Terry Cline, Ph.D: Future SAMHSA funding should provide for "a
continuum of services that focus on an entire population rather than on
individuals with individual illnesses."
When Terry Cline, Ph.D., talks about "ripple effects" and"
human costs" in mental health and addiction policy he refers to
specific people he has seen devastated by those conditions over the years.
During recent Senate testimony, Cline, the new administrator of the
Substance Abuse and Mental Health Services Administration (SAMHSA), described
his agency's most pressing public-policy issues through the prism of his
Cline began his tenure as SAMHSA administrator on January 8, after serving
as Oklahoma's secretary of health.
When discussing the need for community-based health care approaches with
senators at the hearing, Cline first described the children he encountered
during his college years while working in a childrens' psychiatric hospital,
who were still there years later when he returned as a working
Cline's push to apply a comprehensive health care approach to those with
mental illness, including addiction, was fostered by his experience with a
50-year-old woman who finally managed to gain the upper hand over a mental
illness shortly before she died of a heart attack.
Likewise, Cline discussed the need for more evidence-based suicide
prevention efforts in the context of Americans dying annually in numbers that
would have wiped out the Oklahoma town of 25,000 in which he grew up.
"I saw in the private and public-health sectors in Oklahoma what
happens when we're not able to get the services to the people who need
them," Cline said.
Since becoming SAMHSA administrator Cline has sought to expand many
programs he found helpful and effective as Oklahoma's secretary of health.
For example, his experience implementing Mental Health Transformation State
Incentive Grants in Oklahoma—one of the first seven states to receive
them—convinced him of the benefits of the program. The program helps
states develop a comprehensive mental health plan and improve their service
infrastructure and rewards them for concrete steps, such as expanded use of
evidence-based practices and improved access to care through technology.
The latest evidence to support an increased federal role in mental health
and addiction services, Cline said, is a recent Department of Health and Human
Services survey that found a quarter of adult hospital stays involved a mental
illness or substance-use problem.
Cline promoted a "public-health model" to Congress as a guide
to future SAMHSA funding, which provides "a continuum of services that
focus on an entire population rather than on individuals with individual
illnesses." The continuum starts with an assessment of the types and
extent of mental health and substance use needs and continues through
population-based research on addressing those needs and identifying policies
and practices that promote recovery.
The public-health approach can help overcome the divisions between mental
health and other types of health care, in which health professionals in each
area fail to consider the areas of the patient's health outside their"
narrowly focused" responsibility, Cline said.
"If you have a relationship with a patient and are already providing
care, it's a great opportunity to expand that care or to make sure they get
the needed care elsewhere," Cline said, about the comprehensive approach
he advocates. "We've seen it work for other illness categories, and we
know it works with mental illness."
Such a quality-based approach aims to make sure those with substance abuse
or mental health disorders not only get treatment but also become employed,
connect with family members, and avoid incarceration.
Cline noted that SAMHSA's efforts to have all states collect and submit
detailed information on the number and location of people who need either
mental health or substance abuse assistance—information needed to make
any national public-health model succeed—remains incomplete because some
states "have struggled to collect the data." However, he plans to
push for completion of the data-collection effort.
Because data are the keys to comprehensive care, Cline said he will push
the agency to continue development of an electronic health record that would
be available to psychiatrists and mental health professionals, including those
who treat substance abusers. Preliminary work on such records has begun but
several issues, including ones regarding privacy of the records, remain
SAMHSA under Cline also will expand its outreach to veterans. In recent
months, the agency met separately with state mental health directors and
officials from the Department of Defense and Department of Veterans Affairs to
discuss ways SAMHSA can help returning combat veterans with posttraumatic
stress disorder and other conditions. Their effort has so far resulted in
development of an antistigma campaign that encourages former members of the
military to seek help or get their friends and family members to health
professionals when the warning signs of mental illness or substance abuse
Although Cline came to SAMHSA well after its Hurricane Katrina response, he
said the agency is still looking for ways to improve its response to future
disasters. One lesson learned by SAMHSA officials was that disasters can
ripple across many states, so they continue to coordinate interstate planning
efforts. SAMHSA also is considering ways to compensate for the unanticipated
flight of physicians and health care professionals from areas struck by
disaster, he said. Leaders at SAMHSA sent every available health care worker
they had to the Gulf region, but the need far exceeded the agency's personnel