Q&A with APHA Annual Meeting keynote speaker Pamela Hyde: Communities are crucial to success: Prevention of mental illness, substance abuse gaining recognition

You’ll be delivering one of the keynote addresses at the Annual Meeting Oct. 30. What will you focus on?

I like to focus on the fact that behavioral health is essential to health. For a public health conference, I think that’s a good message to have. I usually try these days to talk about the context we’re in, and frankly that means a context of change, because we’re in a major change environment. And then we have a couple of things that we’re particularly working on that I’d like to share with this particular group about our quality framework and some public awareness and national dialogue work that we’re working on.

What are the biggest issues in mental health and substance abuse prevention?

If I had to boil it down, I think one of the biggest issues is the belief — or lack thereof — or the perception — or lack thereof — that prevention works. Mental health and substance abuse prevention are a little bit late to the game of public health. In decades past they’ve been seen — by the general public, not public health professionals — as perhaps moral and social problems instead of public health problems. So to get people to understand that there is a prevention science in both substance abuse and in the prevention of a mental illness and in the development of emotional health is, I think, one of our biggest issues. We also have all kinds of technical issues, everything from the way benefits are designed to the way evidence-based practices get developed and then how we get them out into the field.

The theme for this Annual Meeting is “Healthy Communities Promote Healthy Minds and Bodies.” What role do communities play in substance abuse prevention and mental health?

Communities are critical. The health of the community is critical in how the community organizes itself and how it puts an emphasis, or not, on the issue of substance abuse prevention and mental health and emotional development. Obviously, a fair amount of the work on prevention has to happen on the community level. That’s part of the reason we’ve been focusing so much on this issue of how people view behavioral health and how do they view it as an essential part of their community’s health.

Could you talk a bit about the connection between substance abuse and mental health?

Substance abuse and mental health are distinct fields and issues, but they’re alike in that they both have debilitating results when they’re left untreated. (Those issues include) criminal justice issues, homelessness, family issues, community issues. In both cases, people who have these disorders can recover and sometimes the public doesn’t always believe that. There are common risk and protective factors, which is pretty clear from the research, and then frankly there is a significant amount of co-occurring disorders. A significant portion of people with substance abuse issues have depression, anxiety, post-traumatic stress disorder, and other kinds of mental health disorders, and folks with mental health disorders also have a higher proportion of substance abuse than the general population. There is also a significant amount of similarity in the brain connections and chemicals that are impacted by these disorders.

How will the Affordable Care Act help people with substance abuse and mental health needs?

Making sure that young people aren’t precluded from getting insurance due to preexisting conditions (is an important part of the Affordable Care Act). It’s important if those young people have either a mental illness or an addiction, that they are contending with and need treatment for. Then as we move to 2014, that coverage opportunity really expands. Behavioral health is intimately and intricately involved in the implementation of the Affordable Care Act. There’s also a number of things that are specific for substance abuse and mental health, which are things like health homes, which is a construct that allows us to look at coordinating care, integrating care for people with chronic conditions. There’s also some specific provisions like the home visitation program that included specifically substance abuse issues. (The program allows) workers to go into homes with young children (where) they can actually address not only the physical health needs or issues of parenting and things of that nature, but they explicitly can and will address the substance abuse issues. There’s also a major focus on prevention. The National Prevention Strategy that just came out includes alcohol and substance use and behavioral health disorders. So it is front and center and is paying attention to behavioral health issues in ways that has not been true in the past.

SAMHSA has a number of programs in place to address substance abuse and mental illness prevention. Could you highlight a few of them?

We have a program called the Strategic Prevention Framework State Incentive Grant. This one is an approach to planning and assessing and taking action to prevent the onset and progression of substance abuse, including underage drinking. On the mental health side we have a number of programs, but one is called Project Watch. It implements evidence-based practices specifically focusing on children aged 0-8. We also have a program called the Garrett Lee Smith suicide prevention program. This is a program that was started because of the death by suicide of Garret Lee Smith, who was the son of Sen. Gordon Smith. Those programs provide grants to states and tribes and to campuses to specifically focus on suicide, especially among young people.

Hyde

Has what you have learned from these programs caused you to make any changes to the upcoming budget request?

What we have done in the president’s 2012 budget is to propose a different way of structuring these grants so we have three new grants that take some of those dollars and put them together. One program we’re working on is a substance abuse state prevention program, which would give all states funding to address substance abuse prevention using the strategic prevention framework approach because we have pretty good evidence that it works. (Another) one that we’re proposing that I’m really excited about is the behavioral health tribal prevention grant. It would be the first time that any tribe that wants these dollars would have them available to address substance abuse and suicide prevention. Those are the two issues that the tribes in all the consultations we do continue to raise as their biggest concerns. The good news about this is that it’s both mental health and substance abuse, and it addresses the things that tribes want to address. It would allow tribes to use traditional practices and approaches that are culturally appropriate for them. So tribes are always concerned about having to compete with each other and counties and states that they may or may not have the same infrastructure to compete in these competitive grant programs. So there are lots of things going on. The issue is whether or not we can get them to Congress and get on with implementing those grants.

—Interview conducted, edited and condensed by Charlotte Tucker

For more information, visit www.samhsa.gov.