Mr. Chairman, Members of the Subcommittee, thank you for the opportunity to provide
testimony on the reauthorization of the Substance Abuse and Mental Health SAMHSA administers the Substance Abuse Prevention and Treatment Block Grant
and the Community Mental Health Services Block Grant to the States. Through our data
collection efforts, SAMHSA serves as a national authority on the prevalence and incidence of
drug use and abuse, addiction treatment capacity and services delivered, mental health
epidemiological data on adults and children and data on mental health providers and services.
SAMHSA also administers the Children's Mental Health Services Program, the Protection and
Advocacy Program, and the Projects for Assistance in Transition from Homelessness program
(PATH). And, SAMHSA's discretionary grant program is focused on increasing the use of
proven practices through "Knowledge Application" and increasing behavioral health system
capacity by improving efficiency and effectiveness of services through "Knowledge
Development". Given Nation's substance abuse prevention, addition treatment and
mental health service systems.
At SAMHSA, w proposals. Finally, I will discuss how these
proposals will ensure that SAMHSA continues to provide leadership for the 1
Nation's substance abuse prevention, addition treatment and
mental health service systems.
At SAMHSA, we work to achieve our mission in partnership with other Federal agencies,
States and counties, communities and employers, consumers and families, advocates and
associations, and health professionals through a number of funding streams and programs. In
particular, SAMHSA administers the Substance Abuse Prevention and Treatment Block Grant
and the Community Mental Health Services Block Grant to the States. Through our data
collection efforts, SAMHSA serves as a national authority on the prevalence and incidence of
drug use and abuse, addiction treatment capacity and services delivered, mental health
epidemiological data on adults and children and data on mental health providers and services.
SAMHSA also administers the Children's Mental Health Services Program, the Protection and
Advocacy Program, and the Projects for Assistance in Transition from Homelessness program
(PATH). And, SAMHSA's discretionary grant program is focused on increasing the use of
proven practices through "Knowledge Application" and increasing behavioral health system
capacity by improving efficiency and effectiveness of services through "Knowledge
Development". Given Nation's substance abuse prevention, addition treatment and
mental health service systems.
At SAMHSA, we work to achieve our mission in partnership with other Federal agencies,
States and counties, communities and employers, consumers and families, advocates and
associations, and health professionals through a number of funding streams and programs. In
particular, SAMHSA administers the Substance Abuse Prevention and Treatment Block Grant
and the Community Mental Health Services Block Grant to the States. Through our data
collection efforts, SAMHSA serves as a national authority on the prevalence and incidence of
drug use and abuse, addiction treatment capacity and services delivered, mental health
epidemiological data on adults and children and data on mental health providers and services.
SAMHSA also administers the Children's Mental Health Services Program, the Protection and
Advocacy Program, and the Projects for Assistance in Transition from Homelessness program
(PATH). And, SAMHSA's discretionary grant program is focused on increasing the use of
proven practices through "Knowledge Application" and increasing behavioral health system
capacity by improving efficiency and effectiveness of services through "Knowledge
Development". Given this approach, we call our discretionary grant program our
Knowledge Development and Application or KDA program.
Over the past five formative years for SAMHSA, each of these programs and funding
streams have faced and improved as a result of barrage of changes and challenges. A confluence
of deficit reduction, government streamlining, increased accountability and emphasis on outcome
measures, devolution of Federal responsibilities to States, and a revolution in behavioral health
care service delivery have resulted in an opportunity to propose creative, new approaches for
achieving SAMHSA's mission.
At the same time, the Nation's leading indicator on drug abuse, SAMHSA's National
Household Survey on Drug Abuse, has shown that marijuana use among the Nation's youth is on
the rise and our children are trying drugs at increasingly younger ages. Yet, in a tribute to
successful prevention efforts, overall adult rates of illicit drug use in the United States has been
cut in half from the peak in 1979 and remained level since 1992.
If there is one thing we have learned from the recent increase in youth drug use it is that
preventing and reducing drug abuse requires a long-term sustained commitment of Federal, State
and community leadership, as well as resources and the development of creative new ideas. Our
past work has shown we cannot focus on just one drug alone. Starting early in life, each new
generation needs to be immunized and receive "booster shots" against all forms of substance
abuse - from methamphetamine to marijuana and from alcohol to tobacco.
