Remarks by
Frances Randolph D.P.H.
Director

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

IHS/SAMHSA National Behavioral Health Conference


San Diego, CA
June 7, 2006

PowerPoint version

Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.

SLIDE 1—TITLE

Thank you for your kind introduction, Jon/Mr. Perez.

Good morning. It’s a privilege to speak to you today on behalf of Kathryn Power, the director of the Center for Mental Health Services (CMHS). Director Power is currently in Scotland at a meeting of the International Initiative for Mental Health Leadership (IIMHL). The IIMHL is a group of mental health leaders from Canada, Australia, New Zealand, and the United Kingdom. The purpose of their meetings is to help them identify ways to effectively improve mental health care policies and practices for citizens around the world.

Last year, the IIMHL met in New Zealand. New Zealand’s work with indigenous peoples serves as a model for how to better integrate the strengths and values of native people into behavioral health care. This year, the IIMHL will be addressing the issue of social inclusion. Social inclusion ensures that individuals with a mental or substance use disorder can remain valued members of their communities…that they can have homes and jobs and meaningful relationships with others as they seek recovery. This is an issue that crosses all geographic and cultural boundaries. Social inclusion is just as important to the people in this room as it is to cultural and ethnic groups in any country.

Director Power regrets that her participation in the IIMHL meeting conflicts with your conference. She has asked that I convey her sincerest wishes for a successful meeting. She also wants you to know that the needs of American Indians and Alaskan Natives remain in her thoughts and are a major concern within CMHS.

SLIDE 2—– ORG CHART/CMHS MISSION

CMHS is one of three centers within the Substance Abuse and Mental Health Services Administration (SAMHSA). Our role is to lead national efforts in promoting mental health and facilitating recovery from mental illnesses. We work to improve and increase the quality and variety of treatment, rehabilitation, and support services for all children and adults with or at risk for mental health problems, their families, and communities. We also collect new data, evaluate programs to determine which work best and for whom, and share the latest information with the field.

SLIDE 3—THE FOUR REDWOODS

SAMHSA, through CMHS, is leading a national drive to transform mental health care for all Americans. Mental health transformation is one of the four top priority programs within SAMHSA, together with reducing substance abuse and co-occurring disorders and strengthening prevention efforts.

Our effort was prompted in part by the President’s New Freedom Commission’s Report on Mental Health. The Commission declared that the time has passed for piecemeal reform…that what we really needed to do was fundamentally change how our Nation views, provides, and finances mental health care. Among the goals set forth by the commission are to make care more consumer and family driven and to eliminate disparities of care for minorities and people who live in rural and other underserved areas.

We’re excited by the possibilities of transformation, which will ultimately result in the high-quality mental health care that all Americans need and deserve. Transformation represents a tremendous shift: from a system that manages symptoms to one in which recovery is the EXPECTED outcome of treatment.

Transformation rejects a “cookie cutter” approach to treatment. Each individual faces unique challenges in achieving and sustaining recovery. There may be events and circumstances in a person’s life that have made him or her more vulnerable to a mental or substance use disorder. These factors may make recovery more difficult. However, each individual also possesses unique strengths that can aid recovery and build resilience. Many of these strengths are rooted in the values and beliefs of a person’s culture and community. Part of transformation is to acknowledge the healing power of cultural values and beliefs and to integrate them into prevention and treatment practices.

Today, I want to briefly discuss some of the challenges facing the American Indian and Alaska Native communities. I also will describe some of the ways SAMHSA and CMHS are working with native communities to develop culturally appropriate responses.

SLIDE 4—ROLE OF CULTURE

Let’s start by defining the role of culture in treatment. Culture is critical in determining what people bring to the clinical setting. It affects the language we use, how we express and report our concerns, how we seek help, the development of coping styles and social supports, and the degree to which we attach stigma to behavioral health problems.

At this time, most service providers simply don’t know enough about native cultures and the differences between them to provide culturally appropriate services…or to train providers in how to honor diversity. To close the cultural gap, SAMHSA has asked American Indians and Alaska Natives to help guide our efforts to develop effective practices for their communities. This is how we can create stronger programs: through collaborations that respond most effectively to the people being served.

Traditional interventions have enormous potential to prevent and treat mental disorders and substance abuse in native communities. By acknowledging that traditional interventions can be best practices, we can honor and affirm their power to change lives. We are pleased that the Suicide Prevention Resource Center and the American Association of Suicidology are presenting a conference workshop on cultural competencies in suicide prevention.

Cultural competency must be part of the solution to every mental health challenge confronting American Indian and Alaska Native communities. A primary challenge is substance abuse, which is closely linked with mental health disorders. Compared to other cultural and ethnic groups, American Indians and Alaska Natives are disproportionately affected by diseases and death due to alcohol and other substance abuse. They also appear more vulnerable to mental illnesses. According to SAMHSA’s National Survey on Drug Use and Health, American Indians and Alaska Natives have the highest incidence of serious mental illnesses compared to other groups.

