Living in the Light

1. Living in the Light A. Kathryn Power, M.Ed. Region I Regional AdministratorOctober 20, 2012 Marlborough, MA

2. Mission: to reduce the impact of substance abuse and mental illness on America’s communities Roles: Voice and leadership Funding - service capacity development Information and communications Regulation and standard setting Practice improvement SAMHSA’S Mission and Roles

3. SAMHSA Principles www.samhsa.gov

4. SAMHSA’S Strategic Initiatives

5. Strategic Initiative • 1. Prevention • 1.Prevention • Prevent substance abuse (including tobacco) and mental illness and build emotional health • Suicide prevention • Underage drinking/alcohol polices • Prescription drug abuse

6. Suicide Prevention Initiative On September 10, 2012, the National Action Alliance for Suicide Prevention—in collaboration with the U.S. Department of Health and Human Services and SAMHSA—released the revised National Strategy for Suicide Prevention that features 13 goals and 60 objectives, and emphasizes the role every American can play in protecting friends, family members, and colleagues from suicide.  It also provides guidance for schools, businesses, health systems, clinicians and many other sectors considering nearly a decade of research and advancements since the last strategy was published.

7. Notable Initiatives in Prevention Synar In August 2012, a new report on the Synar Amendment program – a federal and state partnership aimed at ending illegal tobacco sales to minors—showed that all the states and the District of Columbia have continued to meet their goals of curtailing sales of tobacco to underage youth (those under 18). The report by SAMHSA shows that the average national retailer violation rate of tobacco sales is down to 8.5 percent, the lowest level in the history of the program.

8. Trauma-informed care and screening; trauma specific services Collaborate to address childhood trauma within juvenile justice and child welfare Adult trauma screening and brief interventions Court collaboratives to address persons with MI and/or addictions Decrease impact of disasters on BH of individuals, families, and communities Strategic Initiative • 2. Trauma and Justice

9. SAMHSA Initiative Addressing Trauma and Justice SAMHSA's National Center for Trauma-Informed Care (NCTIC) is a technical assistance center dedicated to building awareness of trauma-informed care and promoting the implementation of trauma-informed practices in programs and services Traumatic experiences can be dehumanizing, shocking or terrifying, singular or multiple compounding events over time, and often include betrayal of a trusted person or institution and a loss of safety

10. Policy Academies, December 2011September 2012 Purpose is to facilitate the creation of interagency strategic plans that ensure needed behavioral health services are accessible to the nation’s service men and women and their families. Policy academies also comprise site visits and are followed by technical assistance site visits to help states activate their plans Support programs and practices to enhance resilience and emotional health and prevent suicide Strategic Initiative • 3. Military Families

11. 2001 through 2011: 2,519 members of the Armed Forces took their own lives; an average of 1 death every 38 hours Suicide among veterans accounts for as many as 1 in 5 suicides in the U.S. U.S. Army suffered a record 32 suicides in July 2012, the most since it began releasing monthly figures in 2009 Tough Realities about Suicide 11

12. Strategic Initiative • 4. Recovery Support

13. RecoveryWorking Definition In a context in which behavioral health is essential to health, recovery is: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to achieve their full potential.

14. Recovery 2.0 How Recovery is Defined: There are many dictionary definitions of recovery, but most encompass five major elements: • regaining of something lost or taken away • restoration or return to health from sickness • restoration or return to a former and better state or condition • restoration of function in usable form • regaining of one's strength, composure, balance, etc. The earliest root of the word is from the Latin word recuperāre- to regain. Common English synonyms in the context of healthcare are “heal”, “cure”, “overcome” and “rehabilitate”. Recovery is a noun that articulates the outcome of a process rather than the process itself.

15. Recovery Principles Person-Driven Many Pathways Holistic Peer Support Relational Culture Addresses Trauma Strengths/Responsibility Respect Hope

16. Strategic Initiative #4:Recovery Support Purpose of Initiative #4 - Partnering with people in recovery from mental and substance use disorders and family members to guide the behavioral health system and promote individual, program, and system approaches that foster health and resilience; increase permanent housing, employment, education, and other necessary supports; and reduce discriminatory barriers.