Today's social trends make this generation of youth even more vulnerable than those in the
past. The proponents of drug legalization are better organized than ever before; kids report drugs
are easily obtained; and the perception of harm of drug use is on the decline among youth. For
the first time ever, we're facing a generation of youth many of whose well-educated parents
experimented with marijuana in their own youth. Therefore our problem is made even more
difficult because these parents maybe uncomfortable telling their own children not to use
marijuana.
Today, we know with certainty what we were not sure of 30 years ago: marijuana is
harmful. It is harmful to an individual's health and the public safety. We must continue to make
a serious effort to protect our children. In this regard we are particularly concerned about the
efforts to legalize medicinal use of marijuana in California and Arizona. These efforts are
especially problematic because they send mixed messages about smoked marijuana use and are
really a covert attempt to legalize marijuana use for non-medical purposes.
The good news is that SAMHSA's past investments in substance abuse prevention
demonstration grants have produced strategies that directly counteract some or all of these
national social trends. In short, we know what prevention strategies work. Successful programs
are comprehensive and take advantage of key opportunities to provide youth -- early on in life --
with positive messages, role models and opportunities to learn and achieve. The programs that
have employed these strategies have shown positive long-term effects and cost savings. We are
now working on ways through our KDA program and block grant to achieve wider adoption of
these strategies.
Another area where SAMHSA is making a difference is in the field of addiction treatment.
Last fall, we released the preliminary findings of the National Treatment Improvement
Evaluation Study (NTIES), a five-year study on the impact of drug and alcohol treatment on over
5,000 clients treated in substance abuse treatment programs funded by SAMHSA. In a
comparison of behaviors a year before and a year after drug abuse treatment, the rate of
respondents reporting marijuana use declined 50 percent, cocaine use declined 55 percent, crack
use declined 51 percent, and heroin use declined 46 percent. The study also noted large
reductions in criminal behavior - the rate of respondents selling drugs and committing violent
crime declined by 78 percent. These results are from our most under served and vulnerable
populations whose drug problems tend to be more severe and who have few social supports to
help in their recovery.
Addiction treatment is effective, it improves lives and saves resources across a broad
spectrum of public sector programs. For example, a California study of treatment effectiveness
indicated that for every dollar invested in treatment the public incurred a return of 7 dollars of
savings from reducing criminal justice, health care, and welfare costs. A similar study in Oregon
found for each dollar invested in treatment there was more than a 5 dollar return in savings.
Unfortunately, the problem is that almost half of the 3.5 million people in serious need of
treatment for drug dependence, do not 6 receive treatment. Through our KDA program we are
working on developing cost saving strategies that can potentially increase the capacity to provide
services and at the same time improve the quality of these services.
In the delivery of mental health treatment, we face similar challenges. Appropriate mental
health services can prevent problems from compounding and promise recovery for many people
who have serious mental illness. Indeed, 80 to 90 percent of those who experience depression
respond quickly to treatment. Medications and therapy can help up to 80 percent of those
diagnosed with bipolar disorder, and with proper medication, 80 percent of people diagnosed
with schizophrenia can be relieved of acute symptoms and move beyond illness to lead
productive lives. Yet, despite the many advances in mental health treatment in America, we
know that services are not reaching all those who need them. Only one fourth of the more than
50 million Americans who experience a mental disorder in any given year receive treatment.
While the President's and Congress's support of the law that requires insurance companies to
have the same annual and life time limits for mental health services as they do for primary
health care will certainly help, there are still a number of barriers to appropriate mental health
care, including stigma associated with mental illness, lack of insurance coverage, lack of
information in some communities on effective treatment and service approaches. SAMHSA is
working in partnership with States, communities, service providers, consumers and families to
address service and information gaps and improve system performance.
Addressing the needs of people with co-occurring disorders is another challenge and
SAMHSA is leading the progress. In addition to the prevalence of drug use, SAMHSA's Nation
Household Survey on Drug Abuse shows a clear relationship between mental health and
substance use, abuse and dependence. Adolescents with psychosocial problems are more likely
to use cigarettes or engage in "binge" drinking and much more likely to use marijuana than those
with little or no indication of mental health problems. Adults with a major depressive episode,
generalized anxiety disorder or panic attack are about twice as likely to be dependent on
cigarettes and several times more likely to be dependent on illicit drugs than those with none of
these mental disorders.
According to the National Comorbidity Survey, with co-occurring disorders, the mental
disorder often occurs first, during adolescence and 5 to 10 years before the addictive disorder.
