Mental Health Services Administration Research Articles

Suicide Prevention Programming: Comparing Four Prominent Frameworks.

Suicide is a significant public health concern. About 48,000 individuals died by suicide in 2021 in the United States, and approximately one in 100 deaths globally are due to suicide. Continuing efforts in program development and evaluation are vital to preventing suicide. Multiple frameworks have been developed to reduce suicide rates, but they have not been compared to assess their comprehensiveness, nor have their components been classified. In 2019, the authors conducted a narrative review of the literature and identified four major frameworks for suicide prevention: the U.S. Department of Veterans Affairs (VA) Suicide Prevention Program, the Defense Suicide Prevention Program of the U.S. Department of Defense, Zero Suicide in Health and Behavioral Health Care, and the technical package developed by the Centers for Disease Control and Prevention. Program components for these frameworks were identified and classified by using two prevention strategy classification systems: the National Academy of Medicine's (NAM's) continuum-of-care model and the Substance Abuse and Mental Health Services Administration's (SAMHSA's) prevention model. The cross-program comparison revealed that no single program included all components of suicide prevention programs. However, the VA program was the most comprehensive in terms of the number of components and their spread across prevention strategy classifications. The programs used few components categorized under NAM's promotion or selective prevention strategy classifications. The SAMHSA prevention strategy classifications of information dissemination, community-based processes, and positive alternatives were also used infrequently. Organizations, health care systems, and policy makers may use these findings as they develop, improve, and implement suicide prevention programs.

Methadone's Resurgence in Bridging the Treatment Gap in the Overdose Crisis: Position Statement of AMERSA, Inc (Association for Multidisciplinary Education, Research, Substance Use, and Addiction).

The United States is grappling with an unprecedented overdose crisis, exacerbated by the proliferation of potent synthetic opioids like illicitly manufactured fentanyl. Despite the efficacy of methadone treatment in managing opioid use disorder, regulatory barriers hinder its widespread utilization. This article examines the complex landscape of methadone regulation across federal, state, and local levels, highlighting disparities and opportunities for reform. The COVID-19 public health emergency prompted temporary flexibility in methadone regulations, including expanded take-home doses and telehealth counseling, leading to improved treatment experiences and retention. Permanent revisions to federal guidelines have since been introduced by the Substance Abuse and Mental Health Services Administration, reflecting a progressive shift toward patient-centered care and streamlined access. State regulations, managed by Single State Agencies and State Opioid Treatment Authorities, vary widely, often imposing additional restrictions that impede access to methadone treatment. Local OTP clinics further exacerbate barriers through stringent policies, despite federal and state guidelines advocating for flexibility. Coordinated efforts among policymakers, healthcare providers, and communities are needed to promote the development of accountability measures, incentives, and community involvement to ensure equitable access and quality of care. To truly meet the demand needed to end the existing overdose crisis and enhance accessibility and comprehensive healthcare services, methadone treatment expansion beyond traditional OTP settings into primary care offices and community pharmacies should take place.

How do the Substance Abuse and Mental Health Services Administration's Technology Transfer Centers Decide What Evidence-Based Practices to Disseminate and Determine How to Do So? A Cross-Sectional Study of a National Network.

It is important to use evidence-based programs and practices (EBPs) to address major public health issues. However, those who use EBPs in real-world settings often require support in bridging the research-to-practice gap. In the US, one of the largest systems that provides such support is the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Technology Transfer Center (TTC) Network. As part of a large external evaluation of the Network, this study examined how TTCs determine which EBPs to promote and how to promote them. Using semi-structured interviews and pre-testing, we developed a "Determinants of Technology Transfer" survey that was completed by 100% of TTCs in the Network. Because the study period overlapped with the onset of the COVID-19 pandemic, we also conducted a retrospective pre/post-pandemic comparison of determinants. TTCs reported relying on a broad group of factors when selecting EBPs to disseminate and the methods to do so. Stakeholder and target audience input and needs were consistently the most important determinant (both before and during COVID-19), while some other determinants fluctuated around the pandemic (e.g., public health mandates, instructions in the funding opportunity announcements). We discuss implications of the findings for technology transfer and frame the analyses in terms of the Interactive Systems Framework for Dissemination and Implementation.

Continuous Quality Improvement in the Substance Abuse and Mental Health Services Administration's Technology Transfer Center Network: A Process Evaluation.

