Curie Articulates SAMHSA Priorities
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
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
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
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
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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