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PARTNERSHIPS IN CHALLENGING TIMES:IMPROVING THE BEHAVIORAL HEALTH OF 

THE NATION TOGETHER

Pamela S. Hyde, J.D.Administrator

Substance Abuse and Mental Health Services Administration

ADAMHS Board of Cuyahoga County and The Woodruff Foundation

Breakfast ForumCleveland, OH • June 5, 2014

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TODAY’S DISCUSSION

NATIONAL BH AND OHIO BH:   BY THE NUMBERS

ACA CHANGING THE BH LANDSCAPE

PEOPLE RECOVER 

FAITH AND COMMUNITY‐BASED PARTNERSHIPS

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BEHAVIORAL HEALTH MATTERS TO PUBLIC HEALTH

Half of us will meet criteria for MI or SUD in life

Half of us know someone in 

recovery from addiction now

In a given year:1 in 4, if substance use disorders  are included

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They change biology

They are often co‐morbid w/physical illnesses

They are preventable

They are treatable

They are NOT moral issues

BEHAVIORAL HEALTH DISORDERS ARE LIKE OTHER CHRONIC ILLNESSES 

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DIFFERENT VIEWS = DIFFERENT INDIVIDUAL & PUBLIC POLICY RESPONSES

Public sees social rather than health consequences

● Homelessness, gangs, jails, tragedies (e.g., mass casualty shootings), disability, lost productivity, high health care and government costs results in 

● Inadequate responses – mandates, exclusions, controls

Mental disorders seen as public safety issue & substance use disorders seen as moral issue (matter of will)

● Comprehensive responses – diseases or conditions to be prevented, treated, recovered from, with whole community engagement and support

● Example:  Diabetes is not just about eating choices

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PUBLIC ATTITUDES CHANGING, BUT CHALLENGES REMAIN

2/3 think treatment & support can help people w/ MI lead normal lives

2/3 believe addiction can be prevented

3/4 believe recovery from addiction is possible

30% think less of person w/ addiction

20% think less of friend/relative in recovery

38% unwilling to be friends w/ a person with MI

64% would not want person w/ schizophrenia as co‐worker

68% would not want persons w/ depression to marry into family

Less willing to pay to ameliorate condition, even when understand implications• Don’t trust that BH treatment will help them

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2012 NSDUH:  SUBSTANCE DEPENDENCE OR ABUSE, PAST YEAR, 12 AND ↑

SA/Dependence – 22.2 M (8.5 percent)• Same as 23 M with diabetes

Prescription Drugs (Non‐Medical Use) ↓ but . . .• Continuing ↑ in # of people w/ dependence/abuse of pain meds• ↑ in adverse events/deaths – ER visits, now surpassing illicit drugs

Heroin ↑• # of past year users almost doubled 2007 – 2012 (373K to 669K)• # of persons w/ dependence/abuse >2x since 2002 (214K to 467K) 

Cocaine/Methamphetamine ↓

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2012:  MARIJUANA AND ALCOHOL USE

Alcohol – most commonly used substance

• 136 M individuals reported past month use

• 60 M reported binge drinking

• 17 M reported heavy use

Marijuana – most commonly used “illicit” drug

• 18.9 million past month users• 2007 – 2012, current use ↑ from 5.8 to 7.3 percent

• 2007 – 2012, daily/almost daily use ↑ from 5.1 to 7.6 M

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4,304

2,056

1,119

629

535

467

331

164

135

0 1,000 2,000 3,000 4,000 5,000

Marijuana

Pain Relievers

Cocaine

Tranquilizers

Stimulants

Heroin

Hallucinogens

Inhalants

Sedatives

Numbers in Thousands

SPECIFIC IILICIT DRUG DEPENDENCE OR ABUSE PAST YEAR, 12 OR ↑

2012

SAMHSA NSDUH 2012

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166+

119+166+

136+

339

161+

213 193+239

281335

404+

314+

398+

379+

560

373+

455+

582621 620

669

0

100

200

300

400

500

600

700

800

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Past Year

Past Month

Numbers in Thousands

HEROIN USE:  PAST MONTH AND PAST YEAR  12 OR 

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BH BAROMETER:  OHIO 12 AND 

Alcohol Dependence/Abuse:  Rate was similar to national rate; ~ 702,000 (7.3%)

Tx for Alcohol Dependence/Abuse:  Rate was similar to national rate; ~ 59,000 (8.5%)

Illicit Drug Dependence/Abuse:  Rate was similar to national rate; ~ 285,000 (3.0%)

Tx for Illicit Drug Dependence/Abuse:  Rate was similar to national rate; ~41,000 (14.3%)

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OPIOID OVERDOSES AND DEATHS

NATIONALLY

• 2010:  38,329 deaths from drug overdose; up from 37,004 deaths in 2009 

• 2010:  3,094 a ributable to heroin; 55 percent ↑ since 2000

OHIO

• 2012:  1,914 deaths from unintentional drug overdoses (record high; 366 percent ↑ since 2000)

• 2012:  680  heroin overdose deaths  (60 percent ↑ from 426 in 2011 and 2x the 338 deaths in 2010 – just under 11 percent of nation’s total)

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Heroin was responsible for 35.5 percent of total overdoses in 2012, less than 1 percent behind all prescription opiates at 36.4 percent.

