2. Changing the Conversation: Challenges and Opportunities
Pamela S. Hyde, J.D.
SAMHSA Administrator
Federal Partners Meeting
on the
Borderline Personality Disorder
Rockville, MD • November 9, 2011

3. FOCUS AREAS FOR TODAY’S DISCUSSION3
CONTEXT: DRIVERS OF CHANGE
FOCUS  PREVENTION, TREATMENT, RECOVERY
NATIONAL DIALOGUE ON ROLE OF BH IN PUBLIC LIFE

4. Federal Domestic Spending
DRIVERS OF CHANGE 4
EMERGING SCIENCE
Health Reform
State Budget Declines
Federal Domestic Spending

5. STAYING FOCUSED DURING CHANGE5

6. SAMHSA’S STRATEGIC INITIATIVES6
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

7. CHRONIC DISEASES: GLOBAL IMPACT7
World Economic Forum: Global economic impact of 5 diseases could reach $47 trillion over the next 20 years
MH will account for $16 trillion – a third of cost
Cancer
Diabetes
Mental Illness
Heart Disease
Respiratory Disease

8. IMPACT ON HEALTH CARE COSTS8
By 2020, M/SUDs will surpass all physical diseases as a major cause of disability worldwide
U.S. 2006: Mental disorders were 3rd most costly health condition behind heart conditions and injury-related disorders
Mental illness and heart diseases alone account for almost 70 percent of lost output/productivity
M/SUDs: almost ¼ of all adult stays in community hospitals
30-44 percent of all cigarettes consumed in the U.S. are by individuals with M/SUDs
Up to 83 percent of people w/SMI are overweight or obese

9. Borderline Personality Disorder (BDP)- Common, COMPLEX & MISUNDERSTOOD9
An estimated 18 million Americans will develop BPD in their lifetimes.
This makes BPD more common than schizophrenia and bipolar disorder.
Individuals are frequently misdiagnosed and receive inappropriate treatment.
They often have co-occurring mental and substance use disorders.

10. 10 LEADING CAUSES OF DEATH United States, 2008, All Races, Both Sexes
RANK
ALL AGES 1.
Heart Disease: ,828 2.
Malignant Neoplasms: ,469 3.
Chronic Low Respiratory Disease: ,090 4.
Cerebro-vascular : ,148 5.
Unintentional Injury: ,902 6.
Alzheimer's Disease: ,435 7.
Diabetes Mellitus: ,553 8.
Influenza & Pneumonia: ,284 9.
Nephritis: ,237
10.
Suicide: ,035
WISQARSTM
Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC
Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System

11. DAILY DISASTER OF UNPREVENTED AND UNTREATED M/SUDs11
Any MI: million
37.9 % receiving treatment
SUD: million
11.6 % receiving treatment
Diabetes: million
84 % receiving treatment
Heart Disease: 81.1 million
74.6 % receiving screenings
Hypertension: 74.5 million
70.4% receiving treatment

12. TOUGH REALITIES 12 12
The suicide rate of people with major depression is 8 times that of the general population. Individuals diagnosed with BPD have a suicide rate 50 TIMES that of the general population.* The estimated rate of self-injury for individuals with BPD is 60 to 80 percent.
*separate study

13. TOUGH REALITIES AGE 14-18 AGE 18 AND ↑ HAD SERIOUS THOUGHTS OF SUICIDE13
AGE 14-18
AGE 18 AND ↑
HAD SERIOUS THOUGHTS OF SUICIDE
2.9 million, 13.8%
8.4 million, 3.7%
MADE A PLAN
2.3 million, 10.9%
2.2 million, 1%
ATTEMPTED SUICIDED
1.3 million, 6.3%
1.1 million, .05%
DIED BY SUICIDE
>1,000
>36,000

14. MISSED OPPORTUNITIES = LIVES LOST14
77 percent of individuals who die by suicide had visited their primary care doctor within the year.
45 percent had visited their primary care doctor within the month.
18 percent of elderly patients visited their primary care doctor on same day as their suicide.
THE QUESTION OF SUICIDE WAS SELDOM RAISED…

15. NATIONAL ACTION ALLIANCE FOR SUICIDE PREVENTION15
Priorities:
Surgeon General’s NSSP
Public Awareness
High-risk populations

16. PREVENTION WORKS: 2009 IOM REPORT16
Common risk & protective Factors
Build emotional health in young children
Prevent substance abuse, adolescent depression, conduct disorders
Risk factors: biological, psychological, family, community, or cultural
Protective factors: individual, family, school/community
Signs evident 2‐4 years before disorder
Intervene earlier, consistently, and across multiple institutions
Parents, teachers, clergy, community
Coordinate/collaborate at policy levels

17. TRAUMA IS PERVASIVE, DISABLING17
Childhood traumas/difficulties potentially explain 32.4% of psychiatric disorders in adulthood
February 2010 Archives of General Psychiatry
Based on analyses of the National Comorbidity Survey Replication

18. CHILDREN ARE VULNERABLE18
More than 6 in 10 U.S. youth have been exposed to violence within the past year; nearly 1 in 10 injured.
Adverse childhood experiences (ACEs, e.g., physical, emotional, and sexual abuse, as well as family dysfunction) associated with mental illnesses, suicidality, substance abuse, and physical illnesses.
40% to 70% of individuals with BPD in inpatient and outpatient settings report childhood sexual abuse.

