The document summarizes challenges and opportunities in substance abuse and mental health prevention. It discusses how health reform aims to expand access to care through Medicaid expansion and insurance exchanges. This will provide opportunities to integrate behavioral health prevention and treatment into primary care. The document also outlines SAMHSA's strategic initiatives to focus on prevention, trauma, military families, recovery support, and using data and health IT to drive performance and outcomes.

1. The Future of Prevention:
Our Challenges and
Opportunities
Frances M. Harding, Director
SAMHSA’s Center for Substance Abuse Prevention
2011 NCADD Conference of Affiliates
Arlington, VA • September 7, 2011

2. SAMHSA’s Key Messages
 Behavioral health is essential for health
 Prevention works
 Treatment is effective
 People recover from mental and substance use
disorders

3. Role of Prevention in Substance Use
and Mental Health Disorders
 Behavioral health is essential for health
 Addiction as a complex and chronic disease
 Recovery as a process rather than an event
 Ongoing contact and support to complement treatment
 Natural supports such as friends, peers, and family
 Evidence-based, multi-component prevention programs

4. Assessing Public Knowledge and
Attitudes: What Americans Believe
66 percent 20 percent say
believe they would 30 percent say
20 percent feel
treatment and Two thirds 75 percent think less of a they would
persons with
support can believe believe recovery friend/relative if think less of a
mental illness
help people addiction can from addiction they discovered person with a
are dangerous
with mental be prevented is possible that person is in current
to others
illness lead recovery from addiction
normal lives an addiction

5. Drivers of Change
EMERGING
Federal SCIENCE
Domestic
Spending
State
Budget
Declines
Health Reform

6. Health Reform
 More people will have insurance coverage.
 Theme: prevent diseases, promote wellness
 Integrated care: new thinking—recovery, wellness, role of
peers, response to whole health needs
 New opportunities for behavioral health:
• Parity: Mental Health Parity and Addiction Equality Act
and within Affordable Care Act
• Tribal Law and Order Act
• National Action Alliance for Suicide Prevention
 Medicare and Medicaid changes

7. Beginning in 2014: 32 Million More Americans
Eligible to be Covered
4-6
mil

8. Challenges—State Leadership
Individuals Served by SSAs Individuals Served by MHAs
Insured
Uninsured
39%
39%
Uninsured Insured
61% 61%
• 90–95 percent will have the opportunity to be covered
by Medicaid or through insurance exchanges.

9. Federal Domestic Spending
 Focusing on the Strategic Initiatives
 Revised Approach to Grant-Making
 Prevention Funding for 2012:
• Substance Abuse-State Prevention Grant ($395 million).
• Mental Health-State Prevention Grant ($90 million).
• Behavioral Health-Tribal Prevention Grant ($50 million).

10. Staying Focused During Change

11. SAMHSA’S Strategic Initiatives
6. Health 7. 8. Public
2. Trauma and 3. Military 4. Recovery 5. Health
1. Prevention Information Data, Outcomes Awareness &
Justice Families Support Reform
Technology & Quality Support

12. Strategic Initiative 1: Prevention of
Substance Abuse and Mental Illness
Goal 1.1
With primary prevention as the focus, build emotional health, prevent or
delay onset of, and mitigate symptoms and complications from
substance abuse and mental illness.
Goal 1.2
Prevent or reduce consequences of underage drinking and adult problem
drinking.
Goal 1.3
Prevent suicides and attempted suicides among populations at high risk,
especially military families, LGBTQ youth, and American Indians and
Alaska Natives.
Goal 1.4
Reduce prescription drug misuse and abuse.

13. Work Ahead—SAMHSA
 Revised Block Grant application and reporting
 Implementation of Tribal Law and Order Act—Office of
Indian Alcohol and Substance Abuse
 Decisions and implementation of prevention funds
 Evidence of good and modern services:
• Benefit decisions, practice protocols, research agenda

14. Current Federal Partners
• Administration for Children and • Office of Minority Health
Families • Office of National Drug Control
• Administration on Aging Policy
• Centers for Disease Control and • Office of the Surgeon General
Prevention • Department of Education
• Centers for Medicare and • Department of Defense
Medicaid Services • Department of the Interior
• Food and Drug Administration • Department of Justice
• Health Resources and Services
Administration
• Indian Health Service
• National Institutes of Health

15. New Roles—State SA and MH Leadership
 Take key role in design and execution of health reform.
 Develop or enhance strategic partnerships for
prevention.
 Think beyond traditional Block Grant populations.
 Focus on recovery support—help people get and stay
well.

16. We’ve Been Here Before
Risk and protective factors—Commonalities
between mental health and substance
abuse.
Chronic disease indicators—Substance use
represents a spectrum of conditions and risk
factors as well as social context.
Links with physical health care providers—
Prevent problems related to mental illnesses
and substance abuse.

17. SAMHSA’s PRINCIPLES
PEOPLE PERFORMANCE
PARTNERSHIP
Stay focused on the Make a measurable
goal Cannot do it alone
difference
www.samhsa.gov