By Paolo del Vecchio, MSW; SAMHSA Executive Officer
As a person with lived experience of mental illness, addictions, and trauma, I consider July 26 - the 31st anniversary of the Americans with Disabilities Act (ADA) - to be our nation’s second Independence Day. For the millions of us with disabilities, it is a day to celebrate our freedom. Freedom from discrimination and the barriers that block our inclusion in community life. Freedom from unjustified segregation and institutionalization. Freedom to earn and to learn. Freedom to pursue recovery and receive services and supports – including mental health and addiction services – that help us participate fully in American life.
As an employee with SAMHSA for over 26 years, I am proud of our leadership in protecting the rights of people with mental illness and/or addictions including:
- Advocating for the Rights of People with Mental Illness. SAMHSA administers the Protection and Advocacy for Individuals with Mental Illness (PAIMI) program that supports agencies in all states and territories to investigate abuse and neglect, address civil rights violations, and enforce the U.S. Constitution, Federal laws and regulations, and state statutes. Many PAIMI agencies have helped enforce the ADA.
- Reducing and Ultimately Eliminating Seclusion and Restraint. SAMHSA works to prevent and end the use of seclusion and restraint given it can result in trauma, psychological harm, physical injuries and death to both people subjected to and the staff applying these techniques. In so doing, SAMHSA recognizes the need to develop alternatives to the use of such practices.
- Enforcing Mental Health and Substance Use Disorder Parity. SAMHSA, along with the U.S. Department of Labor and the Centers for Medicare and Medicaid Services (CMS), provides oversight of the Mental Health Parity and Addiction Equity Act of 2008 that requires health insurers and group health plans to provide the same level of benefits for mental and/or substance use treatment and services that they do for medical/surgical care. Information on knowing your parity rights is available in SAMHSA’s publications.
- Guarding the Confidentiality of Substance Use Disorder Patient Records. SAMHSA establishes standards for the appropriate and allowable disclosure of addiction treatment records.
- Protecting the Civil Rights Protections for Individuals in Recovery from an Opioid Use Disorder. SAMHSA collaborates with the HHS Office of Civil Rights on civil rights protections for individuals receiving Medication Assisted Treatment.
- Helping People with Mental Illness and/or Addictions Involved in Criminal Justice Systems. SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation expands access to services for people with behavioral health disorders in contact with the adult criminal justice system. This includes improving law enforcement response to people in mental health crises that too often results in tragic outcomes.
- Facilitating Community Living. SAMHSA collaborates with CMS and the Administration for Community Living in promoting Home and Community-Based Services, older adult mental health, and peer and family support. SAMHSA also encourages self-directed care approaches in behavioral health.
- Advancing Behavioral Health Equity. SAMHSA works to reduce disparities in mental health and/or substance use disorders across populations. This includes support of the National Network to Eliminate Disparities in Behavioral Health.
- Involving People with Lived Experience. SAMHSA is dedicated to involving people with mental illness and/or addictions in the planning, delivery, evaluation, and policy formulation of behavioral health services. This includes encouraging shared-decision making and psychiatric advance directives in clinical care.
- Promoting Recovery and Recovery Support. SAMHSA’s Working Definition of Recovery states that “protecting…rights and eliminating discrimination – are crucial in achieving recovery.” SAMHSA focuses on the four major dimensions that support a life in recovery: Health, Home, Purpose, and Community.
Over the past 31 years, America has made significant progress in protecting and enforcing the civil rights of people with disabilities – including those of us with mental illness and/or addictions. Despite this progress, we have much more work to do to realize the full promise of the ADA. Too many of us are still without the freedom that all Americans deserve.
Sitting next to President George H.W. Bush, on July 26, 1990, when he signed the ADA into law, was renowned disability advocate Justin Dart Jr. As we continue our pursuit of justice and freedom, let us remember and heed Dart’s call to action to “Lead On!” Happy 31st Anniversary of the ADA!
My Test, My Way – My contribution to Ending the HIV Epidemic in the U.S.
