This year, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) celebrates 20 years of working to reduce the impact mental health and substance use problems have on the nation's communities.
The federal agency came into being in 1992, when its predecessor — the Alcohol, Drug Abuse and Mental Health Administration — split in two. Its research components became part of the National Institutes of Health, and its service provision components became SAMHSA.
"The past 20 years have witnessed dramatic developments and pivotal changes in behavioral health care," says SAMHSA Administrator Pamela S. Hyde, JD. SAMHSA has supported many of those developments, encouraging new thinking in such areas as suicide prevention and trauma-informed care, helping to diversify the behavioral health workforce and promoting the idea that recovery from mental and behavioral health disorders is possible.
APA and its members have also been involved in many of these milestones:
President's New Freedom Commission on Mental Health. The commission's 2003 report, Achieving the Promise: Transforming Mental Health Care in America, identified six goals for transforming the nation's mental health system: ensuring Americans understand mental health's central role in overall health, making mental health care consumer- and family-driven, eliminating disparities, encouraging early screening, delivering excellent care and accelerating research and using technology. "It was a landmark document in that it boldly declared our nation's mental health system to be fragmented and inadequate, and then offered ways to remove barriers to care and provide critically needed services to individuals across the life span," says Ellen Garrison, PhD, APA's senior policy advisor.
Parity. Before the 1996 Mental Health Parity Act, patients with mental health and substance use disorders often found themselves running up against draconian benefit limits, says Doug Walter, JD, of APA's Practice Organization. Building on that law, the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act "ended benefits discrimination completely for large employer plans," says Walter. Requiring insurers to cover mental and physical health equally, the law prevents them from limiting hospital days or outpatient sessions or demanding higher co-pays or deductibles for psychological services.
Health-care reform. The Patient Protection and Affordable Care Act of 2010 is another major milestone, says Diane Elmore, PhD, of APA's Public Interest Government Relations Office. APA secured key provisions related to several of the priorities it advocated for in the final law, including an emphasis on integrating mental and physical health care, a focus on prevention and a greater emphasis on the mental health workforce.
Building the minority workforce. Launched at the National Institute of Mental Health and now funded by SAMHSA, the Minority Fellowship Program (MFP) has significantly increased the number of ethnic-minority mental and behavioral health care providers. The program provides financial support, professional development activities and guidance to doctoral and postdoctoral trainees to help move them toward high achievement. Past MFP fellows include APA Past President Melba J.T. Vasquez, PhD; Spelman College President Beverly Daniel Tatum, PhD; and Rep. Judy Chu, PhD (D-Calif.).
National Child Traumatic Stress Network. Established in 2001, the SAMHSA-funded network aims to improve access to care for traumatized kids. "The network has greatly accelerated advances and the development of evidence-based treatment and the dissemination of trauma-informed services for children," says John Fairbank, PhD, who co-directs the UCLA/Duke University National Center for Child Traumatic Stress. Plus, he says, the network has helped to close the gap between the development of evidence-based treatments and their adoption as standards of care, via online toolkits, webinars and other resources. "It's an experiment in science to service," says Fairbank.
Suicide prevention. "Suicide prevention has really only become a significant public policy priority within the last 20 years," says Richard McKeon, PhD, of SAMHSA's Suicide Prevention Branch. The last decade has seen two key pieces of legislation aimed at reducing suicides. The first, the SAMHSA-administered Garrett Lee Smith Memorial Act, provides more than 100 grants to states, tribes and — thanks to APA's advocacy support — college campuses. And because of the Joshua Omvig Veterans Suicide Prevention Act, every VA medical center now has a suicide prevention coordinator. Veterans can also call SAMHSA's National Suicide Prevention Lifeline at 800-273-TALK and be connected to a veterans crisis center.
The recovery movement. As recently as the 1970s, even many psychologists believed that people with serious mental illness could never recover. Then, research by psychologists and others began proving that recovery was possible, and those with mental illnesses began to push for better services. Since then, the recovery movement has flourished. APA is one of six national mental health organizations participating in a SAMHSA-funded initiative called Recovery to Practice. The goal of the effort is to develop an online database of resources and recovery-focused training for mental health professionals. "Focusing on self-direction and empowerment so that people can reach their full potential is what recovery is all about," says Andrew T. Austin-Dailey, who directs the Recovery to Practice program at APA.
Rebecca A. Clay is a writer in Washington, D.C.