Remarks by
Anne Mathews-Younes, Ed.D.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Substance Abuse and Mental Health Professionals: Fellow Travelers On the Road to Healthier Communities
New York, NY
August 29, 2005
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 slide]
Thank you for that introduction…and my thanks to the conference organizers for including a representative from the Center of Mental Health Services (CMHS) in this plenary session. We mental health professionals always welcome the opportunity to meet with substance abuse professionals. For the past several years, your field has led the way in promoting the concepts of prevention and recovery. My field has been able to follow, for the benefit of the millions of Americans with or at risk of developing mental illnesses. On their behalf, I thank you for your pioneering efforts.
Mental health and substance abuse professionals are fellow travelers on the road to healthier communities through prevention. In fact, we share common opportunities to achieve our goal because we so often serve the same at-risk population. Our commonalities point us in the best direction, which is to work together. We can reach our common destination faster, and with less effort and fewer resources, if—in effect—we carpool.
As Administrator Curie mentioned, SAMHSA annually conducts the National Survey on Drug Use and Health. In 2003, more than 19 million Americans had a serious mental illness. More than 22 million Americans had a serious substance abuse disorder.
[SLIDE 2. SMI/SA overlap]
Of these, approximately 4 million Americans had co-occurring disorders. Four million! This figure represents the estimated number of individuals who had both a serious mental illness and a serious substance abuse disorder. If we include those with less severe mental and substance abuse disorders, the number of Americans with co-occurring disorders would be much higher.
We see these individuals in our clinical practices. Fifty to 75 percent of consumers in substance abuse treatment programs have co-occurring mental illnesses. Twenty to 50 percent of those treated in mental health settings have co-occurring substance abuse. Co-occurring disorders are so common that they should be considered the norm and not the exception of persons seeking treatment in behavioral health settings.
Science has yet to find a genetic vulnerability that would cause both disorders to strike the same person. Some serious mental illnesses appear to increase the risk for substance abuse. Conversely, substance abuse may worsen or hasten psychiatric disorders in persons who are genetically predisposed.
The complexity of co-occurring disorders challenges our traditional—and frequently separate—approaches to mental and substance abuse disorders. We tend to put people into “disease categories,” which often have been created by funding streams. But this division is not reality nor does it reflect our greatest opportunity for prevention. If we work together to prevent and treat both disorders, we will reduce the prevalence of either disorder. This is a truly transformational idea!—We serve our own constituency best when we also work to prevent multiple disorders!
[SLIDE 3. Four redwoods]
Many of you will be familiar with the concept of mental health transformation. It is one of SAMHSA’s four redwood, or priority, programs that involve all three of SAMHSA’s centers. Don’t think of these programs as stand-alone trees. Instead, think of them as a small forest of redwoods with intertwined branches. The success we achieve in any of these programs will promote growing success in the other three.
For the past 2 years, SAMHSA, through the Center for Mental Health Services, has been leading the Federal effort to transform the national mental health system.
[SLIDE 4. Federal Partners Workgroup]
Nine U.S. Departments and the Social Security Administration now are members of our Federal Partners Workgroup. Together, we are responding to the final report by the President’s New Freedom Commission on Mental Health, which called for a system that is consumer driven and focused on recovery. “Consumer driven” means that each adult and each child and family will have full access to the services and supports they need to build resilience and to facilitate recovery.
[SLIDE 5. Action Agenda]
Last month, SAMHSA released a document called Transforming Mental Health Care in America: TheFederal Action Agenda. This document summarizes the actions being taken by members of our Federal Partners Workgroup to change the very form and function of our mental health system. Copies of the report are available to you at the SAMHSA exhibit booth.
Our report, similar to the report by the New Freedom Commission, addresses co-occurring disorders in the broader context of transformed mental health services. There is a reason for this. Transforming services for individuals with co-occurring disorders is as basic to mental health transformation as equal opportunity is to civil rights. Prevention and treatment of co-occurring disorders define what is meant by consumer-driven recovery.
- Consumer-driven recovery becomes possible when individuals are able to seek treatment willingly, openly, and with hope.
- Consumer-driven recovery becomes possible when we offer evidence-based treatments that work for different populations and in different settings.
- Consumer-driven recovery becomes possible when we screen for disorders across the lifespan and across systems, such as the child welfare and juvenile justice systems. It becomes possible when any door becomes the right door for treatment.
