2. 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

3. A PUBLIC HEALTH MODEL FOR BEHAVIORAL HEALTH3
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

4. 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

5. 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

6. BEHAVIORAL HEALTH AS SOCIAL PROBLEM6
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”

7. LEADING TO INSUFFICIENT RESPONSES7
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

8. BEHAVIORAL HEALTH FIELD’S MESSAGES8
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

9. COMPARE (Part 1). . . Physical Health Behavioral Health What It Takes9
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

10. COMPARE (Part 2). . . Physical Health Behavioral Health10
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

11. 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

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

13. STRATEGIC INITIATIVE # 1 – PREVENTION13
Prevent SA and MI through community-based approaches
Underage Drinking
Suicide
Prescription Drug Abuse/Misuse

14. 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

15. MENTAL & SUBSTANCE USE DISORDERS CAN BE PREVENTED15
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

16. EARLY INTERVENTION REDUCES IMPACT16
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

17. 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

18. TRAUMA A near universal experience for children in targeted systems18
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

19. 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

20. 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

21. CONTEXT: AFFORDABLE CARE ACT21
Opportunities for Coverage – Kids Get Care if Parents Do
42% of parents below poverty & 33% between % 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

22. 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?

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