Kristin Roha, MS, MPH, SAMHSA Public Health Advisor for HIV
On June 27th of each year, National HIV Testing Day (NHTD) reminds us of the importance of HIV testing and gives us the opportunity to share HIV testing resources. Getting tested for HIV is easy, fast, confidential, and safe, and is the first step in knowing your HIV status. For people who test positive for HIV, getting tested is the gateway to accessing lifesaving treatment. For people who test negative for HIV, getting tested can provide empowering information that can help make them decisions about sex, drug use, and health care. For people at risk for HIV, a negative test can also be the gateway to accessing powerful preventive tools, including pre-exposure prophylaxis (PrEP).
SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. People with mental illness and/or substance use disorder are at increased risk of getting HIV, and of passing the virus on to others. From SAMHSA’s National Survey on Drug Use and Health (NSDUH), we know that the prevalence of mental illness is higher among people living with HIV than among the general population; mental illness is also is linked to behaviors that increase the likelihood of getting HIV. We also know that the prevalence of substance use is higher among people living with HIV than among the general population, and that substance use disorder – especially injection drug use – can increase the risk of getting HIV. For this reason, SAMHSA is a proud partner in the Ending the HIV Epidemic in the U.S. initiative, which aims to reduce new HIV infections in the U.S. by 90% by 2030.
Substance use disorder and mental healthcare practitioners like SAMHSA’s grant recipients and partner organizations serve on the front lines of the HIV epidemic and can play a vital role in ensuring people at risk for HIV receive an HIV test. SAMHSA has long encouraged substance use disorder and mental health treatment providers to integrate HIV testing into their routine standard of care, and we have made it a requirement for some of our grants. The CDC recommends that that people who inject drugs (PWID) and share needles, syringes, or other drug injection equipment should get tested for HIV every year, but in 2018 only 55% of PWID had been tested for HIV in the past twelve months. This year on NHTD, SAMHSA again encourages all substance use disorder and mental health treatment providers to test new clients for HIV and hepatitis at intake.
The theme for this year’s NHTD is “My Test, My Way,” because today there are more HIV testing options available than ever before. This year the COVID-19 pandemic changed the way people access healthcare, including HIV testing. Though many of SAMHSA’s grant recipients were able to remain open and offer in-person testing, others experimented with offering HIV self-tests via contactless pickup or through the mail. Now, though many facilities are open and able to offer HIV testing in person again, it’s important to seek testing in whatever way makes you feel the most comfortable. If you would like to receive an HIV test in person, you can find a testing provider through the CDC’s Get Tested website. Get Tested also has resources to help you find condoms and PrEP providers in your area. If you would prefer to get tested at home or at another preferred location, HIV self-tests can be used wherever you choose. Right now, many local health departments and community-based organizations, as well as the CDC, are distributing free HIV self-testing kits through a program funded in part by the Minority HIV/AIDS Fund. Finally, if you, or someone you know, is seeking help for substance use or mental illness, SAMHSA’s Behavioral Health Treatment Services Locator can help you connect with treatment programs in your area.
Testing, including self-testing, is one of the many tools we have at our disposal for ending the HIV epidemic. We are closer to reaching this goal than we have ever been. SAMHSA would like to take this opportunity to thank our grant recipients and partner organizations for your perseverance and flexibility in ensuring that your clients were able to get tested for HIV over the past year. We would also like to encourage everyone at risk for HIV to take the opportunity provided by NHTD to get tested in a way that works best for you – whether it’s self-testing in your own space of finding a testing site nearby. Together we can contribute to ending the HIV epidemic, one HIV test at a time.
By Kristin Roha, MS, MPH, SAMHSA Public Health Advisor for HIV
June 5th marks 40 years since the first five cases of what later became known as AIDS were officially reported by the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR). June 5th also is observed as HIV Long-Term Survivor’s Day. On this 40th anniversary, SAMHSA commemorates the more than 32 million people, including 700,000 in the United States, who have died from AIDS-related illness globally since the start of the epidemic, and honors the resilience of long-term HIV survivors and the vital role they play within our communities.
SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. People with substance use disorder and/or mental illness are at increased risk of getting HIV, and of passing the virus on to others. People with HIV, mental illness, and/or substance use disorder also face increased behavioral health challenges as each comorbidity acts as a potential obstacle in treatment of the other two. They also face a complex healthcare system that can be difficult to navigate. We know from SAMHSA’s National Survey on Drug Use and Health (NSDUH) that the prevalence of substance use is higher among people living with HIV than among the general population, and that substance use disorder can increase the risk of getting HIV and negatively impact HIV care, treatment, and related health outcomes. We also know that the prevalence of mental illness is higher among people living with HIV than among the general population; mental illness can interfere with HIV prevention and adherence to treatment and is linked to behaviors that increase the likelihood of getting HIV. Mental health and substance use disorder healthcare practitioners like SAMHSA’s grant recipients and partner organizations serve on the front lines of the HIV epidemic and can play a vital role in linking individuals to HIV testing, counseling, treatment, and prevention. For this reason, SAMHSA is a proud partner in the Ending the HIV Epidemic in the U.S. initiative.
SAMHSA’s HIV funding targets people who have mental illness, substance use, and HIV. SAMHSA has pushed for universal HIV testing upon admission to substance use disorder treatment, and it is a requirement for some of our grants. SAMHSA also has funded grants that provide individuals with HIV peer support and navigation services through a complex healthcare system; provide one-stop-shop healthcare models that promote full integration and collaboration in clinical practice between primary and behavioral health care; and fund increased engagement in care for racial and ethnic minorities with substance use disorder and/or co-occurring mental disorders who are at risk for HIV or are HIV positive.
June 5th also is observed as HIV Long-Term Survivors Day. SAMHSA honors long-term survivors of the HIV epidemic and recognizes the needs, issues, and journeys of Americans who are long-term survivors in our families, neighborhoods, communities, and healthcare systems. We recognize the need to continue addressing both the physical and mental challenges to their well-being due to decades of successful disease management. More than ever long-term survivors need our support to manage both the physical impact of decades of HIV disease management, and feelings of social isolation, loneliness, and depression, with which many of them struggle. With many current HIV efforts focused on prevention and testing, long-term survivors can feel overlooked. These feelings of isolation have been made worse by the ongoing COVID-19 pandemic, HIV stigma, ageism, homophobia, racial discrimination, and other interrelated social issues. Substance use and mental health programs can ensure they identify and serve older Americans, including long-term survivors, who may struggle with feelings of social isolation, loneliness, and depression.
If you, or someone you know, is seeking help for substance use or mental illness, SAMHSA’s Behavioral Health Treatment Services Locator can help you connect with treatment programs in your area. You can use this resource to locate substance use and/or mental health treatment providers in a confidential and anonymous manner.
On this 40th anniversary, SAMHSA is honored to work with our federal, domestic, and international partners and members of the HIV community in our shared effort to end the HIV epidemic in the United States.
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By Anita Everett M.D. DFAPA, Director, Center for Mental Health Services
988: The New National Suicide Prevention Lifeline Number
The past several years have marked several groundbreaking developments with respect to the National Suicide Prevention Lifeline (1-800-273-TALK). In fiscal year (FY) 2001, SAMHSA awarded a competitive, discretionary grant to establish a network of crisis centers that would respond to crisis calls from their local communities, to ensure those crisis center counselors were trained, and that all crisis centers in the network met standards for accreditation. A single national number was established, which in 2005 became the National Suicide Prevention Lifeline (Lifeline; 800-273-8255 (TALK)). The Lifeline answered more than 2.1 million calls and 234,671 chats in FY 2020.
The vision of the advocates who supported the effort to establish a three-digit national suicide prevention number was that a three-digit number would be more easily remembered and more likely to be utilized in a crisis, both because a 3-digit number is more likely to be encoded and retained, and also because individuals are more likely to struggle with information recall during times of emotional distress.