While this provides a "window of opportunity" for targeted substance abuse prevention
interventions and needed mental health services, two-thirds of young people in this country who
suffer from a mental disorder are not receiving the help they need. Without that
help these problems can lead, in addition to alcohol and illicit drug abuse, to school failure,
family discord, violence and even suicide. SAMHSA is leading a vigorous efforts to help
families, educators, and others who work with children and adolescents, as well as young people
themselves - to recognize mental health problems and seek appropriate services. This is a key
goal of our Children's Mental Health Services Program and our Caring for Every Child's Mental
Health: Communities Together initiative.
We know that substance abuse prevention, addiction treatment and mental health services
improve lives, strengthen families and increase productivity, yet needs exceed our national
capacity. This fact combined with the evolving health care system, the changing roles of and
relationships between Federal, State and local governments, and the efforts at deficit reduction
all factor into how SAMHSA plans to continue to execute its mission in the years to come.
One of the most important tools available to SAMHSA for increasing the capacity to
deliver quality services and to implement new findings is the substance abuse and mental health
block grants. We are proposing to transition these block grants into Performance Partnership
Block Grants. Our proposal will increase State flexibility by allowing States to set their own
priorities for expenditures and management of grant funds.
For example, we propose consolidating 12 required State plan criteria for the Community
Mental Health Services Performance Partnership Block Grant into five. This will not only
reduce the quantity of requirements on the States but also provide States more opportunity to
focus on and develop a community based mental health approach.
For the Substance Abuse Prevention and Treatment Performance Partnership Block Grant,
we are proposing to increase flexibility through a reduction in the number of mandatory
requirements and the creation of a conditional waiver authority for the Secretary of the
Department of Health and Human Services for some provisions such as tuberculosis services, the
set aside for pregnant addicts and mandatory treatment for intravenous drug users. To maintain
the focus on services for particular populations of importance to Congress and constituency
groups the granting of the waiver would be conditioned on the development of performance
measures for the particular target populations under the requirement. SAMHSA proposes to
develop such performance measures which would include capacity, process and outcomes
measures through a negotiated process in partnership with the States and other constituency
groups.
As we transition to Performance Partnership Block Grants, our efforts are guided by four
core principles: 1) we are working with State and local governments on the basis of a trust
relationship and in an open effort to define shared expectations about program outcomes. 2) The
emphasis will be on ultimate outcomes. Performance measures that identify meaningful
outcomes should be the basis for assessing the success or failure of programs. 3) States or
communities should be given maximum flexibility to adjust programs to local needs and
priorities, work with SAMHSA to develop a minimum set of performance measures for treatment
and prevention programs, and to put in place a consistent with the broad purposes of the
authorizing statutes. 4) The Federal government will continue to provide leadership, vision and
the core resources to enable States and communities to be effective in their management of
programs. Maintaining and enhancing core capacity includes assisting with high quality data and
surveillance systems to meet national and state needs, infrastructure and the ongoing provision of
technical assistance and training.
We are already beginning to work with some States through pilot projects to identify
performance measures, develop data reporting systems and establish a sound basis for outcome
oriented, Federal-State partnerships. Currently, SAMHSA devotes approximately 56 million
annually to data collection in the Substance Abuse and Mental Health fields combined. It is very
clear that the States vary in their ability to collect and analyze data on cost, organization, human
resources and especially outcomes data. Therefore, to support the modification of the Block
Grants, we are proposing a new authority for grants to States for data collection and analysis with
regard to performance measures including measures of capacity, process and outcomes. In
exchange for new resources States would agree to work with SAMHSA to develop a minimum
set of performance measures for treatment and prevention programs, and to put in place a system
for the collection and reporting of such information. We believe such a program will not only
assist State in their outcome measurement efforts, but would also contribute to the national
picture of our progress in mental health and substance abuse prevention and treatment, and aid us
in fulfilling requirements under the Government Performance Review Act (GPRA).
The Knowledge Development and Application (KDA) program also represents a new
approach for SAMHSA's discretionary grant program. Given changing needs and new national
priorities, SAMHSA re-directed the focus of its discretionary grant program from one of
supplementing and building service capacity to a leverage Federal resources. For example, we
are increasing the use of proven and we anticipate increasing in system capacity by improving
efficiency and effectiveness of services through "Knowledge Development" arm.
