A PUBLIC HEALTH APPROACH TO PREVENTION OF BEHAVIORAL HEALTH CONDITIONS

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 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

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 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”

7. LEADING TO INSUFFICIENT RESPONSES 7

8. 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

9. COMPARE (Part 1). . . 9 Physical Health Behavioral Health 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 • 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

10. COMPARE (Part 2). . . 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

11. SAMHSA’S VISION 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 – PREVENTION 13 Prevent SA and MI through community-based approaches Underage Drinking Suicide Prescription Drug Abuse/Misuse

14. WE’VE GOT A PROBLEM . . . 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 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

16. 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

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 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

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 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

22. A BOLDER VISION? 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.