Behavioral Health: Challenges and Opportunities in Indian Country

Pamela S. Hyde, J.D.SAMHSA Administrator

National Indian Health Board (NIHB)Board Meeting

Washington, DC • January 24, 2012

FOCUS AREAS FOR TODAY’S DISCUSSION

BUDGET UPDATE & REVISED APPROACH GRANT-MAKING

PREVENTION CHALLENGES: SUICIDE & HEART DISEASE

PREVENTION: SUICIDE & HEART DISEASE

TLOA UPDATE & INAGUARAL NEWSLETTER

SAMHSA REGIONAL ADMINISRATORS

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BUDGET UPDATE

Promising news: SAMHSA ↓ ~1% while others saw sharp cuts

• The 1% reduction = strategic and creative decisions to sustain

Disappointing news: proposed new BH-TPG not funded

• A multi-year non-competitive award in the amount of $50K to prevent substance abuse and suicide

SAMHSA still fielding inquiries from tribal communities asking when the RFA will be out this year – w/o appropriation from the ACA Prevention Fund, SAMHSA isn’t able to support the program

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REVISED APPROACH TO GRANT-MAKING

Braided funding within SAMHSA & with partnersEngaging with States, Territories & Tribes

• Funding for States to plan or sustain proven efforts• Requiring/encouraging work with communities

Revised BG application • Tribal impact:

• In Section G: Tribal Consultation - States must show evidence tribal consultation was part of planning process

• Tribes will not have to waive sovereignty in order to receive BG funds/services

• Must include a copy of suicide prevention plan - if no plan then must demonstrate how one will be developed

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SAMHSA’S STRATEGIC INITIATIVES

AIM: Improving the Nation’s Behavioral Health (1-4)AIM: Transforming Health Care in America (5-6)AIM: Achieving Excellence in Operations (7-8)

1. Prevention

2. Trauma and Justice

3. Military Families

4. Recovery Support

5. Health Reform

6. Health Information Technology

7. Data, Outcomes &

Quality

8. Public Awareness &

Support

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PREVENTION CHALLENGES AI/AN COMMUNITIES

Higher adolescent death ratesHigher past month binge alcohol useHigher past month illicit drug useHigher 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 traumaHigher youth suicide ratesHigher rates of heart disease

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1.Prevention

5 Leading Causes of Death, United StatesAI/AN, Non-Hispanic, Both Sexes

Age Groups

Rank <1 1-4 5-9 10-14 15-24 25-34 35-44 45-54 55-64 65+ All Ages

1

Congenital Anomalies

68

Unintentional Injury

30

Unintentional Injury

11

Unintentional Injury

21

Unintentional Injury 278

Unintentional Injury 287

Unintentional Injury 292

Malignant Neoplasms

357

Malignant Neoplasms

584

Heart Disease 1,556

Malignant Neoplasms

2,630

2

SIDS 43

Homicide 7

Malignant Neoplasms

5

Suicide 14

Suicide 128

Suicide 88

Liver Disease

154

Heart Disease

340

Heart Disease

467

Malignant Neoplasms

1,538

Heart Disease

2,549

3

Short Gestation

33

Heart Disease

6

Influenza & Pneumonia

4

Homicide 3

Homicide 58

Homicide 68

Heart Disease

117

Unintentional Injury 295

Liver Disease

191

Diabetes Mellitus

447

Unintentional Injury 1,575

4

Unintentional Injury

28

Malignant Neoplasms

5

Congenital Anomalies

3

Congenital Anomalies

2

Heart Disease

19

Liver Disease

44

Malignant Neoplasms

105

Liver Disease

215

Diabetes Mellitus

165

Chronic Low. Respiratory

Disease 437

Diabetes Mellitus

754

5

Placenta Cord

Membranes 16

Congenital Anomalies

4

Benign Neoplasms

1

Influenza & Pneumonia

2

Congenital Anomalies

9

Heart Disease

33

Suicide 76

Diabetes Mellitus

87

Unintentional Injury 127

Cerebro- vascular

336

Liver Disease

717

2008 CDC – WISQARS**Most Recent Data Available

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http://millionhearts.hhs.gov9

