Public Policy Update

What is SAMHSA and why is it important to psychology?

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services was established by an act of Congress in 1992. SAMHSA was created as a services agency to focus attention, programs and funding on improving the lives of people with or at risk for mental and substance abuse disorders. SAMHSA's current budget totals $3.2 billion, with about 27 percent allocated to mental health services and about 73 percent to substance abuse services. SAMHSA consists of three major centers and supporting offices, including the Center for Mental Health Services, the Center for Substance Abuse Prevention and the Center for Substance Abuse Treatment.

When will it be reauthorized?

Congress is committed to reauthorizing SAMHSA by the end of this Congress. In preparation for this important reauthorization, APA's Government Relations Offices of the Education and Public Interest Directorates have developed a set of recommendations that would address a number of mental and behavioral health needs that exist across the country.

What is APA seeking to secure in the reauthorization?

Campus suicide prevention is among APA's priorities. For Americans under age 20, the suicide rate climbed 18 percent from 2003 to 2004. Suicide is now the third leading cause of death for 15- to 24-year-olds. In addition, depressed adolescents are at risk for school failure, social isolation, promiscuity, and self-medication with drugs and alcohol. College and university counseling centers have been experiencing a sharp increase in the demand for counseling services as well as a rise in the number of students with severe crises.

SAMHSA oversees the administration of the Campus Suicide Prevention program that was established in the Garrett Lee Smith Memorial Act (GLSMA) in 2004. The act, introduced by Sen. Christopher Dodd (D-Conn.), Sen. Gordon Smith (R-Ore.), Sen. Mike DeWine (R-Ohio), and Sen. Harry Reid (D-Nev.) is named in memory of Sen. Smith's son, who had recently committed suicide. The act contained provisions from the Campus Care and Counseling Act [introduced in the 108th Congress by Sen. Jack Reed (D-R.I.) and Rep. Danny Davis (D-Ill.)], an APA-initiated piece of legislation. APA seeks to expand the GLSMA to include the original provisions of the Campus Care and Counseling Act, including students' access to a wider range of mental and behavioral health services in an effort to better meet their needs.

More specifically, APA seeks expanded prevention, screening, early-intervention, assessment and treatment programs; more education for college students and their families about mental and behavioral health problems; the hiring of appropriately trained staff; and the strengthening and expansion of mental and behavioral health training opportunities in internships and residency programs, such as psychology doctoral and postdoctoral training, among others.

What else is APA seeking?

Work force development is also important to APA and its members. When Congress created SAMHSA, its focus was on service-delivery and training. However, except for a few small but important programs, such as the Minority Fellowship Program and HIV/AIDS training, and despite a serious shortage of qualified mental health professionals, there is very little mental health work force development at SAMHSA. Yet the Health Resources and Services Administration Office of Shortage Designation reports that there are more than 2,700 Mental Health Professional Shortage Areas.

Shortages in the mental health work force are well documented. For instance, the Annapolis Coalition (2007), which was commissioned by SAMHSA to study work force issues over a period of five years, found that there is overwhelming evidence that the mental and behavioral health work force is not equipped in skill or number to respond adequately to the changing needs of Americans. In addition, the coalition found compelling evidence of an anemic pipeline of new recruits to meet the complex mental and behavioral health needs of the growing and diverse U.S. population.

To effectively address these needs would require the expansion of certain existing strategies and an investment in new ones. APA is recommending that Congress authorize the Minority Fellowship Program, establish a new competitive institutional grant program and a loan-repayment program that would attract more mental health workers, and expand work force data collection, analysis and dissemination activities.

What about older adults?

As discussed in last month's Monitor, APA believes there is a substantial need for more collaborative, integrated models of care to address mental health problems in older Americans, particularly in primary-care settings. These integrative models of care are particularly helpful in identifying and addressing the mental health needs of older adults, who often have complex health-care needs and may be more likely to go to primary-care providers and other traditional health-care settings. To address these issues, APA is recommending that Congress incorporate the Positive Aging Act (S. 982/H.R. 1669) into the SAMHSA reauthorization bill. The bill seeks to improve access to quality mental and behavioral health care for older adults by integrating mental health services into primary-care and community settings where older adults reside and receive services.

What about care for children and adolescents?

APA is advocating to improve mental health services for children and adolescents, of which one in 10 has serious mental health problems and another 10 percent has mild to moderate problems. These problems can lead to tragic consequences, including suicide, substance abuse, inability to live independently, involvement with the correctional system, and lack of vocational success. As a result, APA is recommending that Congress incorporate the Child and Adolescent Mental Health Resiliency Act (S. 1560) and the Mental Health in Schools Act (S. 1332) into the bill to reauthorize SAMHSA. These bills support evidence-based programs that lead to the prevention of and early intervention of mental health problems.

APA is also making recommendations on child traumatic stress. Traumatic events can have a significant impact on the physical, mental, emotional, and behavioral health of children and families. APA is recommending that Congress boost support for SAMHSA's National Child Traumatic Stress Network, which includes programs to support the recovery of children, families and communities impacted by a wide range of traumatic experiences, including physical and sexual abuse, violence in families and communities, natural disasters and terrorism, accidental or violent death of a loved one, life-threatening injury and illness, and refugee and war experience (especially the impact of war on active duty, Guard and Reserve military families).

What else is important?

Emergency preparedness. Both human-made and natural disasters can have significant effects on the mental health and well-being of individuals, families and communities. Among the most common mental health problems encountered by disaster survivors are post-traumatic stress disorder, depression, anxiety, and increased alcohol, tobacco and substance use. Evidence suggests that several subgroups within the population may be at greater risk of negative physical and mental health effects of disasters, including children, people of low socioeconomic status, individuals with physical and mental disabilities, older adults and caregivers. To this end, APA is asking Congress to incorporate the Public Mental Health Emergency Preparedness Act of 2007 (S. 1452) into the bill to reauthorize SAMHSA to enhance the nation's public mental health preparedness and response efforts in the event of a public health emergency.

The Government Relations staff of the Education and Public Interest Directorates will continue to advocate to have the recommendations, developed with input from APA members, included in the legislation to reauthorize the critically important programs under SAMHSA.

Emily Rath is a legislative associate in APA's Education Government Relations Office.