A PUBLIC HEALTH APPROACH TO PREVENTION OF BEHAVIORAL HEALTH CONDITIONS Pamela S. Hyde, J.D. SAMHSA Administrator Project LAUNCH Grantees’ Spring Training Institute Rockville, MD • May 15, 2012

A PUBLIC HEALTH MODEL FOR BEHAVIORAL HEALTH 3 Universal – Focus on Population and Individual Health Health of any affects health of all – social inclusion Prevention First – Aim Is Healthy Individuals; Healthy Communities Preparation and activities to promote emotional health development and wellness, prevent disease/disorder, and react quickly and effectively to conditions that impact health

A PUBLIC HEALTH MODEL . . . 4 Data & Information Driven – To Track and Improve Population-Based Health Status and Quality of Care/Life What drives health? What causes disease/disorder? What works to prevent, treat and support recovery – evidence-based approaches? Policies – Affecting the Environment In Which Health or Disease Occurs Laws, regulations, rules, norms, culture, conditions, expectations re individual and collective behavior for self and toward others

A PUBLIC HEALTH MODEL . . . 5 Structures – Creating & Supporting Government and Community Infrastructure and Capacity Departments, boards, committees, councils, commissions, coalitions, schools, universities Access – Assuring availability of right services when individuals, families, community need them Prevention, treatment and recovery supports Adequate, trained, and culturally capable workforce

BEHAVIORAL HEALTH AS SOCIAL PROBLEM 6 Public dialogue about behavioral health is in a social problem context rather than a public health context Homelessness Crime/jails Child welfare problems School performance or youth behavior problems Provider/system/institutional/government failures Public tragedies Public (and public officials) often misunderstand, blame, discriminate, make moral judgments, exclude Ambivalence about worth of individuals affected and about the investment in prevention/treatment/recovery Ambivalence about ability to impact “problems”

LEADING TO INSUFFICIENT RESPONSES 7 Increased Security & Police Protection Tightened Background Checks & Access to Weapons Legal Control of Perpetrators & Their Treatment More Jail Cells, Shelters, Juvenile Just ice Facilities Institutional System Provider Oversight

BEHAVIORAL HEALTH FIELD’S MESSAGES 8 Multiple and inconsistent messages Disease; disability; chronic medical condition; social reaction to difference; brain/genetic or environmental; treat the same as physical conditions; treat with a different psychosocial approach Substance abuse and mental illness stem from the same causes and often co-exist; or they are completely different fields and different diseases/conditions Behavioral health is and should be extraordinary; or should be the same as any other health condition

COMPARE (Part 1). . . Physical Health Behavioral Health What It Takes 9 Physical Health Behavioral Health What It Takes Nutrition Exercise Rest Good Genes Reducing Risks Hand-washing Covering cough Protecting v food-borne illnesses Getting immunizations Taking universal precautions Avoiding unprotected sex What It Takes Understanding/managing emotions Managing stress Positive social relationships Hope – Spirituality Reducing Risks Trauma Chronic stress, esp. in childhood Non-supportive or destructive relationships Uninformed parenting No or limited skills

COMPARE (Part 2). . . Physical Health Behavioral Health 10 Physical Health Behavioral Health Recognizing Signs Suicidal thinking Depression and anxiety Post-traumatic stress Substance abuse Underage drinking or inappropriate amounts in adults Knowing When & How to Get Help Early detection – screening/brief interventions Stop emotional pain Keep safe – for individual and for community Recognizing Signs Temperature Cough Fever Pain Avoiding Behaviors That Increase Risks Knowing When & How To Get Help Early detection – tests/screening Stop the bleeding and pain Save life first

SAMHSA’S VISION A Nation That Acts On the Knowledge That: 11 A Nation That Acts On the Knowledge That: Behavioral health is essential to health Prevention works Treatment is effective People recover A Nation/Community Free of Substance Abuse and Mental Illness and Fully Capable of Addressing Behavioral Health Issues That Arise From Events or Physical Conditions

THERE IS NO HEALTH WITHOUT BEHAVIORAL HEALTH! 12 “Heal the soul and the body will follow.” Stevenson Kuartei, Minister of Health, Republic of Palau

STRATEGIC INITIATIVE # 1 – PREVENTION 13 Prevent SA and MI through community-based approaches Underage Drinking Suicide Prescription Drug Abuse/Misuse

WE’VE GOT A PROBLEM . . . Every day in America: 14 Every day in America: ~ 7,500 adolescents (12-17) drink alcohol for the first time ~ 4,360 use an illicit drug for the first time ~ 3,900 smoke cigarettes for the first time ~ 3,700 use marijuana for the first time and ~ 2,500 abuse pain relievers for the first time Young people with major depressive episode are twice as likely to take 1st drink or use drugs the 1st time as those who do not experience a depressive episode Suicide is the third leading cause of death among young people; second among NA youth

MENTAL & SUBSTANCE USE DISORDERS CAN BE PREVENTED 15 Product of biological, environmental and social factors Experiences trigger or exacerbate BH problems Trauma, adverse childhood experiences, disasters and their aftermath, poverty, domestic violence, involvement with the criminal justice or child welfare systems, neighborhood disorganization and family conflict Addressing risk factors is effective in reducing likelihood of M/suds Individual, family and community risk and protective factors Brain impacts – chronic acute stress in early childhood can lead to: Future health problems (including depression and other BH problems) Damage to hippocampus Smaller physical size of developing brain

EARLY INTERVENTION REDUCES IMPACT 16 1/2 of all lifetime cases of mental illness begin by age 14; 3/4 by age 24 On average, > 6 years from onset of symptoms of M/SUDs to treatment Effective multi-sectoral interventions & treatments exist Need treatment & support earlier Screening Brief interventions Coordinated referrals

SI # 2 – TRAUMA & JUSTICE 17 Trauma-informed care in BH, Child Welfare and Juvenile Justice systems Prevention and diversion for JJ and adult justice systems Data about trauma and its impacts

TRAUMA A near universal experience for children in targeted systems 18 A near universal experience for children in targeted systems The more traumatic experiences in childhood (ACEs), the more mental health issues, substance abuse/addiction, and physical health conditions in adolescents and adulthood Building emotional health and resilience is building protections

NATIONAL CHILD TRAUMATIC STRESS NETWORK (NCTSN) 19 Evidence-based clinical interventions & trauma services Develop & adapt resources for early childhood traumatic stress Training & consultation to child-serving organizations Deliver services to young children & their families 26% of children served are < age 6

PROJECT LAUNCH 20 Screening and assessment in a range of child-serving settings Integration of behavioral health into primary care Mental health consultation in early care and education Enhanced home visiting through increased focus on social and emotional well-being Family strengthening and parent skills training

CONTEXT: AFFORDABLE CARE ACT 21 Opportunities for Coverage – Kids Get Care if Parents Do 42% of parents below poverty & 33% between 100-200% FPL do not have coverage, but will have opportunity in 2014 Children to age 26 on parents commercial policies currently No denial for pre-existing conditions for children now; for adults, too, beginning in 2014 Qualified Health Plans (QHPs) network of providers including those specializing in MH and SA Essential Health Benefits must include BH Home visiting program through HRSA

A BOLDER VISION? Can we imagine: 22 Can we imagine: A generation without one new case of trauma-related mental or substance use disorder? A generation without a death by suicide? A generation without one person being jailed or living without a home because they have an addiction or mental illness? A generation without one youth being bullied or rejected because they are LGBT? A generation in which no one in recovery struggles to find a job?

Reinhold Niebuhr 23 Nothing that is worth doing can be achieved in a lifetime; therefore we must be saved by hope.