NATIONAL ACTION ALLIANCE FOR SUICIDE

PREVENTION A public-private partnership established in 2010 to revise and

advance the National Strategy for Suicide Prevention (NSSP)

Leadership: • John McHugh, Secretary of the Army• Former Senator Gordon H. Smith, Pres/CEO, Nat’l Assoc of Broadcasters

Vision: The National Action Alliance for Suicide Prevention envisions a nation free from the tragic experience of suicide

Priorities: • 1: Update/implement the Surgeon General’s NSSP by 2012• 2: Public awareness and education• 3: Focus on suicide prevention among high-risk populations

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NATIONAL ACTION ALLIANCE FOR SUICIDE

PREVENTION 11

AI/AN SUICIDE PREVENTION ACTIVITIES

Next steps being considered by BIA, BIE, IHS and SAMHSA re: suicide prevention and lessons learned from last year’s regional listening sessions and the two Action Summits for suicide prevention (Phoenix & Anchorage) – report coming soon

One of the Action Summit workshops on the use epidemiological data to prevent suicide grew out of a workgroup consisting of Tribal and State representatives that was facilitated by SAMHSA’s CAPT

SAMHSA’s Office of Behavioral Health Equity is planning a 2-day BH institute in conjunction with the American Indian Higher Education Consortium Student Conference (Rapid City) - March

• Focus: National dialogue on BH in tribal college setting

• Focus: How students and faculty can promote BH in their communities

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UPDATES - TLOA SECTION 241SAMHSA HAS LEAD TO:

Create and staff a SAMHSA Office of Indian Alcohol and Substance Abuse (OIASA)

• Director’s position: Interviews held, decision soon Develop a MOA with Justice, Interior and HHS

Secure operating framework for a Tribal Action Plan (TAP)

• SAMHSA’s Collaborative for the Application of Prevention Technologies (CAPT)

• Native American Center for Excellence (NACE) Support for Tribes Pursuing Tribal Action Plans under the Tribal Law and Order Act

• Tribal Action Plan Guidelines 2011

Establish Inventory/Resource Workgroup

Establish an Education Services Workgroup

Seek Tribal Leader input (consultation)

Establish Newsletter Workgroup

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NEWSLETTER WORKGROUP LAUNCHES FIRST ISSUE

Published quarterly

Includes reviews of exemplary alcohol/SA programs

Provides valuable information and circulated w/o charge

Interagency Council will work together to disseminate the newsletter electronically in order to reach schools, tribal offices, BIA regional offices and agencies, IHS area and service unit offices, IHS alcohol programs, and other entities serving AI/AN

Available on the new SAMHSA IASA website, www.samhsa.gov/tloa

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REGIONAL ADMINISTRATORS

• Region I: BostonA Kathryn Power M. Ed.

• Region II: New YorkDennis O. Romero

• Region III: PhiladelphiaJean Bennett

• Region IV: AtlantaStephanie McCladdie

• Region V: ChicagoJeffrey A. Coady, Psy.D

• Region VI: DallasMichael Duffy RN, BSN

• Region VII: Kansas CityLaura Howard, JD

• Region VIII: DenverCharles Smith, Ph.D.

• Region IX: San FranciscoJon Perez, PhD.

• Region X: SeattleDavid Dickinson

Among first activities for RAs - HHS Regional Consultation Sessions

RAs to communicate SAMHSA’s message and to convey BH challenges and successes from the field to headquarters

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SAMHSA’S CONTINUED FOCUS

People - NOT moneyPeople’s lives - NOT diseasesSometimes focus so much on a

disease/condition we forget people come to us with multiple diseases/conditions, multiple social determinants, multiple cultural attitudes

It’s a public health issue!Behavioral health is essential to

health!

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