In healthcare and related fields, there is often a gap between research and practice. Scholars have developed frameworks to support dissemination and implementation of best practices, such as the Interactive Systems Framework for Dissemination and Implementation, which shows how scientific innovations are conveyed to practitioners through tools, training, and technical assistance (TA). Underpinning those aspects of the model are evaluation and continuous quality improvement (CQI). However, a recent meta-analysis suggests that the approaches to and outcomes from CQI in healthcare vary considerably, and that more evaluative work is needed. Therefore, this paper describes an assessment of CQI processes within the Substance Abuse and Mental Health Services Administration's (SAMHSA) Technology Transfer Center (TTC) Network, a large TA/TTC system in the United States comprised of 39 distinct centers. We conducted key informant interviews (n = 71 representing 28 centers in the Network) and three surveys (100% center response rates) focused on CQI, time/effort allocation, and Government Performance and Results Act (GPRA) measures. We used data from each of these study components to provide a robust picture of CQI within a TA/TTC system, identifying Network-specific concepts, concerns about conflation of the GPRA data with CQI, and principles that might be studied more generally.

30 years of youth system of care lessons learned – a qualitative study of Hawaiʻi’s partnership with the Substance Abuse and Mental Health Services Administration

BackgroundThe Hawaiʻi State Department of Health, Child and Adolescent Mental Health Division (CAMHD) has maintained a longstanding partnership with Substance Abuse and Mental Health Services Administration (SAMHSA) to enhance capacity and quality of community-based mental health services. The current study explored CAMHD’s history of SAMHSA system of care (SOC) awards and identified common themes, lessons learned, and recommendations for future funding.MethodsEmploying a two-phase qualitative approach, the study first conducted content analysis on seven final project reports, identifying themes and lessons learned based on SOC values and principles. Subsequently, interviews were conducted with 11 system leaders in grant projects and SOC award projects within the state. All data from project reports and interview transcripts were independently coded and analyzed using rapid qualitative analysis techniques.ResultsContent validation and interview coding unveiled two content themes, interagency collaboration and youth and family voice, as areas that required long-term and consistent efforts across multiple projects. In addition, two general process themes, connection and continuity, emerged as essential approaches to system improvement work. The first emphasizes the importance of fostering connections in family, community, and culture, as well as within workforce members and child-serving agencies. The second highlights the importance of nurturing continuity throughout the system, from interagency collaboration to individual treatment.ConclusionsThe study provides deeper understanding of system of care evaluations, offering guidance to enhance and innovate youth mental health systems. The findings suggest that aligning state policies with federal guidelines and implementing longer funding mechanisms may alleviate administrative burdens.

Buprenorphine Prescribing and Challenges Faced Among National Health Service Corps Clinicians

The National Health Service Corps (NHSC) Loan Repayment Program (LRP) expansion in fiscal year (FY) 2019 intended to improve access to medication for opioid use disorder (MOUD) by adding more clinicians who could prescribe buprenorphine. However, some clinicians still face barriers to prescribing, which may vary between rural and nonrural areas. To examine the growth in buprenorphine prescribing by NHSC clinicians for Medicaid beneficiaries during the NHSC LRP expansion and describe the challenges to prescribing that persist in rural and nonrural areas. This cross-sectional study analyzed preexpansion and postexpansion Medicaid claims data to evaluate the percentage of prescriptions of buprenorphine filled during FY 2017 through 2021. This study also analyzed challenges and barriers to prescribing MOUD between rural and urban areas, using results from annual surveys conducted with NHSC clinicians and sites from FY 2019 through FY 2021. Prescribing of buprenorphine by NHSC clinicians. The main outcomes were the percentage and number of Medicaid beneficiaries with opioid use disorder (OUD) who filled a prescription for buprenorphine before and after the LRP expansion and the challenges NHSC clinicians and sites faced in providing substance use disorder and OUD services. Survey results were analyzed using descriptive statistics. During FYs 2017 through 2021, 7828 NHSC clinicians prescribed buprenorphine (standard LRP: mean [SD] age, 38.1 [8.4] years and 4807 females [78.9%]; expansion LRPs: mean [SD] age, 39.4 [8.1] years and 1307 females [75.0%]). A total of 3297 NHSC clinicians and 4732 NHSC sites responded to at least 1 survey question to the 3 surveys. The overall percentage of Medicaid beneficiaries with OUD who filled a prescription for buprenorphine during the first 2.5 years post expansion increased significantly from 18.9% before to 43.7% after expansion (an increase of 123 422 beneficiaries; P < .001). The percentage more than doubled among beneficiaries living in areas with a high Social Vulnerability Index score (from 17.0% to 36.7%; an increase of 31 964) and among beneficiaries living in rural areas (from 20.8% to 55.7%; an increase of 45 523). However, 773 of 2140 clinicians (36.1%; 95% CI, 33.6%-38.6%) reported a lack of mental health services to complement medication for OUD treatment, and 290 of 1032 clinicians (28.1%; 95% CI, 24.7%-31.7%) reported that they did not prescribe buprenorphine due to a lack of supervision, mentorship, or peer consultation. These findings suggest that although the X-waiver requirement has been removed and Substance Abuse and Mental Health Services Administration guidelines encourage all eligible clinicians to screen and offer patients with OUD buprenorphine, as permissible by state law, more trained health care workers and improved care coordination for counseling and referral services are needed to support comprehensive OUD treatment.

