VIEWPOINT: SAMHSA goals are resilience and recovery

By Terry Cline, Ph.D.
July 1, 2007 - Last updated: May 31, 2011

The Substance Abuse and Mental Health Services Administration (SAMHSA) remains committed to a clear vision that guides its work: a life in the community for everyone. To that end, as the new SAMHSA administrator, I will continue to advance the agency’s mission of building resilience and facilitating recovery for people with or at risk for mental or substance use disorders.

National policy reports continue to underscore the importance of behavioral health to our nation’s public health. The human costs of substance abuse and mental illnesses – lost jobs, lost families and lost lives – are incalculable.

The economic costs of undiagnosed and untreated mental and substance use disorders in this country are staggering. Almost one-fourth of all stays in U.S. community hospitals for patients age 18 and older – 7.6 million of the nearly 32 million stays – involved depressive, bipolar, schizophrenia and other mental or substance use disorders in 2004, according to a new report by the Agency for Healthcare Research and Quality.

Too often, due to social stigma or lack of understanding, individuals and health care providers do not recognize the symptoms of mental illness or treat mental disorders with the same urgency as other medical conditions. Fewer than half of the more than 24.6 million adults who experienced serious psychological distress in the past year received treatment. Often, the physical health of people with mental disorders is compromised as well, reducing life expectancy by as much as 25 years, according to a report just issued by the National Association of State Mental Health Program Directors.

SAMHSA believes that recovery is the expectation, not the exception. That is why we continue to advance the adoption of evidence-based practices to help rebuild and reclaim lives that otherwise might be lost to devastating symptoms, isolation and even suicide. With a fiscal year 2007 budget of nearly $3.3 billion, SAMHSA funds and administers a rich portfolio of grant programs and contracts that support state and community efforts to build capacity and enhance prevention programs.

The President’s New Freedom Commission on Mental Health reported that the current system unintentionally focuses on managing the disabilities associated with mental illness rather than promoting recovery, due in part to fragmentation, gaps in care and uneven quality.

SAMHSA leads the federal effort to transform today’s mental health system through an executive steering committee, which oversees the Federal Action Agenda for Mental Health Transformation. The Action Agenda aligns nine Cabinet-level federal departments around 70 specific action steps to fundamentally reshape mental health care in America.

Since its establishment, the Federal Executive Steering Committee has identified and focused on five key areas: (1) preventing suicide (2) integrating primary and mental health care (3) appropriately financing mental health care (4) ensuring employment opportunities for people with mental illnesses and (5) providing an appropriate response to disasters and emergency situations.

A transformed mental health delivery system will have a direct impact on local efforts focused on the prevention of suicide and school violence, on children’s mental health, on aiding individuals transitioning from homelessness and on the protection of the rights of individuals with mental illnesses.

Rather than target a few grants toward system transformation, SAMHSA has worked to ensure that the principles of mental health transformation are embedded in all of our mental health grant programs, including the Community Mental Health Services Block Grant that supports comprehensive, community-based systems of care for adults with serious mental illness and children with serious emotional disturbances. Mental Health Transformation State Incentive Grants are enabling states to develop comprehensive mental health plans and to improve their mental health services infrastructure.

As we transform mental health systems, however, we remain mindful that new knowledge must be incorporated into community-based care. To this end, SAMHSA continues to work with the National Institutes of Health to reduce the 15- to 20-year gap between the initial development and the widespread implementation of new and effective treatments and services. For example, SAMHSA developed the National Registry of Evidence-based Programs and Practices (NREPP), a web-based decision-support system designed to help states and community-based service providers make informed decisions about the interventions they select to prevent and treat mental and substance use disorders.

The NREPP system is the culmination of a multi-year process that included input from numerous scientific and health care service experts and the public. It currently provides information on 27 interventions. Two-thirds of these received NIH funds for development and testing. As investments in research provide evidence of the effectiveness of interventions, SAMHSA will continue to support the dissemination and adoption of evidence-based practices.

Yet, systems change is meaningless if it does not result in outcomes that benefit people with mental illnesses. That is why SAMHSA is working to achieve a performance environment with true accountability that targets a limited number of national outcomes with meaningful measures.

The 10 national outcome measures (NOMs) that we have identified in collaboration with the states represent meaningful, real life outcomes for people who are striving to attain and sustain recovery, build resilience, work, learn, live and participate fully in their communities. The first and foremost of these outcomes is decreased symptoms of mental illness with improved functioning. Four other outcomes focus on resilience and sustaining recovery: (1) getting and keeping a job or enrolling and staying in school (2) decreased involvement with the criminal justice system (3) securing a safe, decent, and stable place to live and (4) social connectedness to and support from others in the community, such as family, friends, co-workers and classmates. Two outcome measures look directly at the treatment process: increased access to services for mental health care and decreased inpatient hospitalizations for mental health care. The final three outcomes measure the quality of services provided.

For example, among states reporting data on retention and perception of mental health care, only 8 percent of patients return to state hospitals within 30 days of discharge and 71 percent of patients reported they were doing better as a direct result of services received.

These data only hint at what the national and state pictures will look like in the next few years as the transformation process continues.
Without question, our success will rest on productive collaborations at the federal, state and local levels with providers, consumers and families and with the private sector. SAMHSA cannot do it alone, nor should we.

As a psychologist who has worked in community-based mental heath service delivery, it is clear to me that my colleagues in clinical practice, academia and education, schools and workplaces, both as individuals and as organizations, play an important role in helping people with mental illness achieve the desired outcomes of resilience and recovery.

While we have done a great deal, we must do more. Helping Americans with mental illness toward healthier lives in the community is not a wishful goal. It is a tangible milestone we can achieve together by advancing science, adopting and using effective treatments, enhancing public knowledge and education and working in partnership to transform mental health care into a vital, integrated part of individual health care and the health of our nation.


Terry Cline, Ph.D., is the first psychologist to serve as administrator of the Substance Abuse and Mental Health Services Administration. He was formerly secretary of health for Oklahoma and before that was commissioner of the Oklahoma Department of Mental Health and Substance Abuse. His e-mail address is:

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