This week, SAMHSA released its strategic plan for the next four years, Leading Change 2.0: Advancing the Behavioral Health of the Nation 2015 – 2018 (Leading Change 2.0). This document – along with many other SAMHSA documents and communications – provides a glimpse into the incredible work and reach of this federal agency. Leading Change 2.0 lays out six Strategic Initiatives (SIs) that will guide SAMHSA’s work over the next four years. These SIs encompass all types of approaches and services, all populations, and all parts of the substance abuse and mental health fields.
SAMHSA’s first SI focuses on prevention—largely for youth and young adults. We focus on that population in particular because three-quarters of addictions and mental illnesses start before the age of 24 (IOM, 2009). Yet, SAMHSA’s efforts to prevent suicide and prescription drug and opioid misuse and addiction will also address middle age adults, seniors and populations with special needs, such as American Indians/Alaska Natives. Emerging issues such as first episode psychosis and marijuana misuse and addiction are also included in this SI. Attention to the wellness of all Americans – those with, those without, and those in recovery from mental illness or addiction – is also included here and in other SIs.
SAMHSA’s second SI focuses on health care and health system integration. This SI addresses the treatment needs of persons with mental illness, serious mental illness, substance misuse, and substance use disorders, as well as HIV and AIDS. It also addresses the needs of youth, adults and seniors. Treatment for mental illness, serious mental illness, substance misuse, and substance use disorders in these populations are largely funded by Medicaid, Medicare, private insurance and state and local funds. SAMHSA Block Grant funds complement these insurance-based funding sources for those individuals and those services not covered by insurance, addressing those of all ages with serious mental illness and those needing treatment and services for addictions.
The block grant for substance abuse reflects SAMHSA’s significant commitment to universal prevention efforts in all the states and territories. SAMHSA’s discretionary and other formula (non-block grant) funding often serves to provide the infrastructure for systems development needed or tests new approaches not yet incorporated into insurance coverage. However, SAMHSA’s work on treatment issues goes far beyond its grant funding and includes helping stakeholders enroll in new coverage options, provide evidence-based services for those funded by other federal programs, and restructure systems and regulations in light of health reform changes throughout the U.S. The health care and health system integration SI also demonstrates SAMHSA’s commitment to working with its partners – federal agencies and stakeholder groups – to clarify the role of behavioral health in other prevention, treatment and social support service systems. SAMHSA cannot do it all, but we can and do lend a strong voice to the critical importance of addressing behavioral health issues in all these domains.
SAMHSA’s third SI, trauma and justice, continues to work to acknowledge, understand, communicate and develop appropriate programs to address trauma among children and adults–trauma that has a tremendous impact on health and behavioral health issues. SAMHSA’s work in this SI recognizes the high rate of mental illness and substance abuse among those in or at risk of interacting with the juvenile and criminal justice systems, as well as other social systems such as child welfare. This SI also incorporates SAMHSA’s disaster preparedness, response and recovery work. This SI, like all the others, recognizes the role of partnerships with federal agencies (in this case, the Administration for Children and Families, the Centers for Medicare and Medicaid Services, the Department of Justice, the Department of Veterans Affairs, the Department of Defense, the Federal Emergency Management Agency) as well as with service providers, law enforcement, and academic colleagues throughout the country.
SAMHSA’s fourth SI, recovery support, will continue its work to help those with mental illnesses and addictions address their needs for treatment and health care, housing and housing support, work, education and other approaches to finding and fulfilling their purpose in life, and their critical need for inclusion and support from a community of family and friends. These efforts build on and go beyond the behavioral health treatment system and focus as well on the social services systems so critical to many with serious or long term mental illness and/or addiction. These efforts also support wellness and the voices of those in recovery from addiction or mental illness and their families.
SAMHSA’s fifth SI, health information technology, will work to ensure that critical treatment providers in behavioral health can do their work in an increasingly tech-savvy world. This SI commits to further work on protecting the privacy of treatment records while also helping to assure providers can deliver the best care possible by sharing critical information in treatment and emergency room settings in order to help individuals’ symptoms be stabilized and they and their families reconnected to on-going care. This work occurs in partnership with other federal agencies as well as with providers, technology vendors, individuals with histories of mental illness or addiction, and their families.
SAMHSA’s sixth SI, workforce development, is new but SAMHSA’s commitment to workforce issues is not. Our ongoing work with psychiatry, psychology, social work, and addiction and mental health counseling professions to address minority workforce issues will grow. Because SAMHSA is not the lead federal agency on workforce, we will collaborate with the Health Resources and Services Administration (HRSA) as HRSA increases its capacity-building for behavioral health professions and paraprofessionals. Likewise, SAMHSA is committed to working with HRSA and other professional associations to address training, data, and financing issues for behavioral health professions and for those within the health professions fields who address behavioral health issues in their practices. SAMHSA is also committed to filling the gap not addressed by others to address peer workforce issues.
The combination of these six SIs and SAMHSA’s other leadership efforts means the next four years will be even busier than the last. SAMHSA is a small agency with a big mission–to reduce the impact of substance abuse and mental illness on America’s communities. We cannot do it alone, but rather must work with and through partners at the federal, state and community levels, and with provider, academic, professional, consumer, recovery, and family organizations nationwide.
We are incredibly grateful to everyone who participated in the development of Leading Change 2.0 by providing comments and suggestions. We look forward to working with you to advance the behavioral health of the nation.