Our priorities for "Knowledge Development" are: "managed care", "early childhood
problems and working families", and "improving community services". For example, in the area
of early childhood and working families, SAMHSA has launched a Starting Early-Starting Smart
collaborative effort. Working with The Casey Family Program and the Department of
Education, SAMHSA is developing new knowledge, demonstrating what works, and creating
collaborative community-based partnerships to sustain improved primary, mental health and
substance abuse prevention services for children from birth to age 7 and their families or care
givers. SAMHSA initiated the Starting Early-Starting Smart program because so many social
and economic factors impact children's mental health and well being and their potential for
substance abuse. This interagency collaboration will bring all the available resources to bear on
providing coordinate the involvement of established community groups. We see
community involvement and action as key to the success of this initiative. Further,
State involvement is critical to our need to coordinate efforts and leverage Federal resources.
To effectively carry out the transition to the KDA approach, SAMHSA is proposing
consolidated authorities in substance abuse prevention, addiction treatment and mental health
services. These provisions would replace a number of current prescriptive and restrictive
categorical provisions with programs that provide increased flexibility with a focus on
performance and results.
While the Knowledge Development and Application program and the Performance
Partnership Block Grants remain the largest and most visible of SAMHSA's current efforts, our
proposal continues other SAMHSA activities that are critical to improving quality and
availability of services. These include: collecting and analyzing data; developing comprehensive
community mental health services for children and adolescents; developing the first ever "Report
Card" generated by and for consumers of mental health services to gauge accessibility and
quality of mental health services provided through managed care plans; and investigating
incidents of abuse and neglect of individuals with mental illness.
Over the years, our work and the taxpayers' investment in SAMHSA have shown that
substance abuse prevention, addiction treatment and mental health services can and e the involvement of established community groups. We see
community involvement and action as key to the success of this initiative. Further,
State involvement is critical to our need to coordinate efforts and leverage Federal resources.
To effectively carry out the transition to the KDA approach, SAMHSA is proposing
consolidated authorities in substance abuse prevention, addiction treatment and mental health
services. These provisions would replace a number of current prescriptive and restrictive
categorical provisions with programs that provide increased flexibility with a focus on
performance and results.
While the Knowledge Development and Application program and the Performance
Partnership Block Grants remain the largest and most visible of SAMHSA's current efforts, our
proposal continues other SAMHSA activities that are critical to improving quality and
availability of services. These include: collecting and analyzing data; developing comprehensive
community mental health services for children and adolescents; developing the first ever "Report
Card" generated by and for consumers of mental health services to gauge accessibility and
quality of mental health services provided through managed care plans; and investigating
incidents of abuse and neglect of individuals with mental illness.
Over the years, our work and the taxpayers' investment in SAMHSA have shown that
substance abuse prevention, addiction treatment and mental health services can and do work. We
also know that investing Federal resources in these areas make sense. It improves lives,
strengthens families, and increases productivity. At the same time it saves dollars across a broad
spectrum of other Federal government programs, including housing, education, welfare,
Medicaid, labor and criminal justice.
Mr. Chairman, we are committed to continuous improvement in the way SAMHSA does
business and to ensuring that our efforts continue to have a positive impact on the Nation's
prevention and treatment systems. We are requesting not only reauthorization but some
improvements in our authorizing language that will enhance our ability to have a greater impact
on substance abuse and mental health problems in the U.S. and at the same time demonstrate
accountability for the Federal dollars entrusted to SAMHSA.
It is clear that each new generation of American youth presents us with new challenges. Each
new scientific advance in substance abuse prevention, addiction treatment and mental health
services provides new options. And these options need to be translated and applied to every day,
real-life practices in order to improve the quality and availability of substance abuse prevention,
addiction treatment and mental health services.
SAMHSA's Knowledge Development and Application program is the Federal tool
specifically designed to make progress and improve services in our Nation's communities. Our
Performance Partnership Block Grants with States are the vehicles available to leverage adoption
of best practices and increases our capacity to deliver quality services to individuals in need. In
short, this is SAMHSA's unique role in the Federal government.
I'm optimistic and enthusiastic about what the future holds for our ability, with the
Subcommittee's help to address some of the Nation's most costly and devastating problems.
Again, Mr. Chairman and-Members of the Subcommittee, thank you for the opportunity to
appear today. I'll be pleased to answer any questions you may have.
