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Behavioral Health: Challenges and Opportunities in Indian Country

Pamela S. Hyde, J.D.SAMHSA Administrator

National Indian Health Board (NIHB)40th Anniversary Celebration

29th Annual Consumer Conference Denver, CO • September 25, 2012

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CONGRATULATIONS NIHB AND SAMHSA

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SAMHSA’S ROLES

Leadership and Voice

Funding - Service Capacity Development

Information/Communications

Regulation and Standard setting

Practice Improvement

Data and surveillance

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CHALLENGES IN AI/AN COMMUNITIES

Higher rates of substance dependence and abuseHigher past month binge alcohol useHigher past month illicit drug useHigher current tobacco useHigher youth suicide ratesHigher adolescent death ratesHigher sexual assault rates against femalesHigher homicide rates against women Higher rates of intimate partner violence against womenHigher rates of incarceration and arrestHigher rates of historical trauma

Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2011

Fig7.1

Numbers in Millions

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Both Alcoholand Illicit Drugs

Alcohol Only

Illicit Drugs Only

+ Difference between this estimate and the 2011 estimate is statistically significant at the .05 level.

Note: Due to rounding, the stacked bar totals may not add to the overall total.

22.0+ 21.622.5+ 22.7+ 22.4+ 22.4+22.2+ 22.6+ 22.2+

20.6

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2011 RATE OF SUBSTANCE DEPENDENCE OR ABUSE 12 AND ↑: RACE/ETHNICITY

SAMHSA, CBHSQ, 2011 NSDUH

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2011 RATE OF BINGE ALCOHOL USE 12 AND ↑: RACE/ETHNICITY

SAMHSA, CBHSQ, 2011 NSDUH

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2011 RATE OF CURRENT ILLICIT DRUG USE 12 AND ↑: RACE/ETHNICITY

SAMHSA, CBHSQ, 2011 NSDUH

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2011 RATE OF CURRENT TOBACCO USE 12 AND ↑: RACE/ETHNICITY

SAMHSA, CBHSQ, 2011 NSDUH

Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use:

2011

19.3 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use

Felt They Needed Treatment and Did

Make an Effort

Did Not Feel They Needed Treatment Felt They Needed

Treatment and Did Not Make an Effort

1.5%

Fig7.10

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3.3%

95.3%

Note: The percentages do not add to 100 percent due to rounding.

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NEED FOR AND RECEIPT OF TREATMENT FOR AN ILLICIT DRUG OR ALCOHOL PROBLEM

PAST YEAR, AGED 12 ↑: DEMOGRAPHIC CHARACTERISTICS

SAMHSA, CBHSQ, 2011 NSDUH

2011: Percent Needed Treatment 2011: Percent Needed but Did Not Receive Treatment

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SUICIDE AND SUICIDE PREVENTION

National Action Alliance for Suicide Prevention – part of National Prevention Strategy

• June 26th: Summit , updates from all 14 Task Forces

• June 27th AI/AN research subcommittee Mtg at IHS Conf

NSSP released by SG on Sept 10, 2012

HHS Secretary Sebelius announced $55.6 million in new grants; under the GLS Memorial Act; partially funded by ACA

Last year’s GLS grants included a new cohort of 38 grants; 22 were Tribal grantees

Over 11 million Americans seriously consider suicide each year and over 38,000 died (2010) from this public health issue

America loses approximately 100 people every 24 hours

Suicide: 2nd leading cause of death for AI/AN youth in the 15-24 age group, 2.5x national rate for this age group

Higher risk: young and middle-aged AI/AN

• Ages 15 – 24: Rates of 31.59 per 100,000

• Ages 40 – 59: Rates of 19.43 per 100,000

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STAC and SAMHSA TTAC (webcast on August 24th)Tribal Law & Order Act (TLOA): HHS (IHS, SAMHSA), DOI (BIA,BIE),

DOJ• IASA Intradepartmental Coordinating Committee – Meets monthly• Rodney Robinson, Northern Cheyenne, new Director of OIASA

