NYAPRS Note: When she served as Chief Medical Officer for SAMHSA, Dr. Elinore McCance-Katz wrote the following piece that emphasized that while that agency was tasked with supporting the mental health needs of all Americans, its primary focus was in addressing the needs of those with the most serious conditions. She also demonstrated a full commitment to promoting recovery and person-centered care, First Episode and Mental Health First Aid and approaches that address the social determinants of health.
I share this with the hope that HHS Secretary Price and potential Assistant Secretary for Mental Health McCance Katz’s efforts will only build on SAMHSA’s historic commitment to advancing progressive person-centered approaches that center on promoting person-centered recovery services and supports for those with the greatest needs.
What is SAMHSA’s Role in Today’s Healthcare System?
By Elinore F. McCance-Katz, M.D., Ph.D., FAAAP, Chief Medical Officer, Substance Abuse and Mental Health Services Administration May 29, 2014
The mission of the Substance Abuse and Mental Health Services Administration (SAMHSA) is to reduce the impact of substance abuse and mental illness on America’s communities. The Affordable Care Act and new parity protections are expanding mental and substance use disorder benefits to over 60 million Americans. This historic expansion of insurance coverage presents a unique moment in history to address the long standing barriers to treatment for people with mental illness.
The history of the treatment of mental disorders in the United States is marked by inhumane and questionable interventions that did not recognize individual rights or even the humanity of those affected. We must remain cognizant of this history while offering the best, research-based interventions available today.
As a result of investments by the National Institutes of Health (NIH) and SAMHSA in research, testing, and evaluation of prevention, treatment, and recovery support services, there have been many advances in the field over the past 50 years. Medications development research has produced pharmacotherapies that can ease the distress of auditory and visual hallucinations, improve the disordered and disorganized thinking of some mental conditions, and assist in the resolution of depression and anxiety.
A wide array of therapies has been shown to improve the ability to cope with symptoms of mental disorders. Investments in infrastructure to assist families and treatment providers working with young people with serious emotional disturbances have produced models to improve outcomes for individuals, families, and systems. New interventions to assist with aspects of everyday life so important to a sense of purpose and meaning – stable housing, the ability to obtain an education, getting and keeping a job – are now part of the services available to assist those living with serious mental disorders, including depression, schizophrenia, bipolar disorder and schizoaffective disorder.
SAMHSA embraces these advances and, using its Congressionally appropriated funding, works to help implement these approaches across the country. In fact, the biggest percentage of SAMHSA’s Congressionally appropriated mental health funding is directed toward services and supports for those with the most serious illnesses.
Clinical Support System
SAMHSA works closely with the NIH’s National Institute of Mental Health (NIMH) to help disseminate new and promising practices and advances in the treatment of serious mental disorders. SAMHSA supports national training efforts that provide clinicians and the public with information on these developments and will soon be launching a new clinical support system that will provide training opportunities for clinicians on evidence-based treatments specifically aimed at serious mental illness including the treatment of psychotic, depressive/manic-depressive, and anxiety disorders. SAMHSA also works with researchers, academics, and its grantees to test new models and emerging promising practices to advance the field and the behavioral health of the nation.
SAMHSA emphasizes that recovery is the goal, and that people can and do recover.
Recovery encompasses a wide spectrum of improvements in conditions and resolution of symptoms for most of those affected by mental and substance use disorders. It can include medications and other supportive services necessary for those acutely ill. The recovery approach seeks to empower individuals to be involved in their own care – a patient-centered, shared decision-making approach that has become central to all medical care in the United States.
In a small number of cases, treatment may be required to protect a patient or the public, even when the severity of a mental disorder prevents a patient from understanding the need for treatment. In general, however, those affected by mental illness or addiction have the same ability to be involved in and make decisions about their own care as Americans with other medical illnesses.
Accumulating evidence shows that risk for mental disorders can be identified and addressed prior to onset of serious illnesses such as psychotic disorders. The 2009 Institute of Medicine Report, Preventing Mental, Emotional, and Behavioral Disorders Among Young People, is just one of many scientific reports that documents the opportunities. Further, new NIMH funded research shows that assertive interventions including medication, psychotherapy, and assistance with educational and vocational goals in those experiencing first episodes of psychosis can significantly attenuate the severity of these disorders. SAMHSA supports such programs and is assisting states with implementation of programs to address prevention and early intervention for mental and substance use disorders, including psychosis and other serious mental illnesses.
Further, SAMHSA is working to assist communities in the recognition of symptoms of mental distress. Through programs such as Mental Health First Aid, both school and wider community-based programs will benefit from earlier interventions that will help to identify and engage individuals – youth, adults, their families, educators, and first responders – in recognition, treatment, and recovery support services that may help to avoid some of the tragedies that have occurred in recent years.
SAMHSA takes the view that a whole-person approach to mental health is necessary to achieve the best outcomes. It supports evidence-based practices that will assist those with serious and disabling symptoms, but it also supports programs aimed at maintaining and improving overall mental health of all Americans, including but not limited to those with the most serious mental illnesses. In doing so, SAMHSA helps to diminish the risk for tragedies related to unrecognized or inadequately treated mental illness. Equally important in the equation for successful treatment of mental disorders is respect for individuals and their right to be their own decision makers to the greatest extent possible. This approach is more likely to engage and retain in treatment and recovery those with serious mental illness and this approach will improve outcomes for people with mental disorders, their families, and their communities.
This is SAMHSA’s mission and its work is done efficiently, and effectively within the resources and authorities made available to it by Congress.