On July 15, the Senate Health, Education, Labor, and Pensions Subcommittee on Substance Abuse and Mental Health Services held a hearing to examine issues surrounding the reauthorization of the Substance Abuse and Mental Health Administration (SAMHSA).
An agency of the Department of Health and Human Services (HHS), SAMHSA was established in 1992 by Congress to focus attention and resources on “improving the lives of people with or at risk for mental and substance abuse disorders.” SAMHSA is divided into three Centers: the Center for Substance Abuse Prevention, the Center for Substance Abuse Treatment, and the Center for Mental Health Services. These three entities work in conjunction with state and local governments, consumers, families, service providers, professional organizations, HHS, and the Office of National Drug Control Policy.
SAMHSA Director Charles Curie told the panel that the agency is reengineering its approach to substance abuse prevention, and that there is ample evidence showing that substance abuse prevention can be very effective, if it is done properly.
“Prevention can not only reduce the numbers of individuals who become dependent on substances of abuse,” Mr. Curie said, “but it can also deter substance abuse in the first place. It can pay off not only in terms of health care costs, but also in terms of crime and violence, homelessness, and joblessness.”
Subcommittee Chair Mike DeWine (R-OH) delivered pointed questions to Mr. Curie over the White House’s position on funding prevention programs.
“I’m troubled the administration over the last few years has requested less funding for prevention programs,” said Sen. DeWine to SAMHSA Director Charles Curie.
Mr. Curie told the panel that the agency is focusing its spending on programs that work. “We have growing evidence that tells us which models of prevention work well, which promising models need further evaluation, and which models lack any strong evidence of effectiveness,” he said. “We do not need to reinvent that knowledge. We need to apply what we know. We need to ensure that our dollars support known effective prevention programs, programs built on a solid base of ongoing research.”
Mr. Curie also addressed the Administration’s treatment initiative, “Access to Recovery,” which will use vouchers to purchase substance abuse treatment and support services. He told the subcommittee that the program will enable SAMHSA to “achieve key objectives identified by substance abuse treatment administrators and providers, legislators and policy makers, and people in recovery and their families as critical to moving the substance abuse treatment forward.”
Ohio First Lady Hope Taft echoed Sen. DeWine’s concerns about cuts in funding for substance abuse prevention programs. “Prevention is effective. It is worth the investment.” Mrs. Taft told the panel of her career as a certified prevention specialist. “I have experienced first hand both the devastation substance abuse has on families and communities, as well as the power of effective prevention strategies to reduce the use of alcohol and illegal drugs. … In 1999, I came across some information that convinced me we need to focus even more of our efforts on prevention I read how treatment of addictions is really a growth industry. By the year 2020, the need for alcohol and other drug treatment will increase by 57 percent,” she said.
Lewis Gallant of the National Association of State Alcohol and Drug Abuse Directors addressed funding for the Substance Abuse Prevention and Treatment (SAPT) block grant. Mr. Gallant called the SAPT block grant a crucial program to help fund vulnerable populations, namely youth, and pregnant and parenting women, who have or are at risk of having a substance abuse problem. Prevention, Mr. Gallant said, is also cost-effective. “A 2001 study by the Center for Substance Abuse Prevention estimated a savings of up to $20 for each dollar invested in prevention services,” he said.
The panel also heard from expert witnesses in the field of mental health. Michael Faenza of the National Mental Health Association addressed what he termed the “crisis” in the public mental health system, and the funding shortfalls that are preventing improvements from being made.
“The cracks in the mental health system are growing wider as states and localities grapple with record budget deficits. … The mental health delivery in this country has long been underfunded and overburdened. But economic recession and a rapid transition from budget surpluses to sharp deficits in 44 of the 50 states have placed their mental health systems in real jeopardy.”
Mr. Faenza went on to tell the panel that mental health care for children is even less adequate than that available to adults. “When children’s mental health needs are addressed at all, the system for serving them is often treated as an extension of the adult system, and as a result truly child-and family-focused service planning and delivery is in short supply. In many cases, children with mental disorders are not served at all by the mental health system, but end up in other systems, such as juvenile justice.” He urged the subcommittee to give “particular attention to the needs to children and to support policies that facilitate collaboration among child-serving systems.”
Gloria Walker of the National Alliance for the Mentally Ill (NAMI), who is herself the mother of a child with a mental illness, told the committee that SAMHSA needs to do more to address the absence of a coherent service system for children and adolescents with serious mental illness. Ms. Walker recommended that Congress establish an interagency body on children’s mental health to improve collaboration among agencies charged with providing service to mental health patients. Ms. Walker told the panel that NAMI strongly supports creating home and community-based services for children with mental illnesses and their families.
“It is well documented that families of children with mental illness frequently have no place to turn to access the services that their children need,” she said. “As a consequence, children with mental illness are even more disproportionately represented in juvenile justice systems than adults with mental illnesses are in adult correctional systems. Moreover, many families are forced to literally give up custody of their children to access care for their loved ones. This is a national tragedy.”
