SAMHSA is under attack - and the rank and file are paying the price

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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.

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.

Low morale 
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.

Brain drain
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:

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:

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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scott

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

Comments

  1. Mischief's avatar
    Mischief
    | Permalink
    Thank you.
    That's all.
  2. Nancy jones's avatar
    Nancy jones
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    as a disheartened mom , our 45 yr old son is now homeless, put out untreated and psychotic by behavioral health . Their policy is voluntary only. Our very ill now and missing son suffers from schizoaffective disorder . Having also anasagnosia , he is so ill he doesn't realize he needs medical care from a brain disease, not a behavior disorder.
    I admire dr Tim Murphy for realizing our mental health system is broken . Every agency out there refused to bring us , his family into needed care he should be given as each failed , turning him away as they hide behind the HIPAA confidentiality law.. Sadly ignoring the fact he no longer can make cognitive decisions and at this time has been tossed out to die like yesterday's garbage. SAMSHA funds behavioral health and I can honestly say, their policy is killing my son. This is barbaric!!!!!!
  3. Mary Palafox's avatar
    Mary Palafox
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    Our federal government has divided the brain in two. Conditions that are physical are managed by NIH, and those labeled mental by SAMHSA. This is unfortunate because ilnness is illness and needs to be managed by Medicine/NIH. Its out of SAMHSAs scope of practice to manage illness, but mental health and recovery is within your scope. Health care needs to be integrated and based on sound Medical advice based and current brain research. No longer should medical care be usurped by non-medical professionals using only behavioral health philosophies and behavioral sciences. SAMHSA has not aligned itself well enough with Medicine/neuroscience, and conts to apply "substance abuse" policy & philosophy to complex brain illness-such as schizophrenia and bipolar.
  4. John Doe's avatar
    John Doe
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    You've hit the nail on the head, yet only scratched the surface of the impact on "rank and file" SAMHSA staff. That ripple effect then goes on to impact rank and file staff of SAMHSA funded grant communities as we all struggle to deal with the issues you have shed a light on. I hope your recommendations are considered.
  5. Scott's avatar
    Scott
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    Kate: Thanks for your feedback, and yes, Deb is right - you can read my analysis of the Murphy bill from December, 2013 here - http://bit.ly/11s30dI . The issue you raise is important, as it is far too easy for any of us to think in terms of for or against. I am neither for or against the Murphy bill. What I am is resolute in getting all of us to have a conversation about what is needed for comprehensive mental health reform in America. Unfortunately, the national dialogue has pitted good people into either a "for" camp or an "against" camp. All that has done is to promote stalemate - and we can no longer afford stalemate. The AOT dialogue is a perfect example of our efforts to shatter the "for" or "against" paradigm. Next up, and the reason for the timing of this zen post, is a thorough look at the recommendations in the Murphy bill regarding SAMHSA. If you read my December 2013 zen post you will have a good idea of where I am headed with this. Thank you again for sharing your thoughts and keep readin' and keep sharin'!
  6. Deb's avatar
    Deb
    | Permalink
    Scott can certainly speak for himself, but he was actually one of the first to publicly express serious misgivings about Murphy's bill, well over a year ago. Read his Morning Zen from December 2013 directly addressing it.
  7. Kate's avatar
    Kate
    | Permalink
    I find it interesting that after months of promoting Tim Murphy's bill you have woken up to the fact that he and others want to dismanle SAMHSA. Too little; too late.
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