In 2018, Congress passed and the President signed into law, the National Suicide Hotline Improvement Act in which SAMHSA and the Veterans Administration were called upon to report to the Federal Communications Commission (FCC) regarding the effectiveness of the existing National Suicide Prevention Lifeline and the potential value of a three digit number being designated as the new national suicide prevention number. The FCC subsequently recommended to Congress that the number 988 be designated as the new national suicide prevention number. On July 16, 2020, the FCC issued a final order designating 988 as the new NSPL and Veterans Crisis Line (VCL) number. This order gave telecom providers until July 16, 2022 to make every land line, cell phone, and every voice-over internet device in the United States capable of using the number 988 to reach the Lifeline’s existing telephony structure. On October 17, 2020, the National Suicide Hotline Designation Act of 2020 was signed into law, incorporating 988 into statute as the new Lifeline and VCL phone number.
Why 988 Is Important:
- More people in suicidal and mental health crisis will be helped. Sources of increased contacts (calls, chats, and texts) include baseline contact volume, new contact volume, and contacts diverted from 911 and other crisis hotlines.
- Those in crisis will be more likely to receive help from those most qualified to provide support.
- More effective triage means less burden on emergency medical services, emergency departments, law enforcement, etc. so that their agencies can be appropriately focused their limited resources on those areas for which they are best trained.
- The attention the transition to 988 has brought to crisis services has led to an opportunity for states to reimagine their crisis service provision, and to ensure adequate financing of 1) mobile crisis services, 2) crisis center hubs and 3) crisis stabilization services.
While the FCC ruling requiring activation of 988 by July 2022 is a critical and groundbreaking step in realizing the vision of a nation with easier access to suicide prevention and crisis intervention services, there must be sufficient local crisis center capacity to answer this projected significant increase in contact volume, and for these contacts to be answered rapidly and effectively.
In order to address this need for increased capacity, a number of states already have pending 988 legislation at this time, with 2 states—Utah, and Virginia —having already signed 988 legislation into law. The following states have introduced 988 legislation: Oregon, California, Colorado, Idaho, Kansas, Kentucky, Massachusetts, Nebraska, New York, New Jersey, Rhode Island, and Wisconsin, and the following four states have already passed 988 legislation: Alabama, Indiana, Nevada, and Washington. In addition, 988 legislation is expected to materialize in Arkansas, Pennsylvania, and South Carolina.
Mental Health Block Grant Crisis Set-Aside
A FY 2021 funding measure directed SAMHSA to implement a 5 percent crisis set-aside within its Mental Health Block Grant program. According to the House Appropriations Committee report, “the Committee directs a new five percent set-aside of the total for evidence-based crisis care programs addressing the needs of individuals with serious mental illnesses and children with serious mental and emotional disturbances…The Committee directs SAMHSA to use the set-aside to fund, at the discretion of eligible States and Territories, some or all of a set of core crisis care elements including: centrally deployed 24/7 mobile crisis units, short-term residential crisis stabilization beds, evidence-based protocols for delivering services to individuals with suicide risk, and regional or State-wide crisis call centers coordinating in real time” (House Appropriation Committee Report, 2020).
Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention
In 2001, the U.S. Surgeon General published the National Strategy for Suicide Prevention (NSSP), the intention of which was to outline a comprehensive strategy for reducing the suicide rate in the United States. The National Strategy was revised in 2012 by the National Action Alliance for Suicide Prevention (NAASP), a public-private partnership (its Executive Secretariat is SAMHSA-funded) devoted to the implementation of the National Strategy and to the reduction of suicide. Subsequent to recognition that while significant progress had been made in implementing many elements of the NSSP, implementation progress was relatively lacking in other areas, SAMHSA, the NAASP, and the Office of the Surgeon General published the Surgeon General's Call to Action to Implement the National Strategy for Suicide Prevention (2020).
