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 3

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 4

REVISED APPROACH TO GRANT-MAKING  Braided funding within SAMHSA & with partners  Engaging 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 5

SAMHSA’S STRATEGIC INITIATIVES 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 6

PREVENTION CHALLENGES AI/AN COMMUNITIES  Higher adolescent death rates  Higher past month binge alcohol use  Higher past month illicit drug use  Higher sexual assault rates against females  Higher homicide rates against women  Higher rates of intimate partner violence against women  Higher rates of incarceration and arrest  Higher rates of historical trauma  Higher youth suicide rates  Higher rates of heart disease 7 1.Prevention

5 Leading Causes of Death, United States AI/AN, Non-Hispanic, Both Sexes 2008 CDC – WISQARS **Most Recent Data Available 8

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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 : Public awareness and education 3: Focus on suicide prevention among high-risk populations 10

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 12

UPDATES - TLOA SECTION 241 SAMHSA 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 13

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, 14

REGIONAL ADMINISTRATORS Region I: Boston A Kathryn Power M. Ed. Region II: New York Dennis O. Romero Region III: Philadelphia Jean Bennett Region IV: Atlanta Stephanie McCladdie Region V: Chicago Jeffrey A. Coady, Psy.D Region VI: Dallas Michael Duffy RN, BSN Region VII: Kansas City Laura Howard, JD Region VIII: Denver Charles Smith, Ph.D. Region IX: San Francisco Jon Perez, PhD. Region X: Seattle David 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 15

SAMHSA’S CONTINUED FOCUS  People - NOT money  People’s lives - NOT diseases  Sometimes 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! 16