Substance Abuse & Mental Health Services Administration (SAMHSA) Reauthorization--May 3, 2007

Workforce Recommendations

SAMHSA is expected to be reauthorized in the 110th Congress beginning this year or early next year. Of particular interest to APA is SAMHSA workforce development. SAMHSA's Center for Mental Health Services (CMHS), which administers the federal mental health programs, has the authority to collect and analyze data as well as to support training programs. CMHS has, in fact, collected and analyzed data on psychologists, psychiatrists, social workers, psychiatric nurses, marriage and family therapists and certified counselors with input from each of the associations and has produced an impressive document called Mental Health USA. APA is recommending that this effort not only be continued but expanded to include the number, level and field of training and demographic characteristics of the service providers as well as the type of care provided.

Historically, SAMHSA has done little to support workforce training except for the very successful but small Minority Fellowship Program (MFP) for which the APA Public Interest Directorate) has a grant for pre and post doctoral fellowships for minority psychologists. However, this program is not authorized; it exists at the discretion of agency officials and is subject to the annual Congressional appropriations process for its survival. APA will, therefore, seek full authorization for the MFP during the SAMHSA reauthorization.

Findings of the Annapolis Coalition - There is significant evidence for the critical need to ensure an adequate supply of qualified mental health professionals, as reported by the Annapolis Coalition that was commissioned by SAMHSA to develop a strategic plan for a mental and behavioral health workforce. After five years in early 2007 SAMHSA publicized its action plan for behavioral workforce development. The report stated that: "There is substantial and alarming evidence that the current workforce lacks adequate support to function effectively and is largely unable to deliver care of proven effectiveness. There is equally compelling evidence of an anemic pipeline of new recruits to meet the complex behavioral health needs of the growing and increasingly diverse population." Consequently, the SAMHSA strategic plan has several key guiding principles, which includes: the need for dramatic improvement in initial clinical training and continuing education using evidence based practices; the need to initiate widespread leadership training; the need to address critical training topics (e.g., integration of mental/behavioral services with primary care) and shortages (e.g., services for children and older adults).

IOM 2006 Report - A ground breaking report by the Institute of Medicine in 2001, Crossing the Quality Chasm: A New Health System for the 21st Century, also identified the pervasive problems of health care today and lead to a report in 2006, Improving the Quality of Health Care for Mental and Substance Use Conditions. The 2006 IOM report identified the inadequacy of mental health and substance abuse care and recommended building, maintaining and ensuring a competent and qualified workforce.

Therefore, in addition to authorizing the MFP, APA will be recommending a significant expansion of the CMHS workforce efforts, including a loan repayment program and support for students of the eligible mental health professions in accredited graduate programs and internships. Those students receiving CMHS financial aid will be required to work in a designated underserved community. Students will also have the opportunity to specialize with specific underserved populations. The training would be interdisciplinary and focused on multi-cultural and evidence-based practice.

Campus Suicide Prevention Programs Recommendations

SAMHSA is expected to be reauthorized in the 110th Congress beginning this year or early next year. SAMHSA's Center for Mental Health Services (CMHS) administers the federal mental health programs that include the Garrett Lee Smith Memorial Act (GLSMA) programs in suicide prevention. Each of the three programs authorized by the GLSMA are important and provide critical services to the youth of our nation. The Campus Suicide Prevention program, which is based on the legislation developed by APA members and introduced in both chambers of Congress - The Campus Care and Counseling Act — is of special interest to APA

APA will be working closely with Congress to renew the Campus Suicide Prevention program and to advance some changes that the association believes will make the program more effective on campuses across the country.

During the negotiations on the GLSMA, a number of provisions that had been included in the original legislation were not adopted in the final law. APA proposes including a number of these activities under the "Uses of Funds" section including: prevention, screening, assessment and treatment of mental and behavioral health problems; intervention programs for developmental, transition or adjustment issues that affect students; hiring qualified staff; and strengthening and expanding mental and behavioral health training opportunities in internship and residency program, such as psychology doctoral and post-doctoral training.

Education GRO is working with Senate and House staff in an effort to encourage Congress to consider these changes.