- Consumer-driven recovery becomes possible when we eliminate the division that exists between prevention and treatment. Prevention means more than preventing the onset of a disorder. Prevention also includes the prevention of co-morbidity, relapse, and disability. Under this definition, treatment to support recovery from co-occurring disorders is prevention.
Mental health transformation, similar to the SAMHSA’s Strategic Prevention Framework, is based on the public health model. This model stresses the links between health and the physical, psychological, cultural, and social environments in which people live, work, and go to school. Its premise is that it is inherently better to promote health and prevent illness before it begins.
One key principle of the Strategic Prevention Framework is extremely relevant to transforming services for individuals with co-occurring disorders. This principle states: “Common risk and protective factors exist for many mental health and substance abuse problems. Good prevention focuses on common risk factors that can be altered.”
A couple of years ago, the Center for Mental Health Services looked at prevention programs in SAMHSA’s National Registry of Evidence-Based Programs and Practices. We reviewed 29 model programs to prevent substance abuse. We found that nine of these programs also increased protective factors and decreased risk factors for depression, anxiety, and conduct disorders. It is these programs—the ones that target common risk factors for multiple disorders—that represent the future of prevention research.
The Center for Mental Health Services is working across and outside of SAMHSA to promote integrated efforts. We have tremendous opportunities through collaboration to prevent both mental and substance use disorders.
[SLIDE 6. Co-occurring activities]
Administrator Curie mentioned our State incentive grants for co-occurring disorders and our national policy academies for co-occurring substance abuse and mental disorders. The Center for Mental Health Services and the Center for Substance Abuse Treatment also co-fund the Co-Occurring Center for Excellence, which is the first national resource on co-occurring disorders.
[SLIDE 7. COCE]
The Co-Occurring Center for Excellence provides information about evidence and consensus-based practices for preventing and treating co-occurring disorders. It also offers technical assistance and training for implementing these practices. The Co-Occurring Center for Excellence is a resource immediately available to every person in this audience. Never before has so much information about co-occurring disorders been available from the Federal to the clinical level.
The efforts undertaken by SAMHSA and its three centers provide a model of collaboration for the prevention research field. We serve a common population. We face common problems. We should strive to take full advantage of common opportunities.
As we head down the prevention avenue toward healthier communities, we can be optimistic. Last May, the Society for Prevention Research met in Washington, DC. There was widespread agreement that the intensive research conducted during the past two decades has produced a substantial number of evidence-based prevention practices. In addition, there is a growing market for these practices among increasingly sophisticated community-based users.
We’ve now reached the juncture in the road where we have to choose our next route. The Society for Prevention Research suggests that we focus on distributing the most effective practices we now have. In the meantime, we can develop and test other promising practices.
[SLIDE 8. Science to service cycle]
We also must intensify our efforts to integrate science—or research—and service. Science to service should be a cyclical process. It can help to ensure that what works under controlled research conditions—or efficacy—is translated into practical, high-quality real-world services—or effectiveness.
Science is continuously developing new and potentially more effective prevention methods. The next part of the process is for service to inform science—to use the lessons learned through clinical practice to refine available practices, to further develop the research agenda, and to fill in voids in the knowledge base.
There are other critical next steps we can take to promote prevention. We can insist that community-based prevention programs be data-based, and that collaboration becomes the foundation of community efforts. The very heart of prevention is the community. To paraphrase Martin Luther King, Jr., “ At the heart of all that civilization has meant and developed is ‘community’—the mutually cooperative and voluntary venture of [people] to assume a semblance of responsibility for [others].”
My challenge for this audience is to help identify how we can achieve greater collaboration among those involved with individuals with or at risk of co-occurring mental and substance abuse disorders. How can we work together better to promote prevention and recovery among those we serve? I offer you these ideas as a start.
[SLIDE 9. Proposed actions]
We can :
- Embrace a behavioral health perspective that honors the “whole person”—mind and body;
- Adopt a consensus definition of recovery;
- Encourage professionals in primary care, and mental, substance abuse, and behavioral health care to share experiences as a community; and
- Model the collaborative behaviors we want to promote.
Our most important mission is to become partners in prevention, which also will include treatment. When we work together to prevent mental and substance abuse disorders, we are doing more than transforming our mental health system.
[SLIDE 10. Closing slide]
We also are creating healthier communities for all Americans. Most important, we are transforming lives. May you have an extremely successful conference. Thank you.
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