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6/10/2014
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PARTNERSHIPS IN CHALLENGING TIMES:IMPROVING THE BEHAVIORAL HEALTH OF
THE NATION TOGETHER
Pamela S. Hyde, J.D.Administrator
Substance Abuse and Mental Health Services Administration
ADAMHS Board of Cuyahoga County and The Woodruff Foundation
Breakfast ForumCleveland, OH • June 5, 2014
6/10/2014
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TODAY’S DISCUSSION
NATIONAL BH AND OHIO BH: BY THE NUMBERS
ACA CHANGING THE BH LANDSCAPE
PEOPLE RECOVER
FAITH AND COMMUNITY‐BASED PARTNERSHIPS
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BEHAVIORAL HEALTH MATTERS TO PUBLIC HEALTH
Half of us will meet criteria for MI or SUD in life
Half of us know someone in
recovery from addiction now
In a given year:1 in 4, if substance use disorders are included
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They change biology
They are often co‐morbid w/physical illnesses
They are preventable
They are treatable
They are NOT moral issues
BEHAVIORAL HEALTH DISORDERS ARE LIKE OTHER CHRONIC ILLNESSES
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DIFFERENT VIEWS = DIFFERENT INDIVIDUAL & PUBLIC POLICY RESPONSES
Public sees social rather than health consequences
● Homelessness, gangs, jails, tragedies (e.g., mass casualty shootings), disability, lost productivity, high health care and government costs results in
● Inadequate responses – mandates, exclusions, controls
Mental disorders seen as public safety issue & substance use disorders seen as moral issue (matter of will)
● Comprehensive responses – diseases or conditions to be prevented, treated, recovered from, with whole community engagement and support
● Example: Diabetes is not just about eating choices
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PUBLIC ATTITUDES CHANGING, BUT CHALLENGES REMAIN
2/3 think treatment & support can help people w/ MI lead normal lives
2/3 believe addiction can be prevented
3/4 believe recovery from addiction is possible
30% think less of person w/ addiction
20% think less of friend/relative in recovery
38% unwilling to be friends w/ a person with MI
64% would not want person w/ schizophrenia as co‐worker
68% would not want persons w/ depression to marry into family
Less willing to pay to ameliorate condition, even when understand implications• Don’t trust that BH treatment will help them
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2012 NSDUH: SUBSTANCE DEPENDENCE OR ABUSE, PAST YEAR, 12 AND ↑
SA/Dependence – 22.2 M (8.5 percent)• Same as 23 M with diabetes
Prescription Drugs (Non‐Medical Use) ↓ but . . .• Continuing ↑ in # of people w/ dependence/abuse of pain meds• ↑ in adverse events/deaths – ER visits, now surpassing illicit drugs
Heroin ↑• # of past year users almost doubled 2007 – 2012 (373K to 669K)• # of persons w/ dependence/abuse >2x since 2002 (214K to 467K)
Cocaine/Methamphetamine ↓
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2012: MARIJUANA AND ALCOHOL USE
Alcohol – most commonly used substance
• 136 M individuals reported past month use
• 60 M reported binge drinking
• 17 M reported heavy use
Marijuana – most commonly used “illicit” drug
• 18.9 million past month users• 2007 – 2012, current use ↑ from 5.8 to 7.3 percent
• 2007 – 2012, daily/almost daily use ↑ from 5.1 to 7.6 M
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4,304
2,056
1,119
629
535
467
331
164
135
0 1,000 2,000 3,000 4,000 5,000
Marijuana
Pain Relievers
Cocaine
Tranquilizers
Stimulants
Heroin
Hallucinogens
Inhalants
Sedatives
Numbers in Thousands
SPECIFIC IILICIT DRUG DEPENDENCE OR ABUSE PAST YEAR, 12 OR ↑
2012
SAMHSA NSDUH 2012
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166+
119+166+
136+
339
161+
213 193+239
281335
404+
314+
398+
379+
560
373+
455+
582621 620
669
0
100
200
300
400
500
600
700
800
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Past Year
Past Month
Numbers in Thousands
HEROIN USE: PAST MONTH AND PAST YEAR 12 OR
12
BH BAROMETER: OHIO 12 AND
Alcohol Dependence/Abuse: Rate was similar to national rate; ~ 702,000 (7.3%)
Tx for Alcohol Dependence/Abuse: Rate was similar to national rate; ~ 59,000 (8.5%)
Illicit Drug Dependence/Abuse: Rate was similar to national rate; ~ 285,000 (3.0%)
Tx for Illicit Drug Dependence/Abuse: Rate was similar to national rate; ~41,000 (14.3%)
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OPIOID OVERDOSES AND DEATHS
NATIONALLY
• 2010: 38,329 deaths from drug overdose; up from 37,004 deaths in 2009
• 2010: 3,094 a ributable to heroin; 55 percent ↑ since 2000
OHIO
• 2012: 1,914 deaths from unintentional drug overdoses (record high; 366 percent ↑ since 2000)
• 2012: 680 heroin overdose deaths (60 percent ↑ from 426 in 2011 and 2x the 338 deaths in 2010 – just under 11 percent of nation’s total)
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Heroin was responsible for 35.5 percent of total overdoses in 2012, less than 1 percent behind all prescription opiates at 36.4 percent.