The Call to Action recommends action in each of the following areas:
- Action 1: Activate a Broad-Based Public Health Response to Suicide
- Action 2: Address Upstream Factors that Impact Suicide
- Action 3. Ensure Lethal Means Safety
- Action 4. Support Adoption of Evidence-Based Care for Suicide Risk
- Action 5. Enhance Crisis Care and Care Transitions
- Action 6. Improve the Quality, Timeliness, and Use of Suicide-Related Data
Read the complete Call to Action report.
COVID-19 Suicide Prevention Funding
On top of their FY 2020 grant portfolio, the SAMHSA’s Center for Mental Health Services’ Suicide Prevention Branch funded an additional 53 grants in FY 2020, specifically in response to the COVID-19 pandemic, as follows:
- COVID-19 Emergency Response for Suicide Prevention (Short Title: COVID-19 ERSP) grants: 50 awards, $40,000,000
- Suicide Prevention Lifeline Crisis Center Follow-Up Expansion Grant Program: 3 awards, $3,000,000
- Networking, Certifying, and Training Suicide Prevention Lifelines and Disaster Distress Helpline: 1 supplemental award, $7,000,000
By Dona Dmitrovic, Director, Center for Substance Abuse Prevention
The global coronavirus pandemic has forced us to learn new ways of doing many things. Employees in some job sectors learned to work from home, while others had to find entirely new sources of income. Parents learned to be teachers for their kids, while teachers themselves learned to do their jobs in less-than-ideal remote environments. We figured out how to use technology to celebrate birthday parties, host award shows, and even conduct a presidential inauguration.
One thing we can do to benefit ourselves as a nation is talking with friends, family, and neighbors about underage drinking and adult problem drinking prevention.
According to the 2019 National Survey on Drug Use and Health, 54.3 percent (or 18.3 million) people ages 18 to 25 and 55 percent (or 119.1 million) people ages 26 or older drank alcohol in the past month. Alcohol misuse stays under the radar in our society, especially when it comes to the alcohol use of adults. After all, it’s a legal substance for those over age 21 and so many American adults drink socially and responsibly. Others, however, develop alcohol use disorders, and it can be difficult to determine how and whether to intervene.
SAMHSA’s Center for Substance Abuse Prevention (CSAP) has resources to help facilitate these conversations.
Many of our key initiatives—such as Communities Talk to Prevent Underage Drinking and “Talk. They Hear You.”—are focused on keeping alcohol out of the hands of children and young adults. This is an important age group because alcohol use patterns that start early can last a lifetime. Early initiation of drinking is associated with development of an alcohol use disorder later in life.
But we know that the problem of alcohol misuse goes well beyond this age group. In the era of COVID-19, we’ve seen increases in alcohol use that appear to be linked with pandemic-related stress. Among adults ages 18 and older, 13.3 percent (1 in 10) reported that they started or increased substance use to cope with stress or emotions related to COVID-19. Of course, the pandemic is just one among many factors that is likely contributing to these increases.
According to findings in December 2020 by the Drug Abuse Warning Network (DAWN)—a nationwide public health surveillance system administered by SAMHSA’s Center for Behavioral Health Statistics and Quality—96 percent of reported alcohol-related emergency department (ED) visits between January and August that were due to only alcohol misuse involved those 21 years old or older. Interestingly, alcohol was the most common substance involved in substance-related ED visits (45.1 percent).
The realities indicated by the data are troubling and they demand action. SAMHSA and its partners and the thousands of prevention professionals across the country are committed to making a difference across the populations who misuse alcohol.
We know that while prevention often begins with a conversation, it must go even further. It involves the choices we make for ourselves, in support of those closest to us and our entire communities. It involves looking at the science and the evidence to develop and implement prevention activities in which everyone can a play role. And while the energy may be a little different if such activities take place virtually, there is a lot we can achieve by expanding the universe of ways we “live” prevention.