19. TREATMENT IS EFFECTIVE: EVIDENCE-BASED PRACTICES (NREPP)19
Effective approaches to address trauma, common in individuals with BPD
Dialectical Behavior Therapy (DBT)
Reduces suicide attempts, hospitalization; increases retention in treatment
Family Psychoeducation (SAMHSA EBP KIT)
Helps improve family functioning
Equips family members with coping skills
Improves outcomes for person with BPD

20. PEOPLE RECOVER 20
Despite high rates of suicide and self-injury associated with BPD, the diagnosis has a positive prognosis.
Up to three-quarters of individuals experience measurable improvement with treatment; many symptoms abate significantly.

21. RECOVERY: PROPOSED WORKING DEFINITION21
Recovery from mental and substance use disorders is: A process of change through which individuals improve their health and wellness, live a self- directed life, and strive to achieve their full potential.

22. PROPOSED RECOVERY PRINCIPLES22
Person-centered
Occurs via many pathways
Holistic
Supported by peers
Supported through relationships
Culturally based and influence
Supported by addressing trauma
Involves individual, family and community strengths and responsibility
Based on respect
Emerges from hope

23. RECOVERY CONSTRUCT Individuals and Families HOME ↑ Permanent Housing23
Individuals
and Families
HOME
↑ Permanent
Housing
COMMUNITY
↑ Peer/Family/
Recovery Network
Supports
PURPOSE
↑ Employment/
Education
HEALTH
↑ Recovery
TALKING POINTS:
Issue Statement - Promoting individual, program, and system approaches to building recovery and resilience; developing services, information and partnerships to increase permanent supportive housing, supported employment and education and other recovery support services for persons with mental and substance use disorders; and reducing barriers to recovery for individuals with mental and substance use disorders.
SAMHSA’s portfolio of programs (ATR, Recovery Oriented Systems of Care, 10 by 10 Wellness Campaign, Employment Summit) and evidenced based practice toolkits (supported employment, supported education, supportive housing) along with public awareness campaigns, surveillance and performance system, and partnerships will address the goal areas.

24. SAMHSA’S COMMITMENT 24
A NATIONAL DIALOGUE

25. PUBLIC HEALTH OR SOCIAL PROBLEM?25
Public Health
National Dialogue
Health Needs of People & Communities
Social Problem
Insufficient Response
Attention to Symptoms
Individual Blame

26. TRAGEDIES Grand Rapids, MI Tucson, AZ 2011 – 8 Lost 2011 – 6 Lost26
Grand Rapids, MI
2011 – 8 Lost
Tucson, AZ
2011 – 6 Lost
Asher Brown
2010 – 1 Lost
13 Year Old
West Nickel Mines School, PA
2007 – 6 Lost
Virginia Tech, VA
Lost
Red Lake Band of Chippewa, MN, 2005 – 10 Lost
Columbine High School, TX
Lost

27. FROM EVENTS TO ASSUMPTIONS . . .27
Individual Blame
Misunderstanding
Moral Judgment
Discrimination
Prejudice
Social Exclusion

28. LEADING TO: INSUFFICIENT RESPONSES28
Increased Security & Police Protection
Tightened Background Checks & Access to Weapons
Legal
Control of Perpetrators & Their Treatment
More Jail Cells & Homeless Shelters
Institutional/System/ Provider Oversight

29. WHAT AMERICANS BELIEVE29
66 percent believe treatment and support can help people with mental illness lead normal lives
20 percent feel persons with mental illness are dangerous to others
Two-thirds believe addiction can be prevented
75 percent believe recovery from addiction is possible
20 percent would think less of a friend/relative if they discovered that person is in recovery from an addiction
30 percent would think less of a person with a current addiction

30. SO, HOW DO WE CREATE 30
A national dialogue on the role of BH in public life
With a public health approach that:
Engages everyone – general public, elected officials, schools, parents, community coalitions, churches, health professionals, researchers, persons directly affected by mental illness/addiction & their families
Is based on data, facts, science, common understandings/messages
Is focused on prevention (healthy communities)
Is committed to the health of everyone (social inclusion)

31. WE WANT TO CHANGE THE CONVERSATION FROM:31
“Too lazy , too drunk to work”
“Too dangerous to live next door”
“Too sick to have insight”
“Too ill to participate in treatment decisions”

32. TO: “Too talented to waste”32
“Too talented to waste”
“Too much potential to lock up or keep out”
“Too much insight to ignore”
“Too costly NOT to support prevention and recovery”

33. HELP US CHANGE THE CONVERSATION!
Behavioral Health is Essential to Health!
Prevention Works!
People Recover!
Treatment is Effective! 33
National Dialogue