“The Cuyahoga County Medical Examiner released more recent statistics earlier in the year, announcing 195 heroin-related fatalities in 2013, up from 161 the year before. In 2007, 40 people in the Cleveland-area died of heroin-related overdoses.”

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OPIOID OVERDOSE PREVENTION –EFFORTS AND ACTIONS

Policy Academy:  August 11‐13 in Bethesda, MD

Use of Block Grant funds for Naloxone prevention/education or kits (letter to SSAs April 2014)

Opioid Overdose Toolkit (almost 44,000 downloads since Aug 2013)

MAT Buprenorphine (options memo in process w/ CDC)

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DEVELOPING INFRASTRUCTURE:  EXPANDING PILOT PROGRAMS LIKE OHIO’S PROJECT DAWN 

Currently serves Cuyahoga, Montgomery, and Scioto counties; and Cleveland

ODH has plans to expand to three additional Project DAWN sites

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94.6%

3.7% 1.7%Didn't feel theyneeded Tx

Felt they needed Txbut made no effort

Felt they needed Txand made effort

> 20 MILLION AMERICANS W/ SUDs WENT UNTREATED IN 2012

Individuals >12 years old

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WHERE PAST YEAR SUBSTANCE USE TREATMENT WAS RECEIVED (12 AND )

Numbers in Thousands

2,119

1,505

1,010

1,000

861

735

597

388

0 500 1,000 1,500 2,000 2,500

Self-Help Group

Outpatient Rehabilitation

Inpatient Rehabilitation

Outpatient Mental Health Center

Hospital Inpatient

Private Doctor’s Office

Emergency Room

Prison or Jail

2012

SAMHSA NSDUH 2012

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2012 NSDUH:  MENTAL HEALTH PAST YEAR, 18 AND ↑

Any Mental Illness:  ~ 43.7 M (18.6 percent)

Serious Mental Illness:  ~ 9.6 M (4.1 percent)

Major Depressive Episode:  ~ 16.0 M (6.9 percent)

Suicide (Adults): 38,000 + deaths in 2010• Almost 1/3 have BAC level above legal limit; growing understanding of connection to other drugs

• 9.0 M (3.9 percent) had serious thoughts; 11 M if add youth• 2.7 M (1.1 percent) made a plan• 1.3 M (0.6 percent) attempted

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BH BAROMETER: OHIO ADULTS 18 

SMI:  Higher than national rate; 339,000 (4.6%) 

Tx for SMI:  Higher than national rate; 756,000 (44.9%) 

Suicidal Thoughts:  Similar to national rate; 366,000 (4.2%)

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HEALTH REFORM:  A CHANGING HEALTH CARE ENVIRONMENT 

Prevention and wellness rather than illness – a public health approach

Recovery rather than chronicity or disability

Integration rather than silo’d care – Parity

Access to coverage and care rather than significant parts of America uninsured – Parity 

Quality rather than quantity – control of cost increases through better care rather than more care

Role of states increasing, especially in health “care”

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ACA – COVERAGE ACCOMPLISHMENTS(w/ PARITY OF MH/SA SERVICES)

> 8 M Americans selected plans from state/federal Marketplaces

~ 7 M enrolled in Medicaid or Children’s Health Insurance Program

7.8 M young adults (to age 26) able to stay on a parent’s health plan

7.3 MMedicare beneficiaries rec’d > $8.9 B drug rebates & discounts

62 M Americans gained access to new/expanded MH & SA w/ parity 

71 M privately insured gained improved preventive services coverage

105 M Americans had lifetime limits removed from insurance

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PREVALENCE OF BH CONDITIONS – UNINSURED ADULTS AGES 18‐34 WITH INCOMES < 400% FPL

Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013,http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-Conditions-Among-the-Uninsured/PEP13-BHPREV-ACA

44.0%SMI/ SPD/ SUD

56.0%

“Behavioral Health Conditions” includes serious mental illness (SMI), serious psychological distress (SPD) and 

substance abuse disorders (SUD)

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PREVALENCE OF BH CONDITIONS – UNINSURED ADULTS AGES 35+ WITH INCOMES < 400% FPL

Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013,http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-Conditions-Among-the-Uninsured/PEP13-BHPREV-ACA

23.8% SMI/SPD/ SUD

76.2%

“Behavioral Health Conditions” includes serious mental illness (SMI), serious psychological distress (SPD) and substance abuse

disorders (SUD)