We’ve learned how to keep substance misuse prevention—including underage drinking prevention—alive and well despite social distancing guidelines. The prevention of problem drinking among all adults calls for the same level of innovation and tenacity.
National Prevention Week (NPW)—which is celebrating its 10th anniversary this year—gives us an opportunity to promote collective strategies that work in communities. And when reflecting on the NPW activities over the last 10 years, I’m reminded that prevention is for everyone.
With today’s NPW focus on preventing underage drinking and alcohol misuse, it’s a good time to reinforce all the ways we can move prevention forward across age groups.
If you or someone you know is experiencing alcohol misuse, no matter their age, I encourage you to connect with the National Drug and Alcohol Treatment Referral Routing Service, available at 1-800-662-HELP (4357). This service is confidential and free to use.
We know the risk factors. We know the symptoms. And we know the serious and potentially life-altering consequences of alcohol misuse. We should be quick to openly address the realities associated with problem drinking among adults by speaking up when someone we know may be misusing alcohol, encouraging candid conversations about the issue and implementing adult-focused prevention strategies in our communities.
Anita Everett M.D. DFAPA, Director, Center for Mental Health Services
National suicide rates are rising, and this is especially true for our nation’s youth suicide rate. Suicide is largely a preventable cause of death, and you are more able to help prevent it than you might think.
Suicide is the result of actions being connected to a self-harm idea. Many more people think about suicide than those who die by suicide; however, no one dies by suicide without having thought about it first. There is a thinking-planning phase followed by an action phase. The thinking phase is different for different people: Sometimes it is recurring and intense. Other times it may be fleeting.
There is a suicide sequence that can be interrupted, and those interruptions can be lifesaving. There are several strategies for preventing suicide that have been developed for various settings. Generally, there are several components in these trainings that aim to separate a person’s thinking of suicide from their acting on suicidal thoughts.
Being aware of signs that something has changed in a person’s life that might make them susceptible to suicide is an important initial step. One sign that a person might be having thoughts of suicide would be indications that they already might be engaging in self-harming behaviors. Non-suicidal self-harm often can be a precursor to a suicide attempt. Reaching out to the person in a caring, respectful way is a next important step. The third step is to gently challenge negative thoughts that often accompany or precede suicidal thoughts, and the final step is to encourage the person to seek help or to take some other positive action.
An example of this type of training strategy is the be NICE program that has been widely used and promoted by the Mental Health Foundation of West Michigan. This suicide prevention program uses the acronym “NICE” to represent intervention steps. Here, “N” is for noticing the people in your environment, and “I” is for inviting a person into a conversation that creates a safe space to talk about their worries. “C” is for challenging them to think of themselves as worthy of treatment, and “E” is for encouraging them to feel empowered to get help.
Suicide is preventable. Negative thoughts don’t have to lead to painful actions. Working together, we can make a difference!
Roxana A. Hernandez, MPH, Shayla C. Anderson, MPH, CHES, Mary Roary, PhD, MBA - Oficina de Equidad en Salud Mental (OBHE)
By Roxana A. Hernandez, MPH, Shayla C. Anderson, MPH, CHES, Mary Roary, PhD, MBA - Office of Behavioral Health Equity
By Robert Baillieu M.D., M.P.H., Physician and Senior Clinical and Practice Advisor, Center for Substance Abuse Treatment
In managing or preventing substance use disorders, nothing should occur in isolation. People and systems of care are complex. They require frequent observation, assessment and understanding. To this end, systems focused on medical models, statistics and abstract ideas do not take fully into account the reality of a patient’s situation and place too great an emphasis on the individual as being the source of their own suffering. Such paradigms, while accepting that individuals must make their own health decisions, perhaps negate the influence of social systems and existing policy on health outcomes. In working towards the prevention of substance use disorders, it is important to appreciate those social determinants of health, policies and actions that precipitate adverse outcomes. Furthermore, empowering stakeholders to engage with clinicians and policy makers on issues related to treatment and prevention, is an essential step in understanding what is needed, and how best practices might be implemented.