– SA prevention, intervention, and treatment – most recently TAPs w/set of tribes in Montana

• OIASA website with newsletter at http://www.samhsa.gov/tloa• TLOA webinars: MOA & TAPs (9/12) and Tribal Justice Plan (9/19)

Behavioral Health –Tribal Prevention Grant (BH-TPG)• First proposed in President’s FY 12 Budget• No appropriation in FY 12 ; is in FY 13 Budget request

SAMHSA TRIBAL EFFORTS AND INTIATIVES – FULFILLING FEDERAL TRUST RESPONSIBILITIES

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SAMHSA BEHAVIORAL HEALTH – TRIBAL PREVENTION GRANT (BH-TPG)

FOCUS ON PREVENTION OF SUBSTANCE ABUSE AND SUICIDE

SAMHSA coordinates w/IHS to implement community-based prevention strategies that complement clinical services provided by IHS-funded providers

Non-competitive application process for all federally recognized tribes who want the funds

“Application” every 3 years with annual reporting

Formula to be determined based on 2011 consultations w/ tribal leaders – base amount + additional $ based on formula

Flexibility for tribes to use their approaches

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CHANGES TO BLOCK GRANT APPLICATION PROCESS

Changes to SA and MH Block Grant app’s driven by TLOA, ACA, and MHPAEA

Trying to ensure SMHAs/SSAs are well positioned during FY 2014 and FY 2015

Both MHBG and SABG applications due on same date – April 1, 2013

30 day FRN soon – out to states Nov/Dec 2012

Option to do joint or two separate applications

Reports and reporting periods now same for both MHBG and SABG

• Annual report due dates and annual expenditure reporting periods consistent across both

Plan will cover a two year period (7/1/13-6/30/15) – W/option to amend

Strongly encouraged to show evidence of tribal consultation or must show evidence of tribal input

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BG APP IN 3 MAJOR SECTIONS: INTRODUCTION, IMPLICATION, AND PLANNING

• Trauma• Justice• Parity Education• Primary and BH Care Integration

Activities• Health Disparities• Recovery• Prevention• Children and Adolescents BH

Services

• Health Reform• Coverage of M/SUD services• Affordable Insurance

Exchanges• Use of Evidence in Purchasing

Decisions• Program Integrity• Tribes• Quality

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OTHER EXAMPLES - SAMHSA TRIBAL EFFORTS, INITIATIVES, AND ACTIVITIES

Improving access to grants• ICNAA Matrix of funding opportunities; Tribal eligible programs• August 2012: Tribal grant-writing webinar • SAMHSA roundtable on improving access planned for this fall• E.g., Project LAUNCH – Linking Actions for Unmet Needs in Children’s

Health – CA w/awards up to $850,000 for up to 5 years– RFA included 5 point preference for Tribal applicants – Text was re-written to align w/Tribal Governance infrastructures– Prior only 1 Tribal grantee; 46 percent of this year’s applicants were

from tribes; in FY 12, 6 of 11 new awards will go to tribes

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SAMHSA AI/AN Team (SAIANT) – meets monthly; cross coordination on AI/AN efforts• Annual Project Officer training; rescheduled to October 24th – 26th • Planning fall Tribal Policy Academy on strategic planning use of Tribal facilities• On-gong: Audits/complaints

SAMHSA’s Office of Behavioral Health Equity (OBHE)• Coordinates agency efforts to ↓ BH disparities for diverse populations • NNED - National Network to Eliminate Disparities in BH

July 2012: ICRC training webinar to support Prevention Specialist Certification for Ho-Chunk and Navajo Nation; also statewide Tribal representatives meeting w/Wisconsin BH

September 2012: SAMHSA’s Native American Center for Excellence webinar on Native Two-Spirit (LGBT) issues; over 680 participants; recorded and will be available on-line

SAMHSA TRIBAL EFFORTS, INITIATIVES, AND ACTIVITIES (CONT’D)