APA Urges Greater Recognition of Serious Mental Illness in SAMHSA Plan
Abstract
The development and training of a diverse psychiatric workforce is critical to the care of patients with mental illness, including substance use disorders, as well as frequently comorbid conditions, such as hypertension and diabetes.
APA wants to see greater emphasis on serious psychiatric illness in the strategic planning of the federal agency charged with formulating national mental health policy.
In comments in response to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) draft FY 2015-2018 Strategic Plan titled “Leading Change 2.0: Advancing the Behavioral Health of the Nation,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., called for a much more explicit recognition of the needs of individuals with psychiatric illness—especially serious and persistent mental illness.
The comments were submitted on August 18 in a letter to SAMHSA Administrator Pamela Hyde, J.D.
“APA is strongly concerned about the lack of explicit recognition of the psychiatric treatment needs for Americans suffering from mental illness and substance use disorders, and in particular for the 13 million Americans who suffer from debilitating serious mental illnesses (SMI),” Levin wrote. “Inadequate treatment of SMI continues to precipitate high numbers of costly and preventable hospitalizations and incarcerations, lack of economic productivity, violence (both self-directed and other-directed), and negative budget impacts, as well as untold pain inflicted on family and loved ones. APA urges SAMHSA to develop explicit goals related to the promotion of evidence-based best practices for SMI treatment, improvement of access to appropriate and culturally competent medical care for Americans suffering from mental illness and substance use disorders, including prevention, early intervention, treatment, recovery and wraparound service initiatives, and evidence-based and outcomes-driven reviews of SAMHSA programs.”
SAMHSA’s strategic plan is a 34-page document outlining six strategic initiatives: prevention of substance abuse and mental illness, health care and health systems integration, trauma and justice, recovery support, health information technology, and workforce development.
Each initiative includes an overarching purpose, specific goals and objectives, and measures for determining success. For instance, the first strategic initiative of preventing substance abuse and mental illness includes a goal to “prevent and reduce attempted suicides and deaths by suicide among populations at high risk.” That goal includes several specific objectives—such as to “promote and implement effective clinical and professional practices for assessing and treating those identified as being at risk for suicidal behaviors. “
The goal and the objectives are to be measured by the following metric: “reduce the number of suicide attempts and deaths by suicide.”
While applauding many of what Levin called the “laudable” goals outlined in the strategic plan, APA called for a more vigorous response to the needs of people with serious mental illness—and to the medically trained psychiatrists who treat them—in four areas: prevention and treatment, health systems and health care integration, health information technology, and workforce development.
APA President Paul Summergrad, M.D., thanked the agency for its attention to areas such as reducing health disparities affecting minority communities and reducing the number of people with mental illness in the criminal justice system (see page 4). But he said the proposed plan is “striking for what it leaves out—a focus on the appropriate medical care of patients with serious mental illness, the research needed to inform that care, and the development of a physician workforce that is essential for patients.”
In comments to Psychiatric News, he added, “It is important for SAMHSA to focus on the clinical care needs of patients with serious mental illness. The critical role of scientifically based care provided by psychiatrists also requires far greater emphasis, as does support for psychiatric workforce development. Patients and families suffering with these very disabling conditions deserve nothing less.”
In the letter to SAMHSA, Levin urged the agency to consider specific recommendations in the following areas:
Prevention of substance abuse and mental illness: APA recommends adding objectives related to collaboration with private, nonprofit initiatives dedicated to detection and early intervention of mental illness in acutely vulnerable population groups, such as children and adolescents. APA further advocates for efforts in schools that educate teachers and other school professionals about the early signs of mental illness and substance use. | |||||
Health care and health systems integration: Within models of integrated care, it is essential that the medical psychiatric component is not lost, to ensure that those with SMI receive the appropriate treatment they need to live productive lives. Further, APA recommends that SAMHSA collaboratively develop comprehensive educational materials related to parity implementation for patients, providers, and, especially, government officials who are tasked with enforcing the Mental Health Parity and Addiction Equity Act (MHPAEA). Additionally, SAMHSA should work with other agencies in the Department of Health and Human Services to develop a national database in which patient and provider complaints are tracked to identify patterns of discrimination; this information should be publicized to inform consumers about which carriers have complaints against them concerning noncoverage of mental health treatment. Also, APA recommends that a Mental Health Parity Bill of Rights, which sets out an employee’s rights under MHPAEA, be posted by applicable employers in hospitals, clinics, private practices, and other appropriate health care settings. | |||||
Health information technology: APA recommends that SAMHSA provide the greatest amount of technical support possible for psychiatrists who are eligible for the individual physician incentive within the HITECH program. | |||||
Workforce development: “Due to the significant shortage of psychiatrists, it is of great concern that historically SAMHSA has not included psychiatrists in its proposals for increased workforce development,” Levin wrote. “Psychiatrists are integral to the medical home for patients suffering from SMI. The development and training of a diverse psychiatric physician workforce, including public-sector psychiatrist leaders who are trained in recovery-oriented and trauma-informed care models, is critical to the medical and mental well-being of those individuals diagnosed with a mental illness or substance use disorder and co-occurring conditions, such as hypertension and diabetes. APA recommends that SAMHSA prioritize its advocacy and programmatic activities concerning the development and training of a robust psychiatrist workforce.” | |||||
The comment period ended August 18. A spokesperson for SAMHSA said that comments would be reviewed by the agency and a final report issued this month. ■
