Remarks by
A. Kathryn Power, M.Ed.
Director

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

Fourth SAMHSA/CMS Conference on Medicaid and Mental Health and Substance Abuse Treatment

September 11, 2006
Arlington, VA

Good morning. Welcome to the fourth Conference on Medicaid and Mental Health and Substance Abuse Treatment. This conference is hosted by the Substance Abuse and Mental Health Services Administration, in partnership with the Centers for Medicare and Medicaid Services (CMS). During the next 2 days, you’ll be learning more about issues that profoundly affect the ability of our organizations to achieve our related missions. The rising demand for mental health services compared to available funding requires that we address these issues creatively, collaboratively, and quickly. Never before has it been so urgent for us to find ways to align our programs for the good of the individuals we jointly serve.

As in past years, this conference provides a forum to discuss current policies and research related to the coverage and use of mental and substance abuse treatment services under Medicaid. To start the discussion, let’s consider agency missions and resources. SAMHSA’s mission is to improve the availability and accessibility of high-quality, community-based services for people with or at risk for mental and substance abuse disorders. We strive to develop policies that motivate, facilitate, and compel better service delivery at the State level. We have a budget of about $3.2 billion and a staff of about 550. Our budget, by the way, is roughly 60 percent more than that of the National Institute of Mental Health (NIMH). NIMH conducts basic research into the causes, treatment, and prevention of mental and substance abuse disorders. It has a budget of $1.4 billion and a staff of about 700.

The mission of CMS is to ensure health care security for those in need. It provides treatment to individuals who are among our Nation’s least able to afford high-quality care and the most vulnerable to poor health conditions, including mental and substance use disorders. For Fiscal Year 2007, CMS has a budget of about $663 billion and a staff of 4,800. The budget for CMS is 144 times the budget of SAMHSA and NIMH combined!

What do these figures tell us? Small agencies such as SAMHSA and NIMH are going to have to work harder within their resources to align research, policy, and services. We need to bridge the gap between science and service and accelerate the time it takes for effective research to become clinical practice.

A large agency, such as CMS, is going to have to be more focused in seeing that sufficient funds are allocated to meeting the growing demand for evidence-based services. CMS is the principal funding arm of publicly supported mental health services. As such, it must be a really strong arm, capable of embracing all eligible individuals and the services that support their recovery. How Medicaid policies are designed and how payment rates are determined significantly affect what services are provided and who has access to them.

As Director of SAMHSA’s Center for Mental Health Services, I thank our partners at CMS for their invaluable help in organizing this conference. Financing of public mental health services is a key element of mental health transformation, which is our ongoing Federal initiative to change the way we view and provide mental health care in this country. The ultimate goal of transformation is this: to ensure that everyone with a mental illness will have equal access to the services and supports that will enable a person to recover and to live, work, and participate fully in the community.

Nine Federal departments and 14 agencies and offices within Health and Human Services, including CMS, have joined together to move transformation forward. Our efforts are guided by the Federal Action Agenda, which outlines the steps we will take to better align our resources and programs related to mental health.

Similar to transformation itself, the Federal Action Agenda reflects a continuous process that is meant to create or anticipate the future. It is a living document that will evolve as issues and programs develop and as progress is made. Because the need for improved service delivery is so broad, the impetus so strong, and the opportunities so great, mental health transformation transcends administrators and administrations. SAMHSA’s efforts to lead transformation will continue undiminished and unabated.

CMS is one of SAMHSA’s foremost partners in mental health transformation. Medicaid’s role in service delivery is so significant that transformation cannot happen without Medicaid’s full involvement. Consider the growing impact of Medicaid on State programs. Medicaid now funds more than half of all public mental health services provided by the States. If this trend continues—as is predicted—Medicaid will be financing nearly 70 percent of State mental health services within 10 to 15 years.

The agenda for this conference highlights some of the challenges affecting Medicaid coverage of mental health services. This year, for the first time, we are focusing on substance abuse. Many thanks to our colleagues at SAMHSA’s Center for Substance Abuse Treatment for their outstanding work in developing the workshops and presentations being offered.

Substance abuse, as a mental health problem, has serious implications for research, policy, and funding. A major issue is the frequently overlapping relationship between substance abuse and other mental health problems. Each year, SAMHSA conducts the National Survey on Drug Use and Health. We just announced the latest survey results last week. For 2005, about 25 million adults experienced serious psychological distress. Another 22 million had a serious substance abuse disorder. More than 5 million adults had both a serious mental disorder and a serious substance abuse disorder.

The health care impact of co-occurring disorders is phenomenal! In comparison to individuals with a single disorder, individuals with dual disorders tend to experience more symptoms and have multiple health and social problems. They require more costly care, including inpatient hospitalization. Many are at increased risk of homelessness and incarceration, which further threatens their health status. If only one disorder is treated, both tend to get worse.

Let me give you a better grasp of the dimension of the problem. The number of adults with co-occurring disorders is about the same as the adult population of Virginia. Imagine if every man and woman you see on the streets outside has at least two disorders requiring treatment. How can we adequately meet the service needs of so large a population?

Our agenda illustrates why collaboration will be essential to addressing the complex mental health care challenges that confront us. These are known problems. On this day, however, we must acknowledge that we also must prepare for the unknown. Five years ago today, on September 11, 2001, terrorists struck the World Trade Center in New York City and the Pentagon here in Arlington. Never before has our Nation experienced such a widespread demand for swift, compassionate, and accessible behavioral health services. In New York City alone, CMS made a tremendous effort to accommodate the emergency health needs of the hundreds of thousands of individuals who newly enrolled in Disaster Relief Medicaid.

No one who witnesses or is victimized by a tragedy of the magnitude of 9/11—or by the hurricanes of last year— remains untouched. The need for mental health services following trauma can be enormous and long-lasting…and we must have policies and practices in place that can respond adequately. We can move forward from these recent tragedies by encouraging all of the States to consider Medicaid policies and procedures as an essential part of their disaster planning.

Within each of the challenges we face lies opportunity. We have enormous potential to improve and expand mental health care by better aligning research, policy, and funding. Peer specialist services, for example, are proving successful in promoting recovery. Georgia was one of the first States to offer Medicaid-funded peer specialist services. Its CMS pilot program, headed by Larry Fricks, now serves as a model for other States. To further expand the use of peer specialist services, SAMHSA and CMS have been developing guide books on how States can create their own programs. We hope to publish the books soon. Our collaborative effort in promoting peer specialist services is a shining example of the excellent outcomes that occur when we share and explore innovative ideas.

We have many opportunities to transform mental health services by working closely together. Use this conference to discuss common concerns, to propose shared solutions, and to build continuing channels of communication. Keep the exchange of ideas flowing throughout the year! As Alexander Graham Bell observed, “Great discoveries and improvements invariably involve the cooperation of many minds.”

Each of you has a role in mental health transformation; each of you can contribute to shared efforts to provide services that are high quality as well as more efficient and cost-effective. Millions of Americans with serious mental and substance abuse disorders are counting on us to provide them with the care they need and deserve. Through collaboration, we will succeed. Thank you.