Mental Health as Public Health: Q&A with SAMHSA's Pamela Hyde
The recent first-ever Centers for Disease Control and Prevention report on mental health issues in America, found that half of all Americans have a mental health issue at some point in their lives. Pamela Hyde, JD, Administrator of the Substance Abuse and Mental Health Administration (SAMHSA) a keynote speaker at this year’s APHA annual meeting, focused on what public health can do to identify these issues and improve prevention, treatment and recovery. Watch her opening session speech here, and read an APHA Q&A with her here.
NewPublicHealth: Your keynote speech at the American Public Health Association annual meeting focused attention on the issues of mental health as a pivotal component of public health. What does the American public need to learn about these issues?
Pamela Hyde: Behavioral health is a major public health issue and we in America don’t tend to look at as a public health issue. We tend to look at it as a social problem. The recent mental health parity legislation, which generally requires that insurance coverage is identical for mental and physical health concerns, helps tremendously in the sense that it makes it very clear that mental health and substance abuse services are just as important as healthcare services and that they should be treated similarly.
We use the term behavioral health because we’re trying to encompass everything from prevention to treatment to recovery and we’re trying to encompass both mental illnesses as well as substance abuse and substance use disorders. Behavioral health is a public health issue, just like diabetes or heart problems or hypertension. There are ways to prevent it and there are ways to treat it and people recover from it.
NPH: What are some of SAMHSA’s biggest recent achievements?
Pamela Hyde: Certainly in the last couple of years, what we’ve really tried to do is shine a light on the role that behavioral health plays in our healthcare system. So in this particular two-year period, we’ve been focusing heavily on health care reform implementation and trying to make sure that behavioral health is at the table as all the rules and regulation are written. A key success is with our sister federal agencies who are working on these issues, to know and understand that behavioral health plays a big role. Not only in the health issues, but to the extent that some of the dialogue right now is around cost, we’ve been able, I think, to make an impact on helping people understand why not treating behavioral health issues actually can add to or multiply the cost of health care.
We’ve also brought a lot of attention to certain issues. We’ve focused on prevention, and so we’re doing a lot of work around suicide prevention and we’ve created a national action alliance for suicide prevention that’s a private and public partnership that’s trying to look at suicide awareness and suicide prevention across a number of domains.
We have incorporated or begun to shine a big light on trauma issues. I think everybody’s getting more aware and familiar with the role that trauma plays not just for our military, and we’re working more and more with the Child Welfare System and with the Juvenile Justice System as well as our own behavioral health systems to try to incorporate trauma informed care and to try to learn more across all of those systems about the role that trauma plays in kid’s lives, and, frankly, the role it plays in adult lives who have a history of childhood trauma. And that has implications for adult substance use, adult mental health issues and even adult physical health issues.
NPH: And what are initiatives will you be introducing in 2012?
Pamela Hyde: We just kicked off the National Behavioral Health Quality Framework. We are just 99% done with the framework and we’re now starting to develop measures to determine the quality of behavioral health care.
Last year we proposed a new behavioral health tribal prevention grant program, and this was a program that came out of all of our tribal consultations in which the tribes over and over and over again are telling us that suicide and substance abuse are two of their biggest problems and that they need and want the money to come directly to the tribes to let the tribes develop their own approaches to those two issues using traditional approaches and cultural approaches that make sense to them. So we’ve proposed that program.
And we’ll be working more and more on health information technology with the Office of the National Coordinator for health information technology recognizing the unique needs and opportunities for electronic health records and other kinds of health technology in the behavioral health world, and the need for that to be interoperable with physical health electronic health records.
NPH: You talk about synergies with other departments, looking ahead, is that something that you will be doing more of?
Pamela Hyde: Absolutely. We’ve been doing a lot of that, and we feel really good about the partnerships we’ve developed. We’re a relatively small agency. We have a little over 500 staff and a budget of about $3.5 billion dollars, which is not very much for a big federal agency trying to cover the whole country. So we have to work with our partners at CDC and at Administration of Children & Families and our partners at HRSA, which is the group that does a lot of the work with the federally qualified health centers, and we’ve done terrific work with them on primary and behavioral health care integration and workforce issues. We’ve been working with the Department of Defense on issues like military policy academies trying to address the behavioral health needs of returning military as well as National Guard people and reserves and veterans.
And we do a lot of work with the Department of Justice, especially in the juvenile justice area, but also in the area of drug courts. We work extensively with the Office of the National Drug Control Policy and the Department of Education.
NPH: CDC recently released a report on binge drinking. What are your concerns right now when it comes to alcohol?
Pamela Hyde: We’re particularly concerned about underage drinking on college campuses because kids go to school at age 17, 18, sometimes, 19, and they’re not legally able to drink until they’re 21, and yet there’s a whole lot of drinking that goes on in college campuses and we know that there are both health and death related issues there. So we’ve done a fair amount of work with college campuses around these issues. We’re also trying to just educate kids, and frankly, trying to educate their parents about these issues to help them think about how to talk to their kids about this and how to engage with their kids around drinking in general but binge drinking in particular.
We’ve also reenergized something that we call the Inter-Agency Coordinating Council for Prevention of Underage Drinking. This is a congressionally required entity that was languishing a bit so we have brought that back up and are actively working on the issue of underage drinking.