SAMHSA – Embrace the GAO recommendations for HHS mental health leadership

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On February 11th, the House Energy and Commerce Subcommittee on Oversight and Investigations, chaired by Rep. Tim Murphy (R-PA), held a hearing to learn more about the results of a recent GAO report entitled “Mental Health: HHS Leadership Needed to Coordinate Federal Efforts Related to Serious Mental Illness.”

Why a hearing? 
In 2013, Congressman Murphy introduced the Helping Families in Mental Health Crisis Act, designed to focus on programs and resources on psychiatric care for patients and families in most need of services. One of the key components of the bill focused on how the federal government coordinates efforts to provide services and supports for individuals with serious mental illness.

The sub-committee requested the GAO to conduct a survey and write a report of findings so they could get a better idea of how mental health programming efforts were coordinated across eight federal agencies. SAMHSA’s role in promoting coordination of programs focused on mental illness across the federal government was of particular interest to members of this sub-committee.

What did the GAO report recommend? 
There were two primary recommendations from the report. 

How did SAMHSA respond to the recommendations in the GAO report? 
Unfortunately, and for me, quite stunning, the official SAMHSA response from Administrator Pamela Hyde was to disagree with both recommendations. If you watch the video of the hearing (included at the end of this post), three things become evident:

There were many examples of a sort of cognitive disconnect between the questions being asked by members of the committee and the responses given by Administrator Hyde. Here is one example:

This kind of back and forth continued throughout the hearing. Sitting in the audience, I was getting as frustrated as I am sure both the witnesses and committee members were. And looking around the room, frustration seemed to be running high in the audience, both for supporters and detractors of SAMHSA.

I do believe Administrator Hyde was trying to address the complexities involved in understanding the role of SAMHSA with other federal agencies, attempting to illustrate how those with serious mental illness dip in and out of the programmatic touch of federally funded efforts across myriad agencies. Unfortunately, to my ears, her tone came across as both arrogant and dismissive, particularly to committee members who were more challenging in their tone, and in two particular cases, downright offensive and rude to her. I do not believe the Administrator came into the hearing with the intent of being off-putting, but she, like some of the committee members, appeared to get caught up in the moment. Regardless, getting involved in a wrestling match was not helping anyone.

The elephant in the room 
I have no tangible evidence, just a gut level feeling, that SAMHSA leadership may be a bit concerned that agreeing with the recommendations in the GAO report might open the door for increased support for the creation of the additional layer of oversight over SAMHSA called for in the Murphy mental health reform bill. 

 It is no secret that a core component of Congressman Murphy’s Helping All Families in Mental Health Crisis Act includes the creation of a new HHS assistant secretary for mental health and substance-abuse disorders who, in addition to interagency coordination efforts, would, among other things, supervise the Administrator of SAMHSA.

Let's be clear, I think there are huge challenges with the way the language was written in HR 3717 regarding the creation of an HHS assistant secretary position. Much of what was written looked like tasks that should already be in place as responsibilities of the SAMHSA Administrator. It seems that before adding on an additional layer of bureaucracy, all possibilities should be explored for how coordination and collaboration can be improved within the current structure.

That being said, I think anything remotely resembling a practice that would fit neatly into legislative language calling for an HHS Assistant Secretary (which these recommendations potentially pave the way for), is a frightening prospect for SAMHSA leadership.

In closing, here are a few respectfully submitted recommendations for Administrator Hyde and one big old recommendation for the rest of us:

Recommendations for Administrator Hyde and members of her leadership team 
Show through action, that the type of leadership and accountability called for in the GAO report can be achieved without adding additional layers of bureaucracy.

A simple recommendation for the rest of us 

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Scott Bryant-Comstock
President & CEO
Children's Mental Health Network 


  1. George Patrin, MD/MHA, San Antonio, TX's avatar
    George Patrin, MD/MHA, San Antonio, TX
    | Permalink
    The letter read by Congressman Murphy starting this out was fantastic. How ANYONE in leadership positions can keep defending their work is beyond me! And why tax-payers can't be helped to see these totally inadequate unethical practices is our frustration. It IS unbelievable! Unaccountable government indeed. It's all part of the "Conspiracy of denial" rampant in this country, practiced by all except the 'survivors' of tragedy and loss, it seems. Thanks to Scott and the CMHN for trying to raise these issues to consciousness.
  2. DJ Jaffe's avatar
    DJ Jaffe
    | Permalink
    The most disturbing thing to me was that neither presenter from SAMHSA knew that there IS a federal definition of serious mental illness. It is what is what legislation requires SAMHSA to use to calculate the distribution of mental health block grants. SAMHSA publishes stats on it every year (NSDUH). The fact that the director does not know it exists, explains why so few programs at SAMHSA, even those like MH Block grants that are required to go SMI do not go to SMI. SAMHSA doesn't know they exist. DJ Jaffe, Exec. Dir., Mental Illness Policy Org
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