Thursday, January 15, 2009

The Importance of Appointing a Nationally Recognized Professional with a Strong Science Background to be the Administrator of the Substance Abuse and

The following is a policy statement prepared by a colleague that discusses the rationale for having leadership at SAMHSA (Substance Abuse and Mental Health Services Administration) that is guided by science rather than ideology and politics as the agency has been for some time. It discusses the problems that have resulted from political leadership over the past and why we need a scientist who knows addiction and is committed to supporting evidence-based treatment for substance use and mental health problems and ongoing research to inform improved treatment efficacy of these very common human problems that effect us all.

I welcome comments, support and dialogue on this policy statement.

Andrew Tatarsky, PhD

The Importance of Appointing a Nationally Recognized Professional with a Strong Science Background to be the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA)

Virtually every family in America is affected by mental illness or addiction. The cost in personal suffering and economic loss is staggering. Part of the tragedy of mental illness and addiction is that these diseases typically strike in late adolescence and early adulthood, between 18-25 years of age. By contrast, most major medical illnesses occur much later in life. The World Health Organization found that mental illness and addiction were the leading causes of disability among Americans ages 18-45, confirming that these diseases rob young Americans of their most productive years.

The last two decades have witnessed dramatic scientific advances in understanding mental illness and addiction which have led to the development of effective treatments and prevention programs. Unfortunately, unlike standard protocols for advances in other areas of medicine, these treatments are not reaching the vast majority of the public who need them. For example, the United States spends about $120 billion annually on behavioral health care[1]. Yet, less than 25% of this care is evidence-based, with 75% of questionable value. The result of the mediocre quality of behavioral health care is that many Americans are suffering needlessly and some are dying because they are not receiving treatment has been shown to work.

What can be done to solve this problem? Most advocacy groups call for increased spending. While lack of resources is part of the problem, increasing funding alone will not solve the problem. Currently, Americans are not receiving adequate value for the $120 billion that are spent annually and much more could be accomplished using existing resources. This is the main conclusion of a landmark report on the state of behavioral healthcare issued by the Institute of Medicine of the National Academy of Science in 2006.

The federal government’s response to this situation has been woefully inadequate. The federal agency responsible for overseeing the quality of behavioral health care and prevention is the Substance Abuse and Mental Health Services Administration (SAMSHA). SAMSHA has a $3.3 billion budget. An OMB review of this agency rated the agency’s programs as largely ineffective; an assessment shared by most mental health and addiction experts. Many politicians including Congressman and Senators who sit on relevant oversight committees have never heard of SAMSHA, despite the fact that SAMSHA is on the same organizational level in the Public Health Service as CDC and FDA.

One major reason for SAMSHA’s obscurity and dysfunction has been the failure to appoint a person with significant scientific and professional expertise to the lead the agency. Past administrators have been drawn from the ranks of state government with experience in community action, but without recognized high level scientific mental health, addiction, and public health expertise. By contrast, the recent heads of FDA and CDC have been nationally prominent scientists with accompanying expertise and stature to effectively lead their agencies.

President elect Obama has a unique opportunity to improve the treatment and prevention of mental illness and addiction by breaking with the past tradition of placing a political appointee with regulatory and administrative experience as the Administrator of SAMSHA. Instead, the Obama transition team should seek a professional with a national reputation of excellence as a scientist and innovator in implementing science-based mental health and addiction programs and public health models in communities. This move would be consistent with President elect Obama’s approach to attract the highest caliber professionals into government, has the potential to improve the lives of many Americans, and would elicit uniform praise from advocates, the scientific community, and the press.

[1] Behavioral health care means addiction and mental health services combined.

1 comment:

DuWayne Brayton said...

Hi Andrew and thank you for taking the time to discuss this.

I am in my early thirties and have recently gone from high school dropout, to full time college student. I have recently become a single dad, locked in a custody battle. I have spent much of my adult life struggling with substance abuse issues stemming from my neurochemistry. Mental illness has had a profound and painful affect on my life, the lives of my children and especially on the life of my ex-partner.

We are long past due for some serious changes and political changes are, I believe essential. But underlying this all is a desperate need for a change of our social addiction/mental illness paradigm. As a society we have spent far too long in a rut that glorifies stigma over science and human decency.

I really appreciate your colleague's policy statement and sincerely hope that we will see it become a reality.

Thank you again, for taking to time to write about this and keep a blog. I look forward to future visits.