It was joyous and sobering for me, standing on stage looking out at the audience filled with bright, passionate and dedicated researchers, policymakers and providers. Everyone attending the 28th Annual Research and Policy Conference for Child, Adolescent, and Young Adult Behavioral Health this past week, has in some way been touched by involvement in a SAMHSA-funded grant or initiative.
If my close to 30 years being involved in this work has shown me anything, it is that innovation and creativity always find a way to rise to the top. And this room was full of creative innovators.
How ironic that of the close to 700 people in attendance at the conference, easily two-thirds of them have had direct involvement with a SAMHSA-funded initiative. In that capacity, these bright researchers have been able to extend our knowledge about the science of prevention and treatment strategies that make a difference for youth with mental health challenges and their families. I can only hope that the small slice of SAMHSA that I am most familiar with, the Child Mental Health Initiative, is representative of the other initiatives that SAMHSA funds. If this is the case, then I am inspired and hopeful for the continued development of innovative treatment strategies based on the realities of today, not 30 and 40 years ago.
However, it seems that for each innovative step forward, we tend to cycle through regressive periods when we take three steps back. You know we are in a regressive cycle when you realize that we seem to have forgotten the lessons learned from the evolving science of effective prevention, treatment and support for individuals with mental health challenges. That forgetfulness is evidenced by a tendency to embrace the safety and comfort of antiquated and simplistic notions of effective treatment. We are in such a cycle right now.
SAMHSA is under attack – rank and file are paying the price
SAMHSA, and specifically Administrator Pam Hyde, is under scrutiny by the House Energy and Commerce Committee Oversight and Investigations Subcommittee as part of their ongoing discussion of mental health reform. In the last two years we have seen pronouncements of simple, quick fix answers to some our most complex mental health challenges; the proliferation of six-word sound bytes denigrating SAMHSA (e.g., SAMSHA doesn’t care about mental illness), smug commentaries in leading newspapers across the nation that reward and encourage the constant attack on SAMHSA, and a barrage of questions and probes which focus on individual examples from agency-funded grants that show complete disregard for the overall context in which they exist. I fear that the tug of war between the Oversight and Investigations Subcommittee and Administrator Hyde is a harmful distraction to the overall functioning of the agency.
And yet, the rank and file who work within SAMHSA continue to do the work that needs doing, following orders from above and remaining loyal to the mission of the agency.
- Can you imagine what it must be like to be an employee of SAMHSA, knowing that in the media, the agency you work for is being denigrated daily?
- Can you imagine how hard it must be for the employees of SAMHSA to not take this public barrage as a personal attack?
- Can you imagine the inherent conflict in working late, coming in early and caring deeply about the initiatives that you are a part of, only to have that dedication lumped into sound bytes that suggest incompetence at best, and negligence at worst?
- Can you imagine what it must be like to work for an agency that is rapidly becoming defined by the purchase of a painting or the cost of an early intervention website?
- Can you imagine day in and day out being equated with something that is clueless, out of touch, inexperienced, and wasting taxpayer dollars?
I cannot come close to imagining what that must be like or how it must feel.
SAMHSA employees don’t need to imagine. They live it day in and day out.
The strain on SAMHSA employees is obvious to me and my fellow colleagues. It is also painfully clear in polling data. In a recent poll by the Partnership for Public Service on the best places to work in federal government, SAMHSA ranks 298th out of 315. SAMHSA ranks lowest in morale in all of HHS. There are only 17 agencies in federal government who rank lower.
The deterioration of knowledge within SAMHSA is further evidenced by the increasing number of seasoned professionals leaving SAMHSA for other endeavors. This institutional knowledge cannot be replaced. There has got to be a solid effort to stem the tide of knowledgeable innovators leaving the agency for other pursuits.
Recommendation to Congress
It is no secret that the House Energy and Commerce Committee Oversight and Investigations Subcommittee has had SAMHSA squarely in its sites for some time now. I have written about the childish behavior exhibited by some members of Congress in hearings with SAMHSA Administrator Pamela Hyde, as well as the contentious responses from Administrator Hyde to subcommittee questions. While that behavior on both sides may continue, the staff of SAMHSA do not deserve to be drawn into the fray.
Here is my respectfully submitted recommendation to members of Congress:
- Thank you for your service
One of the most important changes in the public perception of the military of today as to the military in the Vietnam era is the almost universal respect for the soldier. No matter how much for or against military involvement in conflicts around the world, the American public seems united in honoring active duty military and veterans with the common refrain of “Thank you for your service.” The generals and other high-level decision-makers get paid to take the barbs and the hits regarding their decisions. But the soldier is honored for his or her loyalty and commitment to doing the best job possible.
Whenever a member of Congress decides to lay into Administrator Hyde, it would be a good start if he or she would preface the shellacking with acknowledgment of the foot soldiers working within the walls of SAMHSA. If members of Congress don’t begin doing this, then they are part and parcel in contributing to the low morale of agency staff and the alarming brain drain that is taking place.
Recommendation to Administrator Hyde
Yes, some of the barbs thrown your way have, for the most part, been out of context. But the field needs you to rise above and broaden your leadership approach. Viewing your leadership approach from afar feels a bit like “my way or the highway.” That may not be your intent or what you are doing in practice, but that is how it looks and feels to many in the field. I fear that if you stay on this course, SAMHSA ultimately loses. And the loss most significantly will be in the brain trust that is the staff that make up the organization.
Here are my respectfully submitted recommendations to Administrator Hyde:
- Address low morale
Assign a task to the SAMHSA National Advisory Council to review the “Best Places to Work in Federal Government” poll and make recommendations for improving staff morale. Addressing the systemic low morale across the agency needs to be a high priority.
- Revisit the GAO report recommendations
Revisit the GAO report and consider revising your response. At a minimum, identify strategies for addressing the spirit of the GAO recommendations around higher visibility of interagency collaboration efforts.
- More transparency regarding funding decision-making
Consider modeling the approach NIMH Director Tom Insel is taking with the development of a white paper outlining how funding decisions are made at NIMH and the approach being taken in developing their strategic plan.
Folks, SAMHSA is in crisis, and we cannot sit by and watch it both self-destruct and be torn down by political forces outside. There is too much good being done by too many good people to let this happen. Show your support for the dedicated employees who work for SAMHSA and send a clear message to Congress and Administrator Hyde that they have got to figure out how to work together.
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President & CEO
Children's Mental Health Network