“The Cuyahoga County Medical Examiner released more recent statistics earlier in the year, announcing 195 heroin-related fatalities in 2013, up from 161 the year before. In 2007, 40 people in the Cleveland-area died of heroin-related overdoses.”
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OPIOID OVERDOSE PREVENTION –EFFORTS AND ACTIONS
Policy Academy: August 11‐13 in Bethesda, MD
Use of Block Grant funds for Naloxone prevention/education or kits (letter to SSAs April 2014)
Opioid Overdose Toolkit (almost 44,000 downloads since Aug 2013)
MAT Buprenorphine (options memo in process w/ CDC)
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DEVELOPING INFRASTRUCTURE: EXPANDING PILOT PROGRAMS LIKE OHIO’S PROJECT DAWN
Currently serves Cuyahoga, Montgomery, and Scioto counties; and Cleveland
ODH has plans to expand to three additional Project DAWN sites
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94.6%
3.7% 1.7%Didn't feel theyneeded Tx
Felt they needed Txbut made no effort
Felt they needed Txand made effort
> 20 MILLION AMERICANS W/ SUDs WENT UNTREATED IN 2012
Individuals >12 years old
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WHERE PAST YEAR SUBSTANCE USE TREATMENT WAS RECEIVED (12 AND )
Numbers in Thousands
2,119
1,505
1,010
1,000
861
735
597
388
0 500 1,000 1,500 2,000 2,500
Self-Help Group
Outpatient Rehabilitation
Inpatient Rehabilitation
Outpatient Mental Health Center
Hospital Inpatient
Private Doctor’s Office
Emergency Room
Prison or Jail
2012
SAMHSA NSDUH 2012
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2012 NSDUH: MENTAL HEALTH PAST YEAR, 18 AND ↑
Any Mental Illness: ~ 43.7 M (18.6 percent)
Serious Mental Illness: ~ 9.6 M (4.1 percent)
Major Depressive Episode: ~ 16.0 M (6.9 percent)
Suicide (Adults): 38,000 + deaths in 2010• Almost 1/3 have BAC level above legal limit; growing understanding of connection to other drugs
• 9.0 M (3.9 percent) had serious thoughts; 11 M if add youth• 2.7 M (1.1 percent) made a plan• 1.3 M (0.6 percent) attempted
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BH BAROMETER: OHIO ADULTS 18
SMI: Higher than national rate; 339,000 (4.6%)
Tx for SMI: Higher than national rate; 756,000 (44.9%)
Suicidal Thoughts: Similar to national rate; 366,000 (4.2%)
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HEALTH REFORM: A CHANGING HEALTH CARE ENVIRONMENT
Prevention and wellness rather than illness – a public health approach
Recovery rather than chronicity or disability
Integration rather than silo’d care – Parity
Access to coverage and care rather than significant parts of America uninsured – Parity
Quality rather than quantity – control of cost increases through better care rather than more care
Role of states increasing, especially in health “care”
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ACA – COVERAGE ACCOMPLISHMENTS(w/ PARITY OF MH/SA SERVICES)
> 8 M Americans selected plans from state/federal Marketplaces
~ 7 M enrolled in Medicaid or Children’s Health Insurance Program
7.8 M young adults (to age 26) able to stay on a parent’s health plan
7.3 MMedicare beneficiaries rec’d > $8.9 B drug rebates & discounts
62 M Americans gained access to new/expanded MH & SA w/ parity
71 M privately insured gained improved preventive services coverage
105 M Americans had lifetime limits removed from insurance
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PREVALENCE OF BH CONDITIONS – UNINSURED ADULTS AGES 18‐34 WITH INCOMES < 400% FPL
Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013,http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-Conditions-Among-the-Uninsured/PEP13-BHPREV-ACA
44.0%SMI/ SPD/ SUD
56.0%
“Behavioral Health Conditions” includes serious mental illness (SMI), serious psychological distress (SPD) and
substance abuse disorders (SUD)
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PREVALENCE OF BH CONDITIONS – UNINSURED ADULTS AGES 35+ WITH INCOMES < 400% FPL
Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013,http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-Conditions-Among-the-Uninsured/PEP13-BHPREV-ACA
23.8% SMI/SPD/ SUD
76.2%
“Behavioral Health Conditions” includes serious mental illness (SMI), serious psychological distress (SPD) and substance abuse
disorders (SUD)
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HEALTH INSURANCE MARKETPLACE: OHIO BY THE NUMBERS
As of July 2013, 1,354,869 (14 percent) uninsured and eligible
• 1,268,826 (94 percent) estimated to qualify for either tax credits to purchase coverage in Marketplace or Medicaid expansion
As of March 31, 2014, 154,668made Marketplace plan selections
As of March 31, 2014, 208,280 new enrollees in Medicaid/CHIP
Ohio received > $1 million in grants for research, planning, IT development, implementation of Ohio Health Insurance Marketplace
97,000 otherwise uninsured young adults have gained coverage
5,053,131 non‐elderly persons w/ pre‐existing conditions; of these:
• 643,049 children no longer denied coverage
