationwide shortage of psychiatric beds.

If confirmed by the Senate, she's eyeing a dramatic overhaul at SAMHSA that could involve a staff shake-up and a reduction in recovery and wellness programs that the agency has expanded in recent years. That includes funding to increase the peer workforce, which is comprised of people with mental health issues who provide support to others who have "lived experience" with a mental disorder.

Her priority for the agency will be to shift its focus to programs for people with serious mental illness, such as bi-polar disorder or schizophrenia.

Katz, a clinical psychiatrist, came to SAMHSA in 2013 as its first ever chief medical officer, a position created in response to criticism from members of Congress that the mental health agency's leadership did not include a psychiatrist.

She resigned after two years over disagreements with top officials about the direction of the agency, claiming they were more focused on building recovery and wellness programs like the peer workforce, and neglected the treatment needs of people with serious mental illness. Shortly after she resigned, then-SAMHSA administrator Pamela Hyde also left the agency.

In an interview with POLITICO in 2015, McCance-Katz said she left SAMHSA because leadership "very obviously paid no attention to treatment. The most vulnerable population is being ignored by the very organization meant to support them," she said, adding that she "felt embarrassed that the agency couldn't talk about the neurobiological underpinnings of mental illness."

She is among a sizable cohort within the mental health community that believes SAMHSA has strayed from an evidenced-based treatment approach to one focused more heavily on alternative medicine and recovery-based programs. Critics cite the annual Alternatives Conference, which is funded in part by SAMHSA, and offers sessions like "hip-hop Zumba for health," as evidence that the agency promotes wellness and recovery as an option instead of medical treatment. Supporters of the event say talking about recovery is important.

"SAMHSA needs a complete review and overhaul of its current mission, leadership, and funded programs," McCance-Katz wrote in an op-ed in the National Review shortly after President Donald Trump was elected. "For too long the treatment needs of the seriously mentally ill have been ignored by SAMHSA, and this needs to change."

SAMHSA acting deputy administrator Kana Enomoto in December told POLITICO that the agency recognizes change is needed, and is working to focus more attention on evidence-based treatment for the seriously mentally ill — an effort advocates say has been successful.

McCance-Katz's criticism of SAMHSA is echoed by Rep. Tim Murphy, chief sponsor of the mental health legislation that was approved last year by Congress. Murphy designed the assistant secretary position for which McCance-Katz has been tapped in an effort to shift the core mission at SAMHSA away from what he saw as an anti-medical mission focused on wellness and recovery instead of medical treatment. He routinely criticized SAMHSA for having overlapping programs that wasted funding and didn't benefit people with serious mental illness.

Surprisingly, however, Murphy has come out strongly against McCance-Katz's nomination for the position and is asking Trump to withdraw her nomination. He blames her for not working to change things while she was at SAMHSA.

During an interview on CSPAN's Washington Journal on Wednesday, Murphy said of McCance-Katz, "She never stood up or spoke out to the people at her agency. I hope the president withdraws this nomination. I hope if she advances, the Senate doesn't confirm her."

Murphy, who is said to have been involved in the selection process, was pushing Michael Welner, a forensic psychiatrist, for the position.

His opposition has surprised advocates since McCance-Katz was openly supportive of Murphy's mental health bill and because her criticism of SAMHSA and vision of mental health reform are aligned with his.

If McCance-Katz is confirmed, she has hinted that she will focus on expanding assisted outpatient treatment programs — community-based court-ordered treatment — which some groups consider controversial and a violation of patients' rights.

She has also suggested that she wants to increase access to inpatient psychiatric treatment amid a severe bed shortage, and expand the behavioral health care workforce — lofty goals considering that Trump's 2018 skinny budget eliminates $100 million from the Community Mental Health Services block grant, an important source of funding for community-based mental health services nationwide.

She has also credited Obamacare and the law's Medicaid expansion, which the Trump administration has committed to rolling back, as solutions to address barriers to mental health and substance abuse treatment. McCance-Katz has repeatedly hinted at her intent to target SAMHSA grants that go toward building the "peer workforce," a program in which she sees little value.

"To focus scarce resources on programs that do not directly address treatment needs of the severely mentally ill trivializes the devastation that untreated mental disorders can produce for those affected, their families, and their communities," she wrote in the National Review.

McCance-Katz has support from mental health groups focused on treatment, including the American Psychiatric Association, the Treatment Advocacy Center and the LEAP Institutes.

"Millions with severe mental illness also have anosognosia; they do not know they're ill. This new legislation and the overhaul of SAMSHA that it requires needs someone exactly like Dr. McCance Katz at the helm," said Xavier Amador, the director of the LEAP Institute.

But groups that represent peer specialists and support other recovery and wellness programs are terrified by Trump's pick — bracing for their federal funding to hit the chopping block.

"Everyone is really disappointed and scared," said Amanda Kearney-Smith, who runs the Colorado Mental Wellness Network, a group that deploys peer specialists into the community to assist people with mental illness. "A lot of the peer community relies heavily on SAMHSA, we wouldn't be here without that funding. But people receiving the services are usually the last people to be considered or asked what we want," she said.

Kearney-Smith is a peer specialist herself living with bi-polar disorder. She said once she heard McCance-Katz was being considered to head the agency, she worried her organization would be in jeopardy of losing its SAMHSA grant.

"It doesn't have to be peer work versus treatment," Kearney-Smith said.

The Colorado Mental Wellness Network employs peer specialists who usually work alongside social workers and counselors. "We have to work together," she said.

McCance-Katz awaits Senate confirmation.