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SAMHSA at 20: From Hopelessness to Recovery and Prevention
On October 1, SAMHSA will mark its 20th birthday. We wish to commemorate that occasion and to celebrate the progress from hopelessness to recovery and prevention that SAMHSA has helped to foster between 1992 and 2012.
Over the past 20 years, the behavioral health field has seen dramatic change. When SAMHSA was established in 1992, the field was still struggling to develop community-based services, foster the peer/consumer movement, and prove that prevention, treatment, and recovery were possible. Today, consumer self-determination and shared decision-making inform community service systems. The concept of recovery empowers consumers. And health promotion, disease prevention, and early intervention have become essential elements of our behavioral health system.
The experience of recovery—along with the fostering of personal resilience through health promotion and disease prevention—are the two most important outcomes to emerge since SAMHSA’s founding and, actually, since the creation of the behavioral health field itself. Just 20 years ago, recovery was not part of behavioral health’s lexicon. Even within the behavioral health field, many didn’t believe that recovery was actually possible.
The idea of recovery grew out of the self-help movement, including Alcoholics Anonymous, Recovery Incorporated, Narcotics Anonymous, On Our Own, and the family movement including Al-Anon. Peers and consumers brought the concept to the substance use and mental health fields, demonstrating that their knowledge and insights could not only improve their own care but help shape an entire field.
Promoting Recovery. Since then, recovery has become a ubiquitous goal within behavioral health and a national call to action. SAMHSA adopted the concept and has played a vital role in promoting it. For example, SAMHSA recently has formulated a working definition that describes recovery from behavioral health conditions. SAMHSA also articulated several important related principles: recovery emerges from hope; occurs via many pathways; involves individual, family, and community strengths and responsibility; is person-driven, holistic, and culturally-based and influenced; is based on respect; and is supported by peers and allies through relationships and social networks and by addressing trauma.
Promoting Resilience. SAMHSA also recognized early how important it is to pay much more attention to promoting heath and preventing disease. The result has been increased emphasis on trauma’s critical role in mental illness and substance use, and the importance of early intervention efforts, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). The need to contain health care costs points squarely in this direction. SAMHSA has provided essential leadership at the federal, state, and community levels through major prevention initiatives. This work will influence how the Affordable Care Act approaches prevention of chronic disease.
Reducing Disparities. SAMHSA also has made major strides in reducing the disparities in health status and care that people with behavioral health conditions often experience. One direct consequence is the Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008. That landmark legislation reduces treatment disparities between behavioral health and medical care in large, private insurance plans. The ACA has extended those protections to people newly insured through Medicaid and state health insurance exchanges. Universal coverage will promote equity in health status and treatment for those with behavioral health conditions. SAMHSA also has made major strides in addressing another type of disparity: the lack of culturally competent behavioral health care.
Looking to the Future. Much still remains for SAMHSA to do. The ACA offers our field unprecedented opportunities. Thanks to the ACA, for example, adults earning up to 138 percent of the federal poverty level will gain Medicaid coverage. State health insurance exchanges will cover uninsured adults with incomes above that level. As a result of these two changes, 32 million adults—about 12.4 million with pre-existing mental or substance use conditions—will enjoy insurance coverage.
To fulfill these and other opportunities, SAMHSA and the behavioral health field must engage the broader health field, as well as communities themselves, to support good behavioral health for all. They also must promote community- and population-based prevention, treatment, and recovery services, and support individuals as they seek their own paths to resilience and recovery.
To commemorate SAMHSA’s 20th birthday, I and Paul Samuels of the Legal Action Center prepared a view from the field. Our report offers a look at the two decades of SAMHSA’s past successes and the development of the behavioral health community during this period, as well as key directions and steps needed for the future. This report will be available at the SAMHSA anniversary event on October 4.
Our hats are off to SAMHSA and its entire current and past staff for all the remarkable things you have accomplished during your first 20 years. We wish you many, many more years of continued success in your endeavors to improve behavioral healthcare.