988 and crisis, suicide prevention, and substance use

Called the 988 Suicide and Crisis Lifeline, this three‐digit number was launched more than a year ago by the Substance Abuse and Mental Health Services Administration (SAMHSA) to great fanfare. It appeared to everyone to be mainly for suicide prevention. But it is in fact for every crisis, and substance use is included.

Developing and validating a scale to measure trauma-informed practices used by teachers in inclusive schools in Ghana and the United Arab Emirates

Research on trauma-informed practices is common in Western countries, but non-Western countries have made minimal contributions in this regard. This study aimed to develop an instrument which could be used to measure perceived competence of teachers in the implementation of trauma-informed practices for students with disabilities in Ghana and the United Arab Emirates (UAE). The Teacher Trauma Management Scale (TTMS), developed using the trauma framework by the Substance Abuse and Mental Health Services Administration was used to collect data from 514 teachers in Ghana (n 270) and the UAE (n = 244). Data were subjected to confirmatory factor analysis) and a two-way factorial analysis of variance was conducted. While one hypothesis was supported by the study findings, the other was only partially supported. The findings provided theoretical and structural support for the newly developed TTMS in a non-Western context. This study highlights the need to develop contextual trauma management training models or a curriculum for training teachers.

SAMHSA reinstates CSAP Prevention Fellowship program

One of the substance use disorder (SUD) workforce tools to die during the Trump administration was the CSAP (Center for Substance Abuse Prevention) Prevention Fellowship Program, run by the Substance Abuse and Mental Health Services Administration (SAMHSA).

Evidence-based care for suicidality as an ethical and professional imperative: How to decrease suicidal suffering and save lives.

Suicide is a major public and mental health problem in the United States and around the world. According to recent survey research, there were 16,600,000 American adults and adolescents in 2022 who reported having serious thoughts of suicide (Substance Abuse and Mental Health Services Administration, 2023), which underscores a profound need for effective clinical care for people who are suicidal. Yet there is evidence that clinical providers may avoid patients who are suicidal (out of fear and perceived concerns about malpractice liability) and that too many rely on interventions (i.e., inpatient hospitalization and medications) that have little to no evidence for decreasing suicidal ideation and behavior (and may even increase risk). Fortunately, there is an emerging and robust evidence-based clinical literature on suicide-related assessment, acute clinical stabilization, and the actual treatment of suicide risk through psychological interventions supported by replicated randomized controlled trials. Considering the pervasiveness of suicidality, the life versus death implications, and the availability of proven approaches, it is argued that providers should embrace evidence-based practices for suicidal risk as their best possible risk management strategy. Such an embrace is entirely consistent with expert recommendations as well as professional and ethical standards. Finally, a call to action is made with a series of specific recommendations to help psychologists (and other disciplines) use evidence-based, suicide-specific, approaches to help decrease suicide-related suffering and deaths. It is argued that doing so has now become both an ethical and professional imperative. Given the challenge of this issue, it is also simply the right thing to do. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

988: It's not just for suicide, it's for substance use too

Called the 988 Suicide and Crisis Lifeline, this three‐digit number was launched more than a year ago by the Substance Abuse and Mental Health Services Administration (SAMHSA) to great fanfare. It appeared to everyone to be mainly for suicide prevention. But it is in fact for every crisis, and substance use is included.

Implementation of Cognitive Behavioral Therapy for psychosis via telehealth: An expert consultation and clinical service model.