17. Recovery as Treatment Recovery as a treatment outcome can be defined as the state in which: • the symptoms of the illness are no longer manifested • the symptoms of the illness no longer negatively impact the ability of the individual to successfully live, work and integrate with society • the individual is able to adapt in a manner so that his/her symptoms no longer create impairment; and/or, • the individual has successfully learned to have a healthy and successful life despite his/her impairments and symptoms

18. SI Priorities for 2012

19. Initiatives to Prevent Homelessnessthrough CSAT and CMHS The Projects for Assistance in Transition from Homelessness (PATH) program is a formula grant program begun in 1991 provides funds to all states and territories Services in Supportive Housing, begun in 2007, serves individuals and families with BH conditions who experience chronic homelessness. The program provides behavioral health care and supportive services to individuals and families for whom housing alone is not enough

20. Supportive housing WORKS! Supportive housing decreases symptoms Increases housing stability Reduces criminal justice involvement Improves school performance AND is cost-effective. Everyone wins!

21. Strategic Initiative • 5. Health Reform • Essential Benefits, Enrollment • National Center for Innovation and Financing • Uniform Block Grant Application – TA to states • Service definitions w/ Medicaid (health homes, rules/regs, good & modern services, screening, prevention) and Medicare (dually eligible populations, annual wellness visit) • Primary/Behavioral Health integration

22. SAMHSA Health Care Reform Ideology Development of the peer workforce and peer specialists Recovery coaches as integral to the field, especially as health care reform develops standardizing, credentialing and training of the peer workforce in every state “Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS

23. Health Reform Impact of the Affordable Care Act More people will have insurance coverage Medicaid (and states) will play a bigger role in M/SUDs Focus on primary care & coordination w/ specialty care Emphasis on home & community-based services; less reliance on institutional & residential care (health homes) Priority on prevention of diseases & promoting wellness Focus on quality rather than quantity of care (HIT, accountable care organizations) Behavioral health is included – parity

24. e-Health Records Movement toward getting electronic health records (EHR) for behavioral health. EHRs are an evolving concept defined as a systematic collection of electronic health information about individual patients or populations.This digital record can be shared across different health care settings. In some cases this sharing can occur by way of network-connected enterprise-wide information systems and information networks or exchanges • 6. Health Information Technology

25. Strategic Initiative • 7. Data, Outcomes & Quality • National Behavioral Health Quality Framework • Part of National Quality Strategy to Improve Health Care • NSDUH—incidence and prevalence of substance abuse and associated problems • Use of SAMHSA Tools to Improve Practices • Models (e.g., SPF, coalitions, SBIRT, SOCs, suicide prevention) • Emerging science (e.g., oral fluids testing) • Technical assistance capacity (e.g., trauma) • Partnerships (e.g., HIT meaningful use; Medicaid/Medicare)

26. Communications Change the conversation:Behavioral Health seen as social problem rather than public health issue; responses are often inappropriate Communities/governments respond to social problems rather than to health needs of people and community BH field embraces multiple philosophies resulting in multiple and inconsistent messages Disease; disability; chronic medical condition; social reaction to difference; brain/genetic; environment/psychosocial • 8. Public Awareness & Support

27. Public Events Lead to Inaccurate Perceptions • Individual blame based on misunderstanding • Moral judgment, discrimination, prejudice, social exclusion OR • Attention to symptoms • Homelessness; drug-related gangs; child welfare issues due to addiction and mental illness; amount of jail time by persons with M/SUDs; institutional, provider, or system failures LEADING TO • Insufficient responses • Increased security & police protection; tighter background checks; controlled access to weapons; legal control of perpetrators & their treatment; more jail cells, homeless shelters, institutional/system/provider oversight)

29. Congratulations! NAMI 30 years of progress: Shining a light on mental health and recovery

30. Thank you! Questions? A. KATHRYN POWER  M.Ed. Regional Administrator-Region 1 Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services JFK Federal Building 15 New Sudbury Street, Room 1826 Boston, MA 02203 kathryn.power@samhsa.hhs.gov 617-565-1482 617-565-3044 (fax)