Hopeful Signs of Increased Emphasis on Mental Health Issues

A major speech on mental health from Health and Human Services (HHS) Secretary Kathleen Sebelius and the ascension of a new administrator at the Substance Abuse and Mental Health Services Administration (SAMHSA) have sparked hopes that the Obama administration is putting increased emphasis on mental health issues. Buoying those hopes further is the fact that the White House has recruited notable mental health advocates in other top positions, such as Richard G. Frank and Sherry A. Glied, authors of the book Better But Not Well: Mental Health Policy in the United States Since 1950. Glied has been nominated as assistant secretary for planning and evaluation at the HHS. Frank is her deputy for disability and mental health policy.

Michael Hogan, PhD, commissioner of the office of mental health in New York State, said he is enthusiastic about what is shaping up as a first-rate Obama administration mental health team. Hogan, former head of mental health in Ohio, chaired the New Freedom Commission that proposed major mental health system changes in a report that was asked for and published under the George W. Bush administration in 2003.

Expectations are particularly high for Pam Hyde, the new SAMHSA administrator, who was the driving force for consolidation of mental health services in New Mexico, where she served as secretary of the state’s Human Services Department since 2003. One behavioral health executive for a major firm who has worked with Hyde in New Mexico and her counterparts around the country stated that Hyde is “quite a taskmaster.” He explained that mental health services play second fiddle to Medicaid in most state HHS departments, but that Hyde had an “unusual understanding” of the importance of mental health and psychi-atric services. This official decried SAMHSA’s current status as a backwater federal agency, especially with regard to the lackluster programs at the Center for Mental Health Services. “Pam is big enough, and ornery enough, to change that,” he said.

In an interview, Hyde said, “There is more awareness and interest in Congress and this administration in behavioral health than there has been in a long time. I wouldn’t be here if that weren’t the case.” Hyde accompanied Sebelius on her December 16 visit to the Sheppard Pratt Health System headquarters in Towson, Md, where Sebelius made her speech. Sheppard Pratt is a private, non-profit behavioral health organization; Steve Sharfstein, MD, its president and CEO, has held leadership positions within the American Psychiatric Association and was president from 2005 to 2006.

In what the HHS billed as a major speech on mental health, Sebelius alluded to mental health “parity.” She suggested that the concept should be expanded beyond the conventional meaning, which has to do with insurance companies providing psychiatric care on the same financial basis as other medical care. Sebelius stated that it “would encompass investments in prevention, investments in health care delivery reform, investments in support services like housing that can affect behavioral health outcomes, and investments in treatment and service system research.”

However, Sebelius’ first year at the helm of HHS has not resulted in much of anything in the way of mental health initiatives or focus. That can be explained, in good part, by the department’s focus on the emerging health insurance reform bill from Congress and the early indication that the H1N1 flu would be a bigger public health crisis than it has turned out to be. Eric Broderick, DDS, MPH, acting SAMHSA administrator for the past 18 months or so, characterized Sebelius’ 6 priorities as H1N1, regulation of tobacco by the FDA, health care reform, HIV/AIDS, improvement of food safety programs, and the American Recovery and Revitalization Act implementation.

In fact, mental health issues have been invisible at HHS for years, probably since the New Freedom Report was published in July 2003. Sharfstein commented that one of the challenges facing new SAMHSA administrator Hyde is the implementation of recommendations of the New Freedom Commission. “That was an excellent report,” said Sharfstein, “but SAMHSA has been hampered by not having adequate funding to carry out the recommendations.”

Hyde disagreed that the transformation envisioned by the New Freedom Commission has sputtered. “A lot of things in that report already have been talked about, such as the system fragmentation the report highlighted. There have been experiments in states like New Mexico, and the Center for Mental Health Services is working on transformation initiatives. Just because there has not been a lot of money put in doesn’t mean transformation is not being worked on. But I think you are going to see increased efforts to address some of those intractable problems which have been around for a long time.” However, when asked about any particular upcoming mental health initiatives at SAMHSA, nothing came to mind.

Both Hogan and Sharfstein have high praise and high hopes for Hyde who has a reputation as an innovator. New Mexico is about halfway through a 10-year plan to combine 15 state social service departments, including mental health, into what is called the New Mexico Behavioral Health Collaborative-a jumbo state department meant to improve consumer access to services. Kris Ericson, New Mexico–based executive director of the College for Behavioral Health Leadership, of which Hyde is a long-term member, said, “Pam is one of those people who I believe has been an innovator her entire career. Eight to 10 years ago, before I came to this organization, there was a meeting on financing strategies at which Pam spoke, and people are still talking about her comments and ideas today.” Interestingly, the Harvard John F. Kennedy School of Government published a Public Policy and Management Study in January 1987 that discusses Hyde’s consolidation of the Ohio mental health system when she was director of the state department of mental health there in the early 1980s.

As for the consolidation in New Mexico, Ericson stated, “Depending on whom you talk to, people have a variety of opinions.”

Hogan, too, agreed that the “jury is still out” on the success of the New Mexico collaborative. “It was transformational,” Hogan states, “but there have been a number of bumps in the road, and it hasn’t yet achieved its potential.” Hogan called Hyde “very smart, very principled, she knows how to get things done.”

Hyde explained that the collaborative has “achieved tons of stuff already” including developing crosscutting definitions of expected out-comes and commonality in service definitions. “But there are always intervening factors such as the economy,” she added, “and there are still lots of things up in the air.”