Individuals living with psychosis are often underserved in the United States, partly due to the dearth of providers trained in evidence-based practices for this population. One such practice is Cognitive Behavioral Therapy for psychosis, which the Substance Abuse and Mental Health Services Administration has identified as a standard of care for this population. The explosion of telehealth, in large part due to the COVID-19 pandemic, has led to increased opportunities for virtual psychotherapy. Telehealth offers a number of benefits, such as the ability to address service inequities, including lack of access to a local provider well-trained in the modality of therapy needed. The current article describes the National Psychosis Telehealth Program within the National Expert Consultation and Specialized Services (formerly VA National Telemental Health Center) program, U.S. Department of Veterans Affairs. The goal of this telehealth program is to utilize an expert consultation model and offer a remote individual, time-limited Cognitive Behavioral Therapy for psychosis protocol to Veterans across the nation in order to decrease access disparities to this relatively scarce service. We share our initiation activities and lessons learned as we developed this program in hopes of encouraging others to consider similar efforts at their sites. We also include a typical, complex case that serves to illustrate the challenges and benefits of this approach. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

ASAM features harm reduction, methadone, OTPs at conference

Not surprisingly, last week'k American Society of Addiction Medicine (ASAM) conference was sold out, with its big focus on moving methadone out of the opioid treatment program (OTP) system and into general office‐based care (preferably by only ASAM‐boarded physicians), and also considerable attention paid to the value of high‐quality treatment with methadone. A track called “Methadone in the Modern Era” included Ruth Potee, M.D., in an impassioned speech focused on the need for more access to methadone, and on the for‐profit OTPs that are out there. That track also featured Yngvild Olsen, M.D., director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA) who talked about the other modern (aka, real world) era in which OTP regulations have been completely updated and revised. Aaron Ferguson, who said at a public conference last fall that he owed his life to diverted methadone (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33908) despite being a patient advocate, also presented at the conference, this time on harm reduction, which is beneficial to keeping people alive. Many OTPs, especially the large chain for‐profit OTPs, have been a target of ASAM members for years; most are also members of the American Association for the Treatment of Opioid Dependence, and some are members of the National Association for Behavioral Healthcare.

SAMHSA calls for “culture change” in methadone treatment

New regulations for opioid treatment programs (OTPs) create many new flexibilities for methadone practitioners and providers, and last month'h webinar for administrators focused on the key points. The Substance Abuse and Mental Health Services Administration (SAMHSA), which implements the 42 CFR Part 8 regulations, presented the information to about 800 attendees via a Zoom call on March 20 that was hosted by the American Association for the Treatment of Opioid Dependence (AATOD). Next week, ADAW will cover the March 27 webinar, which was for clinicians. For more on the new rule, see https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023.

In case you haven'n heard…

The impact of disasters on substance use disorder (SUD) programs and services was highlighted in a recent policy brief from the National Association of State Alcohol and Drug Abuse Directors (NASADAD). In the brief, NASADAD noted that changes to the federal Robert T. Stafford Disaster Relief and Emergency Assistance Act need to consider SUDs. The statute should include support for individuals struggling with SUDs in the aftermath of disasters. The proposed legislation, known as the Addressing Addiction After Disasters Act (H.R. 5623 or the AAAD Act), is led by Representatives Becca Balint (D‐VT‐at large), Doug LaMalfa (R‐CA), and Jill Tokuda (D‐HI). The AAAD Act would help bolster intentional awareness, planning, and action regarding issues specific to SUDs within the confines of the short‐term approach of the Crisis Counseling Assistance and Training Program of the Substance Abuse and Mental Health Services Administration. For the brief, go to https://nasadad.org/2024/03/policy‐brief‐highlights‐disasters‐and‐substance‐use‐implications‐for‐changes‐to‐the‐federal‐robert‐t‐stafford‐act‐updated/