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HEALTH INSURANCE MARKETPLACE:  OHIO BY THE NUMBERS

As of July 2013, 1,354,869 (14 percent) uninsured and eligible

• 1,268,826 (94 percent) estimated to qualify for either tax credits to purchase coverage in Marketplace or Medicaid expansion

As of March 31, 2014, 154,668made Marketplace plan selections

As of March 31, 2014, 208,280 new enrollees in Medicaid/CHIP

Ohio received > $1 million in grants for research, planning, IT development, implementation of Ohio Health Insurance Marketplace

97,000 otherwise uninsured young adults have gained coverage

5,053,131 non‐elderly persons w/ pre‐existing conditions; of these:

• 643,049 children no longer denied coverage

• Adults w/ pre‐existing conditions no longer denied after 1/1/14

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OHIO:  PREVALENCE OF BH CONDITIONS AMONG Marketplace POPULATION

CI = Confidence Interval

Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey

Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013, Ohio Profile,http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-C onditions-Among-the-Uninsured/PEP13-BHPREV-ACA

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OHIO:  PREVALENCE OF BH CONDITIONS AMONG Medicaid Expansion POPULATION

CI = Confidence Interval

Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey

Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013, Ohio Profile,http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-C onditions-Among-the-Uninsured/PEP13-BHPREV-ACA

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DEFINING RECOVERY

Working common definition of recovery from mental and/or substance use disorders

A process of change through which individuals improve their health and wellness, live a self‐directed life, and strive to reach their full potential

Incorporating into grants

Exploring differences between recovery from MH conditions and addictions

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Treating a Chronic Disorder Must Treat the Whole Person in Their Social Context 

RECOVERY ORIENTED SYSTEMS OF CARE (ROSC) 

Pharmacological Treatments 

(Medications)

Behavioral Therapies

Social Services

Medical Services

Adapted from NIDA Drug Abuse and Addiction

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ReducedCriminalInvolvement

Stability inHousing

Cost Effectiveness

PerceptionOf Care

Retention Abstinence

Employment/Education

Evidence-Based Practice

Social ConnectednessAccess/Capacity

Ongoing Systems Improvement

Recovery

Health

Wellness

Outcomes

Mental Health

Primary Care

Child Welfare

Housing

Human Services

Educational

Criminal Justice

Employment

Private HealthCare

Systems of Care

Organized RecoveryCommunity

DoD &Veterans Affairs

Indian Health Service

Addictions

Tribes/Tribal Organizations

Bureau of Indian Affairs

Child Care

Housing/Transportation

Financial

LegalCase Mgt

Peer Support

Health Care

Mental Health

Alcohol/Drug

VocationalEducation

SpiritualCivic Organizations

Mutual Aid

Services & Supports

Community Individual

Family

ROSC

Community Coalitions

Business Community

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RECOVERY AND THE FAITH COMMUNITY

Place of worship as a “therapeutic system” 

• Allows expression of suffering

• Provides emotional support and acceptance

• Cultivates sense of belonging

• Educates re public health problems and interventions

• Instills/fosters HOPE – an element of recovery

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ROLES OF FAITH COMMUNITIES“EXTRAVAGANT WELCOME”

Education/Awareness – members, public, policy‐makers• Positive messaging in programs and services• Education activities & materials, e.g., prescription drug take‐back days, suicide signs and symptoms

Enrollment and outreach• In insurance coverage; Medicaid; Medicare

Prevention – especially children & youth programsCounseling (lay or clerical) and referrals

• To professional BH treatment when needed• Screenings, e.g., depression• Pay attention to secondary trauma of faith leaders

Source of community and support for recovery• Peers and friends

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ACA:  THE FAITH COMMUNITY

SAMHSA provided technical resources to support the faith community in ACA education and enrollment activities 

52 enrollment events were hosted by faith leaders and congregations; thousands participated

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SUICIDE PREVENTION:  AN EXAMPLE OF FAITH‐BASED PARTNERSHIP

National Action Alliance for Suicide Prevention

Public‐private partnership (est. 2010) to advance NSSP

Faith Communities Task Force

Developing new “Your Life Matters” initiative/campaign

Developing toolkit of resources for congregations to use in suicide prevention efforts (Fall 2014)

• Prayers, liturgies, sermons, reflections, hymns, other sacred songs of hope 

Encouraging faith communities to set aside one Sabbath/yrto focus on hopefulness, reasons for living, educating on warning signs for suicide & how to seek help

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MENTAL HEALTH FIRST AID:  ENGAGING THE FAITH COMMUNITY

Most of us do not know/teach signs, symptoms, how to get help for MH or SA issues

Many of us have opportunities to learn basic first aid for health; some employers require it 

YET…

July 28 ‐ August 1:  SAMHSA providing clergy/faith leaders MH First Aid Instructors training to equip congregations with needed skills

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America is a nation that understands and acts on the knowledge that

Behavioral health is essential to health

Prevention works

Treatment is effective

People recover

SAMHSA’S HERE TO HELP . . .

www.samhsa.gov