Substance abuse and mental health disorders are real and disabling conditions. Research and practice is revealing that the two disorders frequently overlap. If left untreated—or if only one disorder is treated, both disorders usually get worse. Additional complications often arise. These complications include the risk for physical health problems, unemployment, homelessness, incarceration, separation from families and friends, premature death, and suicide. The toll on families, schools, communities, and the workplace is more than any society can afford.

SLIDE 5—CO-OCCURRING CENTER FOR EXCELLENCE

SAMHSA and CMHS are responding to the issue of co-occurring disorders in several ways: by making evidence-based practices more available, by awarding grants to expand the use of integrated treatment, and by offering technical assistance and training in integrated treatment options through the Co-Occurring Center for Excellence.

SLIDE 6—TIP 42

One of our recent efforts is Treatment Improvement Protocol 42: Substance Abuse Treatment for Persons with Co-Occurring Disorders. Tip 42 offers a variety of practical evidence- and consensus-based approaches to integrated treatment. A section on mental disorders contains information about how to integrate treatment of substance abuse and specific mental disorders. I’ve brought forms with me today for you to use to order a free copy of the TIP. SAMHSA’s Web site also offers the latest reports, data, and information on co-occurring disorders. I encourage you to visit the site regularly and to take advantage of the resources it offers.

SLIDE 7—CIRCLES OF CARE

Of course, we are all deeply concerned about our Nation’s children and youth. One way CMHS is supporting children in American Indian communities is through our Circles of Care grant program. Currently, seven tribal communities are grant recipients. The program is designed to help communities build the infrastructure necessary to increase the capacity and effectiveness of their behavioral health systems. It also helps them to reduce the gap between the need for and availability of services.

The participation of consumers, family members, tribal leaders, and spiritual advisors in the design and development of services guarantees that they are based on values and principles they feel are most important. This is a perfect example of transformation’s elasticity. The models developed by native communities will be based on the needs and gaps, resources, and goals of the people living in them.

I want to touch on just one more challenge confronting American Indians and Alaska Natives. This challenge is suicide. Suicide is robbing American Indian communities of their most valuable resources: their children and their future. Suicide is the last, desperate act by individuals whose mental health needs have not been identified, treated, or adequately addressed.

In his testimony before the Senate’s Indian Affairs Committee last year, Surgeon General Richard Carmona said, “Suicide is not a single problem; rather, it is a single response to multiple problems.” Mental and substance use disorders usually play a major role in the tragedy of suicide. We must play an equally strong role in ending it.

SLIDE 8—SAMHSA’S RESPONSE

In essence, all of SAMHSA’s programs are suicide prevention programs. They are designed to facilitate recovery, promote resilience, and prevent and treat substance abuse and mental illness—some of the root causes of suicides.

We also target suicide prevention more directly. I’m only going to highlight a few of SAMHSA’s many programs.

SLIDE 9—SAMHSA’S BUDGET

SAMHSA has allocated approximately $35 million for direct suicide prevention grants and other programs. These programs include the National Suicide Prevention Lifeline, the Suicide Prevention Resource Center, and The Garrett Lee Smith Memorial Act grant program. An increase of nearly $3 million is slated for a new American Indian and Alaska Native suicide prevention initiative.

A few other efforts specifically targeted at suicide prevention for American Indians and Alaska Natives include:

• The Garrett Lee Smith Memorial Act grants to four tribal communities for suicide prevention and early intervention.
• A $1-million grant to help establish the One Sky Center, which is helping to identify and develop culturally specific intervention programs.
• $200,000 for a multiyear collaboration between the Indian Health Service (IHS), CMHS, and tribes nationwide to build greater capacity within tribes to address suicide cluster response and suicide prevention.

We also are participating in a Federal steering committee led by the IHS and the Surgeon General’s Office to develop a national suicide prevention initiative for American Indians. And we will be funding a policy summit on strategic planning for suicide prevention, intervention, and healing. Our goal is to bring national attention to the crisis of American Indian youth suicide. Our partners in this effort include the National Congress of American Indians, the National Indian Child Welfare Association, the National Indian Health Board, IHS, and the Georgetown University Center for Child and Human Development.

In addition to these long-term activities, we also provide emergency funding when the tragedy of suicide strikes. SAMHSA and CMHS remain part of a major interagency effort to support the needs of the Red Lake and Standing Rock Reservations in the aftermath of the terrible events that took place there.

The activities I have just described fit within our ongoing efforts to transform mental health care for all Americans. We are engaged in a national effort to create a mental health system that is consumer driven and focused on recovery. We are moving toward our goal, in part, by working with communities to improve cultural competency and to eliminate disparities.

All Americans deserve equal access to services and supports that can protect and promote sound mental health. Ensuring this access is the only way SAMHSA, CMHS, and collaborating organizations can fulfill the vision of “a life in the community for everyone.”

SLIDE 10—QUOTE

SAMHSA and CMHS are responding to the issue of co-occurring disorders in several ways: by making evidence-based practices more available, by awarding grants to expand the use of integrated treatment, and by offering technical assistance and training in integrated treatment options through the Co-Occurring Center for Excellence.

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