The federal government has a great plan to address mental health needs – but do they have the right model?

6a0105369e3ea1970b014e87489a45970d 320wi - The federal government has a great plan to address mental health needs - but do they have the right model? Should substance abuse recovery and mental health care have as much government attention as physical diseases like arthritis and appendicitis?

Last month the Substance Abuse and Mental Health Services Administration (SAMHSA) published its strategic initiatives paper for its roles and actions for 2011-2014. The paper includes the focus, goals, and action plan for carrying out its mission—of reducing the impact of substance abuse and mental illness in American society.

From months of public discussion and stakeholder contributions, eight strategic initiatives have resulted—on how to best utilize SAMHSA’s resources and improve the behavioral healthcare system in America. It’s focus? The Mental Health Parity, Addiction Equity Act and the Affordable Care Act—to put mental healthcare and substance abuse recovery on equal footing with all other physical aliments.

The initiatives include the following:

1)      Prevention Initiative: Work toward promoting emotional health, reducing instances of mental illness, substance abuse, and suicide. It’s focus: high risk youth, adolescents in tribal communities, and members of military families.

2)      Trauma and Justice: Work toward the integration of trauma approaches in the different sectors of behavioral healthcare and more comprehensively addressing the behavioral health needs of individuals at risk or involved in the criminal system.

3)      Military Families: Working toward enhanced, accessible, and focused care for common mental health concerns for service men, women, and their families.

4)      Enhanced Care for Recovery: Working toward greater collaboration to better serve people in recovery from mental illness and/or substance abuse at the individual and systemic care levels to solidify recovery. Accomplishing this would entail an increase in permanent supportive housing projects, educational opportunities, and employment supports.

5)      Health Reform for Mental Health Diagnoses: Working toward increased access to mental health care, substance abuse services and co-morbid physical and psychiatric conditions. Bridging the gap between the limited the availability of behavioral health services and the widespread availability of regular medical conditions

6)      Health Informatics: Working toward greater collaboration with advances in technology for behavioral health organizations, states, community agencies, and prevention specialists to ensure full adaptation to the newest technology, namely: interoperable electronic health records (HER) and health information technology (HIT).

7)      Strategic Data Analysis: Working toward greater integration and improvement of strategic data analysis; which ultimately informs policy and determines service effectiveness; resulting in visible outcomes in communities, adults, and children.

8)      Public Awareness: Working toward greater knowledge and understanding of mental health diagnoses and substance abuse disorders in communities. This includes the recognition of differing recovery models, prevention strategies, and emergency crisis services; with recovery as the anticipated outcome.


These are great initiatives, and ones that it’s easy to get behind and support. But whether they succeed or not is a matter of more than just good intentions.  Because even if crucial issues like mental health and substance abuse get the attention they deserve, our medical community – dominated by the insurance and pharmaceutical industries – is likely going to try and treat them in a quick-fix manner, just like they do physical ailments.

We’ve all heard the horror stories:  pregnant women kicked out of hospitals just after they’ve given birth; soldiers given pills to fix whatever their problem is and then sent back to the battle field;  surgery patients kicked out of the intensive care unit when their HMOs say so, not their doctors.  All this has one thing in common:  it’s an attempt to minimize the amount of quality human interaction that’s involved in health care.

It’s a terrible idea even for basic hospital care and medical check-ups – but for things like mental health care and substance abuse it completely misses the point.  It’s a basic principle of humanistic psychology, long supported by evidence, that the relationship between the client and the therapist or counselor is THE driving force in healing … not an extra, not a bonus, but the primary force that drives healing.  Take that away, make it institutionalized and impersonal and “one size fits all,” and you’re defeating the point of calling attention to these mental health issues in the first place. 

Which means that it’s not enough to call attention to mental health needs and substance abuse issues;  and it’s not enough to have programs in place:  to be effective, these programs must be run differently than the way we run our conventional health services.  They must emphasize the human element in a way that, frankly, conventional medicine could learn a thing or two from. 


— Liz Schreiber

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