SAMHSA logo Report to Congress - Nov 2002

 

 

 

 

REPORT TO CONGRESS ON THE PREVENTION AND TREATMENT OF CO-OCCURRING SUBSTANCE ABUSE DISORDERS AND MENTAL DISORDERS

 

 


Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services

Chapter 5 - Five-Year Blueprint for Action - Accountability

 

 

SAMHSA will lead the national effort to ensure accountability, capacity, and effectiveness in the prevention, diagnosis, and treatment of co-occurring substance abuse disorders and mental disorders. While SAMHSA will focus on this set of co-occurring disorders, the Department of Health and Human Services and SAMHSA recognize the existence of other sets of co-occurring medical and social conditions in this population that are of equal significance, such as HIV/AIDS, hypertension, chronic liver disease, hepatitis C, homelessness and incarceration.

Co-occurring substance abuse disorders and mental disorders are prevalent, affecting millions of Americans of all ages. When substance abuse disorders and mental disorders occur at the same time in an individual, they lead to significant loss of human potential and increased costs for service systems - losses and costs greater than those arising from each of the disorders alone. Moreover, a growing body of evidence suggests that integrated rather than parallel and sequential treatment approaches are especially effective for people with more severe functional impairment due to co-occurring substance abuse disorders and mental disorders. The lesson from the data is clear: Improving the Nation's public health demands prompt attention to the problem of co-occurring disorders.

As the lead public mental health and substance abuse services agency in the Federal government, it is SAMHSA's responsibility to lead the Nation's efforts to improve and ensure care for children, adolescents, adults, and older adults living with co-occurring substance abuse disorders and mental disorders of any degree of severity. To extend its reach and to leverage resources to the utmost, SAMHSA will strengthen its partnerships across its constituencies, including consumers/recovering persons, family members, faith-based and community organizations, providers, researchers, advocates, State and local authorities, and our Federal partners whose work also impacts people who have co-occurring disorders. The Agency will work in close collaboration with the President's New Freedom Commission on Mental Health, with sister agencies within the Department of Health and Human Services, and with other agencies of the Federal government that have a role in improving lives of people with co-occurring substance abuse disorders and mental disorders.

At the same time, SAMHSA will continue to emphasize the fact that substance abuse disorders and mental disorders are treatable, and people can and do recover from them. Through these efforts, the Agency will work to reduce, and ultimately eliminate, the stigma of mental disorders and substance abuse disorders that keeps individuals of all ages from seeking treatment and systems from providing appropriate services.

Because the real work in mental health and substance abuse services - including services for people with co-occurring disorders - happens in communities and States, SAMHSA will help States and localities reach consensus about the implementation of evidence-based prevention and treatment services. SAMHSA will collaborate in partnership to support innovations in creative and flexible funding to meet the needs of individuals with co-occurring substance abuse disorders and mental disorders.

SAMHSA's strategic plan, built on the goals of accountability, capacity, and effectiveness, is guiding the Agency's efforts. By promoting provider and system accountability; by enhancing the involvement of individuals with co-occurring substance abuse disorders and mental disorders and, as appropriate, their family members in the treatment planning process; by further developing system capacity; and by ensuring effective coordination and collaboration of efforts; SAMHSA and its partners can identify and implement meaningful, effective and economically sound strategies to best serve people with co-occurring substance abuse disorders and mental disorders.

Such changes cannot be realized overnight by providers, systems, agencies or offices. It will take a measured, approach, tailored to the unique needs of each State, tribe, or Territory. SAMHSA will work closely with all groups that have a critical role in helping to address these serious disorders including community and faith-based providers, the business community, consumers and family members. With leadership and focus, more effective, accountable and capable services for people with co-occurring substance abuse disorders and mental disorders can be achieved nationwide.

 

Accountability

 

Co-Occurring Performance Partnership Measures

SAMHSA will continue to work with the National Association of State Mental Health Program Directors (NASMHPD) and the National Association of State Alcohol and Drug Abuse Directors (NASADAD) to refine, test, and apply consistent process, capacity, and outcome measures for the effectiveness and accountability of treatment for people with co-occurring disorders. This action is consistent with the Performance Partnership requirements under Public Law 106-310, the statute that reauthorized SAMHSA in 2000, and it will build on the significant work in performance measurement already conducted.

SAMHSA will ensure that guiding standards and evidence-based practices support the development of performance measures in helping States become more accountable to SAMHSA, their communities, and the individuals they serve by:

. Using this report to Congress - including the goals and action steps highlighted herein, and the process that led to its development - to create a formal 5-year plan of action to guide Agency management, funding, and communications efforts in the area of co-occurring disorders. With a focus on accountability, capacity and effectiveness, the plan will reinforce SAMHSA's commitment to the development of integrated treatment, as defined in this report, and to the use of the NASMHPD/NASADAD conceptual framework for co-occurring disorders as a tool to highlight symptom severity, locus of care, and potential funding mechanisms.

. Ensuring accountability for the Blueprint for Action. To do this, SAMHSA's Administrator is strengthening the role of the Executive Leadership Team's co-occurring disorders leads - the Director of the Center for Mental Health Services and the Director of the Center for Substance Abuse Treatment - and is providing staff coordination and support to these individuals from within the SAMHSA Office of Policy, Planning, and Budget (OPPB). This will result in cross-Center coordination to address SAMHSA's Blueprint for Action and further the development of "One SAMHSA."

. Furthering collaborations between SAMHSA and its Federal partners.

­-SAMHSA will strengthen its partnership with the Centers for Medicare and Medicaid Services, beginning by convening State mental health commissioners and substance abuse directors, State Medicaid directors, community-based providers, consumers/recovering persons, family members, advocates, researchers, academics, and other key stakeholders to develop State Action Plans for co-occurring substance abuse disorders and mental disorders. This group will examine system planning, innovative service strategies, ways to utilize existing reimbursement mechanisms, use of aggregated funding, and development of State-specific Performance Partnership outcome measures. Conference participants will discuss their need for, and ability to provide, technical assistance and training.

­-SAMHSA will collaborate with the Health Resources and Services Administration to enhance attention to co-occurring disorders within the HRSA/SAMHSA Primary Care Summit initiative.

­-SAMHSA will continue its work with HRSA, the Agency for Healthcare Research and Quality, CDC, NASMHPD, NASADAD, the National Alliance of State and Territorial AIDS Directors, State public health organizations and other State representatives, and community-based providers to develop States' capacities to enhance the integration of services for HIV/AIDS, substance abuse disorders, and mental disorders, including the development of case studies of best practices for funding integrated services for individuals experiencing all three of these disorders.

­-SAMHSA will continue to work closely with the Department of Justice (DOJ), drawing on lessons learned from such programs as the DOJ's Serious and Violent Offender Reentry Initiative and the National GAINS Center, to: (1) promote evidence-based programs that divert individuals with co-occurring substance abuse disorders and mental disorders from correctional settings; (2) enhance treatment for co-occurring disorders when it needs to be provided to persons in jails and prisons; and (3) improve discharge/reentry planning for people with co-occurring substance abuse disorders and mental disorders who are returning to the community from corrections facilities.

­-SAMHSA will continue to work closely with the Department of Education in such activities as the Safe School/Healthy Students Initiative and the Comprehensive Community Mental Health Services for Children and Their Families Program to enhance partnerships at the State and local levels to help schools and State mental health and substance abuse authorities address the prevention and treatment of co-occurring substance abuse disorders and mental disorders in children and adolescents.