Pharmaceutical company ranks best, worst states to live in for MH

In an analysis published last month, the online pharmacy company, Universal Drugstore, ranked the best and worst states to live in for mental health after evaluating various data points, including the prevalence of mental illness and the cost of care, FortuneWell, reported on April 8. Montana topped the list of best places to live for mental health, scoring 8.06 out of 10. The state had the lowest number by population of “mentally unhealthy adults” who cannot afford care, and residents took the second‐fewest mental health sick days in 2022. By contrast, Nevada ranked as the worst state for mental health, with a score of 2.06 out of 10. The Silver State placed in the top five for several measurements, including the highest number of mental health sick days taken and the most youth reporting depressive episodes. Nevada also had one of the lowest ratios of psychologists to residents across the nation. Breaking the data down further, South Dakota, ranked fourth as the best state for mental health with the fewest reported mental health sick days (three), while West Virginia and Louisiana, ranked 34th and 44th, reported the most (six). Adults in New Jersey, ranked 16th, had the lowest rates of mental illness diagnoses (16%), while adults residing in Utah, ranked 25th, had the highest rates of mental illness (27%). Oregon, in 50th place, ranked as the second‐worst state for mental health with a score of 2.89 out of 10, tied with New Mexico, ranked 42nd, for the nation's highest percentage of youth experiencing depressive episodes (19%); the lowest is in Washington, D.C. (11%). The nation's capital, which ranked 13th, is also home to the highest proportion of psychologists compared to Alabama, Maine, Georgia, and Louisiana. Researchers used data from the U.S. Bureau of Labor Statistics, the Kaiser Family Foundation, Mental Health America, the U.S. Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration to compile the rankings. They compared each state's ratio of psychologists to residents, the average number of mental health sick days taken, the prevalence of mental illness for adults and youth, the number of beds available in mental health facilities and the cost of prescription drugs.

An Exploration of Geographic Access to Substance Use Treatment Programs and Violence Against Women.

Violence against women (VAW) is a significant public health and human rights issue, with an estimated 736 million women globally experiencing VAW. Consistent evidence demonstrates that substance use is associated with VAW and that participation in substance use treatment programs is associated with reduction in substance use-related violence. While evidence demonstrates the ability to address VAW through substance use treatment programs, less attention has been paid to geographic access to substance use programs. If these programs are geographically inaccessible, particularly to marginalized populations, many people will not get the help they need. This study seeks to explore the relationship between geographic access to substance use treatment programs on VAW. Using data from the HIV Prevention Trials Network (HPTN) 064 study, longitudinal multilevel models were used to assess the relationship between neighborhood-level social determinants, with a specific focus on geographic access to Substance Abuse and Mental Health Services Administration (SAMHSA) certified drug and alcohol treatment programs and VAW. The study included 1910 women, ages 18 to 44, living in select geographic areas with high-ranked prevalence of HIV and poverty. The findings of this study indicate that among women who reside in census tracts with high prevalence rates of HIV: (1) substance use increases VAW; (2) VAW decreases as geographic access to SAMHSA-certified drug and alcohol treatment facilities increases; and (3) when looking at specific types of VAW, emotional and physical abuse decreases as geographic access to substance use treatment increases. Policies and programs to increase access to substance use treatment should be explored and evaluated, and more programs are needed that address the intersectionality of substance use and VAW.

SAMHSA CoE offers Part 2 medical emergency exception tool

The Center of Excellence for Protected Health Information (CoE‐PHI), funded by the Substance Abuse and Mental Health Services Administration, has released a new tool to help substance use disorder (SUD) treatment providers learn about the Medical Emergency Exception to 42 CFR Part 2, the federal regulation that protects the confidentiality of treatment records. The tool is designed to help SUD service providers identify what constitutes a medical emergency and who may receive SUD treatment records pursuant to this exception. Specifically, the tool's objectives are to describe what constitutes a medical emergency, identify when the medical emergency exception applies, and explain who may perceive records pursuant to this exception. This is an on‐demand module that can be accessed at any time. For more information, go to Part 2's Medical Emergency Exception.

Part 8 update: AATOD argues for removing more barriers to methadone treatment

Changes to the CFR 42 Part 8 regulations covering methadone treatment for opioid use disorder (OUD) have been welcomed by opioid treatment programs (OTPs) (see ADAW https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023), which are the only providers with experience using methadone for this condition. However, the devils are, as always, in the details. It's not just a matter of the Substance Abuse and Mental Health Services Administration (SAMHSA) changing its rules.

Caring for Patients With Body Dysmorphic Disorder Seeking to Undergo Plastic Surgery and/or Aesthetic Interventions.

In the field of medical aesthetics and plastic surgery, it is not uncommon to interact with clients who never seem to be satisfied, regardless of the success of an intervention. Medical professionals may attribute this to the patient having an overly critical nature; however, this continual dissatisfaction could also be the result of a mental health disorder known as body dysmorphic disorder (BDD) that is significantly underdiagnosed and prevalent within the plastic surgery and aesthetic patient population. According to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5; American Psychiatric Association, 2013), BDD is defined as, "a preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others" (Substance Abuse and Mental Health Services Administration, 2016, Table 23). Having the ability to identify the signs of BDD, utilize appropriate communication skills with individuals who may have BDD, and understand the implications of providing additional aesthetic treatments for patients who present with BDD allows aesthetic practitioners to prioritize and promote patient safety, well-being, and satisfaction.