Curie Articulates SAMHSA Priorities

SAMHSA Administrator Charles G. Curie

Editor's Note: In recent testimony before the U.S. House of Representatives Appropriations Subcommittee on Labor/Health and Human Services/Education, SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W., who assumed leadership of the Agency this fall, articulated a vision for the future that reinforces SAMHSA's focus on mental health and substance abuse services and highlights the translation of scientific advances to community practice. SAMHSA News excerpts his testimony. For more information on President George W. Bush's New Freedom Initiative, please visit www.hhs.gov/newfreedom/init.html.

In the short time since November that I have spent as Administrator, I've had a chance to begin to learn about SAMHSA's internal activities and external relationships with state and local governments; consumers of services for mental and addictive disorders; families; service providers; professional organizations; our colleagues in the Departments of Health and Human Services (HHS), Education, and Justice; the Office of National Drug Control Policy; and Congress.

At SAMHSA, I have found a staff dedicated to achieving the vision of providing people of all ages with or at risk for addictive disease and/or mental disorders the opportunity for recovery and a fulfilling life that includes a job, a decent place to live, family support, and meaningful relationships.

Ours is a shared vision of hope and recovery focused on providing individuals an opportunity for a meaningful life in their community. To provide focus for our activities, we have identified a matrix of investment priorities and cross-cutting principles.

Among our investment priorities is the Bush Administration's New Freedom Initiative. Its focus on providing community-based alternatives for people with mental illnesses
is central to SAMHSA's overall vision.

Also, within the context of the New Freedom Initiative is the forthcoming President's Mental Health Commission. The commission will provide an action plan for investing and coordinating Federal, state, and local resources to serve people with serious mental illnesses and children with serious emotional disturbances.

Another priority for change is eliminating the abuse of seclusion and restraint. After all, the use of this practice represents a failure of our treatment system.

The President and HHS Secretary Tommy G. Thompson also have expressed their commitment to reducing drug use, building treatment capacity, and increasing access to services that promote recovery and help people rebuild their lives. The President has proposed an increase of $127 million in our budget to help states and local communities to provide increased access to treatment services.

SAMHSA's National Household Survey on Drug Abuse found that in 2000 approximately 381,000 people recognized their need for drug treatment. A total of 129,000 of these people reported that they had made an effort but were unable to get treatment. The other 252,000 reported making no effort at all. We are working with the Office of National Drug Control Policy and the states to implement a plan to reach out and bring these people into quality addiction treatment services.

The President's National Drug Control Policy calls for a 25-percent reduction in current use of illegal drugs by young people age 12 to 17 within 5 years. It also calls for a similar 25-percent reduction in current use of illegal drugs by adults age 18 and older in the same timeframe. These outcome goals, being tracked by SAMHSA's National Household Survey, are the guideposts for our prevention and early intervention efforts.

The recently released evaluation findings from SAMHSA's High-Risk Youth demonstration grant program found an overall decrease of 25 percent in the frequency of substance use among program participants. These new data add to the growing evidence that prevention can work.

To support the delivery of effective substance abuse prevention services at the community level, SAMHSA proposes to expand its State Incentive Grant Program for Community-based Action. Already, this grant program has promoted the development of state/citywide strategies to make optimal use of science-based prevention resources by the governors in 39 states and Puerto Rico, and the mayor of the District of Columbia. In Fiscal Year 2002, the State Incentive Grant program is providing resources to approximately 2,700 community-based and faith-based organizations, community antidrug partnerships and coalitions, local governments, schools, and school districts.

Most are implementing science-based substance abuse prevention strategies, many of which have been evaluated and endorsed by SAMHSA as effective models. On average, these model prevention programs, listed in our National Registry of Effective Prevention Programs, produce a 25-percent reduction in substance use by program participants.

Another priority includes working with the criminal justice system. Too often, jails and prisons are substituting for community-based care for far too many people with mental illness and drug problems.

Reentry and diversion programs need to encompass not only treatment, but also housing, vocational and employment services, and long-term support. Only when we address the issues of mental illness and addiction will the revolving door between prison and life in the community stop spinning.

Some of these very same issues explain why reducing homelessness is on our list of priorities. We know that many of the people who are homeless and have mental and/or addictive disorders have similar needs for treatment and long-term support.

SAMHSA also has a critical leadership role to play in addressing the needs of people with co-occurring mental and addictive disorders. A large number of people who are in our substance abuse or mental health systems have co-occurring disorders. Too often, they get care for one or the other disorder but don't get care for both.

That's not just bad health policy, it's bad economic policy, too. We could serve more people if we spent that money more wisely in the first place.

People with HIV/AIDS who abuse substances or live with mental illness have another kind of co-occurring illness that remains high on our list of priorities. Our efforts will continue to grow in the area of HIV/AIDS.

Finally, the terrorist attacks of September 11 put a new public spotlight on mental health and substance abuse. Under the direction of Secretary Thompson, SAMHSA convened a national summit within 8 weeks of the attacks with representatives from 42 states, the District of Columbia, five U.S. territories, two Native American tribes, and 100 national public service, faith, and community and membership organizations.

We convened to examine and enhance the local, state, and Federal roles in addressing the mental health and substance abuse needs of individuals and communities before, during, and after acts and threats of terrorism. (See Responding to Terrorism: Recovery, Resilience, Readiness.)

The President's 2003 request continues SAMHSA's involvement by proposing to support activities focused on post-traumatic stress disorders, the mental health needs of first responders, and preparation for potential future bioterrorism emergencies.

To ensure that all SAMHSA programs are science-based, results-oriented, and aligned with both SAMHSA and HHS missions, we have initiated a strategic planning process that will guide our decision-making in planning, policy, communications, budget, and programs. The process is evolving around three core themes: Accountability, Capacity, and Effectiveness—in short, ACE!

Even before that plan is set in place, we have already taken steps to expand our partnership with the National Institutes of Health (NIH) to produce a comprehensive "Science to Services" agenda that is responsive to the needs of the field.

We have initiated a dialogue and found a common commitment to this agenda. Over the next year, we will be working together to define and develop a "Science to Services" cycle that reduces the time between the discovery of an effective treatment or intervention and its adoption as part of community-based care. Today, the Institute of Medicine tells us it can take up to 20 years. With the near doubling of the NIH budget driving even more clinical research and development, that gap may grow still greater unless a fundamental change occurs in how scientific advances are incorporated into community care.

Our matrix of program priorities and cross-cutting principles, our strategic planning process, and our commitment to speeding research findings to community-based care will allow us to see real progress in the outcomes we seek.

The ultimate measure of our effectiveness will be gauged by our ability to provide people of all ages with mental and addictive disorders an opportunity to realize the dream of equal access to full participation in American society. 

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