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Behavioral Health: Challenges and Opportunities in Indian Country
Pamela S. Hyde, J.D.SAMHSA Administrator
National Indian Health Board (NIHB)40th Anniversary Celebration
29th Annual Consumer Conference Denver, CO • September 25, 2012
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SAMHSA’S ROLES
Leadership and Voice
Funding - Service Capacity Development
Information/Communications
Regulation and Standard setting
Practice Improvement
Data and surveillance
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CHALLENGES IN AI/AN COMMUNITIES
Higher rates of substance dependence and abuseHigher past month binge alcohol useHigher past month illicit drug useHigher current tobacco useHigher youth suicide ratesHigher adolescent death ratesHigher sexual assault rates against femalesHigher homicide rates against women Higher rates of intimate partner violence against womenHigher rates of incarceration and arrestHigher rates of historical trauma
Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2011
Fig7.1
Numbers in Millions
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Both Alcoholand Illicit Drugs
Alcohol Only
Illicit Drugs Only
+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.
Note: Due to rounding, the stacked bar totals may not add to the overall total.
22.0+ 21.622.5+ 22.7+ 22.4+ 22.4+22.2+ 22.6+ 22.2+
20.6
Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use:
2011
19.3 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use
Felt They Needed Treatment and Did
Make an Effort
Did Not Feel They Needed Treatment Felt They Needed
Treatment and Did Not Make an Effort
1.5%
Fig7.10
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3.3%
95.3%
Note: The percentages do not add to 100 percent due to rounding.
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NEED FOR AND RECEIPT OF TREATMENT FOR AN ILLICIT DRUG OR ALCOHOL PROBLEM
PAST YEAR, AGED 12 ↑: DEMOGRAPHIC CHARACTERISTICS
SAMHSA, CBHSQ, 2011 NSDUH
2011: Percent Needed Treatment 2011: Percent Needed but Did Not Receive Treatment
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SUICIDE AND SUICIDE PREVENTION
National Action Alliance for Suicide Prevention – part of National Prevention Strategy
• June 26th: Summit , updates from all 14 Task Forces
• June 27th AI/AN research subcommittee Mtg at IHS Conf
NSSP released by SG on Sept 10, 2012
HHS Secretary Sebelius announced $55.6 million in new grants; under the GLS Memorial Act; partially funded by ACA
Last year’s GLS grants included a new cohort of 38 grants; 22 were Tribal grantees
Over 11 million Americans seriously consider suicide each year and over 38,000 died (2010) from this public health issue
America loses approximately 100 people every 24 hours
Suicide: 2nd leading cause of death for AI/AN youth in the 15-24 age group, 2.5x national rate for this age group
Higher risk: young and middle-aged AI/AN
• Ages 15 – 24: Rates of 31.59 per 100,000
• Ages 40 – 59: Rates of 19.43 per 100,000
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STAC and SAMHSA TTAC (webcast on August 24th)Tribal Law & Order Act (TLOA): HHS (IHS, SAMHSA), DOI (BIA,BIE),
DOJ• IASA Intradepartmental Coordinating Committee – Meets monthly• Rodney Robinson, Northern Cheyenne, new Director of OIASA
– SA prevention, intervention, and treatment – most recently TAPs w/set of tribes in Montana
• OIASA website with newsletter at http://www.samhsa.gov/tloa• TLOA webinars: MOA & TAPs (9/12) and Tribal Justice Plan (9/19)
Behavioral Health –Tribal Prevention Grant (BH-TPG)• First proposed in President’s FY 12 Budget• No appropriation in FY 12 ; is in FY 13 Budget request
SAMHSA TRIBAL EFFORTS AND INTIATIVES – FULFILLING FEDERAL TRUST RESPONSIBILITIES
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SAMHSA BEHAVIORAL HEALTH – TRIBAL PREVENTION GRANT (BH-TPG)
FOCUS ON PREVENTION OF SUBSTANCE ABUSE AND SUICIDE
SAMHSA coordinates w/IHS to implement community-based prevention strategies that complement clinical services provided by IHS-funded providers
Non-competitive application process for all federally recognized tribes who want the funds
“Application” every 3 years with annual reporting
Formula to be determined based on 2011 consultations w/ tribal leaders – base amount + additional $ based on formula
Flexibility for tribes to use their approaches
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CHANGES TO BLOCK GRANT APPLICATION PROCESS
Changes to SA and MH Block Grant app’s driven by TLOA, ACA, and MHPAEA
Trying to ensure SMHAs/SSAs are well positioned during FY 2014 and FY 2015
Both MHBG and SABG applications due on same date – April 1, 2013
30 day FRN soon – out to states Nov/Dec 2012
Option to do joint or two separate applications
Reports and reporting periods now same for both MHBG and SABG
• Annual report due dates and annual expenditure reporting periods consistent across both
Plan will cover a two year period (7/1/13-6/30/15) – W/option to amend
Strongly encouraged to show evidence of tribal consultation or must show evidence of tribal input
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BG APP IN 3 MAJOR SECTIONS: INTRODUCTION, IMPLICATION, AND PLANNING
• Trauma• Justice• Parity Education• Primary and BH Care Integration
Activities• Health Disparities• Recovery• Prevention• Children and Adolescents BH
Services
• Health Reform• Coverage of M/SUD services• Affordable Insurance
Exchanges• Use of Evidence in Purchasing
Decisions• Program Integrity• Tribes• Quality
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OTHER EXAMPLES - SAMHSA TRIBAL EFFORTS, INITIATIVES, AND ACTIVITIES
Improving access to grants• ICNAA Matrix of funding opportunities; Tribal eligible programs• August 2012: Tribal grant-writing webinar • SAMHSA roundtable on improving access planned for this fall• E.g., Project LAUNCH – Linking Actions for Unmet Needs in Children’s
Health – CA w/awards up to $850,000 for up to 5 years– RFA included 5 point preference for Tribal applicants – Text was re-written to align w/Tribal Governance infrastructures– Prior only 1 Tribal grantee; 46 percent of this year’s applicants were
from tribes; in FY 12, 6 of 11 new awards will go to tribes
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SAMHSA AI/AN Team (SAIANT) – meets monthly; cross coordination on AI/AN efforts• Annual Project Officer training; rescheduled to October 24th – 26th • Planning fall Tribal Policy Academy on strategic planning use of Tribal facilities• On-gong: Audits/complaints
SAMHSA’s Office of Behavioral Health Equity (OBHE)• Coordinates agency efforts to ↓ BH disparities for diverse populations • NNED - National Network to Eliminate Disparities in BH
July 2012: ICRC training webinar to support Prevention Specialist Certification for Ho-Chunk and Navajo Nation; also statewide Tribal representatives meeting w/Wisconsin BH
September 2012: SAMHSA’s Native American Center for Excellence webinar on Native Two-Spirit (LGBT) issues; over 680 participants; recorded and will be available on-line
SAMHSA TRIBAL EFFORTS, INITIATIVES, AND ACTIVITIES (CONT’D)