• Adults w/ pre‐existing conditions no longer denied after 1/1/14
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OHIO: PREVALENCE OF BH CONDITIONS AMONG Marketplace POPULATION
CI = Confidence Interval
Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey
Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013, Ohio Profile,http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-C onditions-Among-the-Uninsured/PEP13-BHPREV-ACA
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OHIO: PREVALENCE OF BH CONDITIONS AMONG Medicaid Expansion POPULATION
CI = Confidence Interval
Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey
Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013, Ohio Profile,http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-C onditions-Among-the-Uninsured/PEP13-BHPREV-ACA
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DEFINING RECOVERY
Working common definition of recovery from mental and/or substance use disorders
A process of change through which individuals improve their health and wellness, live a self‐directed life, and strive to reach their full potential
Incorporating into grants
Exploring differences between recovery from MH conditions and addictions
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Treating a Chronic Disorder Must Treat the Whole Person in Their Social Context
RECOVERY ORIENTED SYSTEMS OF CARE (ROSC)
Pharmacological Treatments
(Medications)
Behavioral Therapies
Social Services
Medical Services
Adapted from NIDA Drug Abuse and Addiction
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ReducedCriminalInvolvement
Stability inHousing
Cost Effectiveness
PerceptionOf Care
Retention Abstinence
Employment/Education
Evidence-Based Practice
Social ConnectednessAccess/Capacity
Ongoing Systems Improvement
Recovery
Health
Wellness
Outcomes
Mental Health
Primary Care
Child Welfare
Housing
Human Services
Educational
Criminal Justice
Employment
Private HealthCare
Systems of Care
Organized RecoveryCommunity
DoD &Veterans Affairs
Indian Health Service
Addictions
Tribes/Tribal Organizations
Bureau of Indian Affairs
Child Care
Housing/Transportation
Financial
LegalCase Mgt
Peer Support
Health Care
Mental Health
Alcohol/Drug
VocationalEducation
SpiritualCivic Organizations
Mutual Aid
Services & Supports
Community Individual
Family
ROSC
Community Coalitions
Business Community
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RECOVERY AND THE FAITH COMMUNITY
Place of worship as a “therapeutic system”
• Allows expression of suffering
• Provides emotional support and acceptance
• Cultivates sense of belonging
• Educates re public health problems and interventions
• Instills/fosters HOPE – an element of recovery
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ROLES OF FAITH COMMUNITIES“EXTRAVAGANT WELCOME”
Education/Awareness – members, public, policy‐makers• Positive messaging in programs and services• Education activities & materials, e.g., prescription drug take‐back days, suicide signs and symptoms
Enrollment and outreach• In insurance coverage; Medicaid; Medicare
Prevention – especially children & youth programsCounseling (lay or clerical) and referrals
• To professional BH treatment when needed• Screenings, e.g., depression• Pay attention to secondary trauma of faith leaders
Source of community and support for recovery• Peers and friends
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ACA: THE FAITH COMMUNITY
SAMHSA provided technical resources to support the faith community in ACA education and enrollment activities
52 enrollment events were hosted by faith leaders and congregations; thousands participated
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SUICIDE PREVENTION: AN EXAMPLE OF FAITH‐BASED PARTNERSHIP
National Action Alliance for Suicide Prevention
Public‐private partnership (est. 2010) to advance NSSP
Faith Communities Task Force
Developing new “Your Life Matters” initiative/campaign
Developing toolkit of resources for congregations to use in suicide prevention efforts (Fall 2014)
• Prayers, liturgies, sermons, reflections, hymns, other sacred songs of hope
Encouraging faith communities to set aside one Sabbath/yrto focus on hopefulness, reasons for living, educating on warning signs for suicide & how to seek help
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MENTAL HEALTH FIRST AID: ENGAGING THE FAITH COMMUNITY
Most of us do not know/teach signs, symptoms, how to get help for MH or SA issues
Many of us have opportunities to learn basic first aid for health; some employers require it
YET…
July 28 ‐ August 1: SAMHSA providing clergy/faith leaders MH First Aid Instructors training to equip congregations with needed skills
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America is a nation that understands and acts on the knowledge that
Behavioral health is essential to health
Prevention works
Treatment is effective
People recover
SAMHSA’S HERE TO HELP . . .
www.samhsa.gov
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