Mental Health Services Administration Research Articles

Opioid treatment worldwide conference set for Baltimore next week

More than 1,200 leaders in opioid treatment plan to convene in Baltimore later this month for the first in‐person conference of the American Association for the Treatment of Opioid Dependence (AATOD) since October 2019. Speakers including Rahul Gupta, M.D., director of the White House Office of National Drug Control Policy (ONDCP), and Miriam Delphin‐Rittmon, Ph.D., leader of the Substance Abuse and Mental Health Services Administration (SAMHSA) and assistant secretary for mental health and substance use of the Department of Health and Human Services. In addition to these federal officials, others, including from SAMHSA and ONDCP, plan to be there to present and answer questions.

Midwifery Care of Pregnant Individuals Experiencing Opioid use Disorder: Changing Regulations, Complexities, and Call to Action.

Opioid use disorder (OUD), overdose, and death have exploded in the United States in the past 2 decades. The number of pregnant and birthing people reporting opioid use and misuse is also rising. Co-occurring mental illness, multisubstance use, and associated medical comorbidities often complicate care for pregnant individuals with OUD. Neonates who are exposed to opioids in utero are at risk for neonatal opioid withdrawal syndrome and other short- and long-term sequelae. Recent changes to the Department of Health and Human Services Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder have now provided a pathway for midwives to prescribe buprenorphine for opioid use disorder (OUD) for up to 30 individuals at one time without further training or certification of ancillary services. Midwives have a key role to play in expanding the availability and quality of interprofessional care provided to individuals with OUD. The Substance Abuse and Mental Health Services Administration and American Society of Addiction Medicine, along with other professional organizations, provide toolkits and guidelines for the provision of MOUD for pregnant people. Midwives who care for individuals with OUD should be familiar with the unique needs of this population and resources to guide their care. This case study highlights midwives' essential role in treating OUD and co-occurring mental disorders.

New federal investments for states to develop CCBHCs

Aiming to further expand opportunities for states to improve access to and delivery of coordinated, comprehensive behavioral health care through Certified Community Behavioral Health Clinics (CCBHCs), the Substance Abuse and Mental Health Services Administration (SAMHSA) and other officials announced new CCBHC planning grants last week.

Findings From Implementing a Patient Experience Survey in a Quality Measurement System for Substance Abuse Disorder Treatment Facilities in 6 States.

Patient experience surveys (PESs) are an important component of determining the quality of health care. There is an absence of PES data available to people seeking to identify higher quality substance use disorder treatment providers. Our project aimed to correct this by implementing a PES for substance use disorder treatment providers and publicly disseminating PES information. We created a population frame of all addiction providers in 6 states. Providers were asked to disseminate a survey invitation letter directing patients to a survey Web site. No personally identifiable information was exchanged. We developed a 10-question survey, reflecting characteristics National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), Substance Abuse and Mental Health Services Administration (SAMHSA) have identified as reflecting higher-quality addiction treatment. Nineteen percent of facilities participated; among participating facilities, 9627 patients completed the survey. Patient experience varied significantly by facility with the percentage of a facility's patients who chose the most positive answer varying widely. We calculated that between-facility reliability will meet or exceed 0.80 for facilities with 20 or more responding patients. We searched for but did not find evidence of data falsification. This cost-efficient survey protocol is low burden for providers and patients. Results suggest significant differences in quality of care among facilities, and facility-level results are important to provide to consumers when they evaluate the relative patient-reported quality of facilities. The data are not designed to provide population-based statistics. As more facilities and patients per facility participate, public-facing PES data will be increasingly useful to consumers seeking to compare and choose facilities.

Trauma-Informed Care in the Neonatal Intensive Care Unit: Through the Lens of the COVID-19 Pandemic.

Trauma is rooted in an individual's experience of an event that leads to physical or mental harm and can have a long-lasting, unfavorable effect on their well-being and functioning. Being aware of the effects of trauma, recognizing its signs, understanding how it informs individual responses, and actively trying to prevent re-traumatization are the tenets of trauma-informed care. Admission to the neonatal intensive care unit (NICU) is widely considered to be an extremely stressful time for parents and infants alike. With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, there were significant changes in healthcare delivery. Widespread closures, restrictions due to infection control measures, the spread of misinformation, increased psychosocial hardships, and amplification of cultural, gender, and racial biases intensified NICU-related stressors. Adoption of the principles of trauma-informed care, as defined by the Substance Abuse Mental Health Services Administration, to the NICU can help buffer some of these stressors. We present a review of these principles viewed through the lens of the COVID-19 pandemic. The lessons learned will help inform practices and policies and allow us to navigate similar challenges more effectively in the future.

Opioids: The Elephant in the Room

America is currently immersed in an opioid crisis brought on by the overprescription and misuse of oral outpatient opioids. The Centers for Disease Control and Prevention (Atlanta, Georgia) current data report reveals that “More than 932,000 people have died since 1999 from a drug overdose. Nearly 75% of drug overdose deaths in 2020 involved an opioid.”1 The Substance Abuse and Mental Health Services Administration’s (San Antonio, Texas) annual report noted that, “Among people aged 12 or older in 2020, 3.4% (or 9.5 million people) misused opioids [and]…an estimated 667,000 people misused prescription pain relievers and used heroin in the past year.”2 Some physicians and specifically anesthesiologists may think they fully grasp this calamity because they prescribe opioid analgesics. Unfortunately, some have firsthand experience with the devastating consequences of the opioid crisis. Others may not fully grasp this or are somewhat blind to the depth and breadth of the opioid crisis. I have a suggestion for all of us that is bound to aid understanding of the opioid crisis.American poet John Godfrey Saxe (1816 to 1887) graced us with his retelling of the Indian parable, “The Blind Men and the Elephant.”3 This tale reveals the very different accounts of what the elephant is as explained by the blind men who each touched a different part of the mammoth creature and described their impressions. Each was sure, yet none had seen the elephant. There certainly is some truth that beauty originates from the eyes (more than touch) of the beholder. I encourage you to read two current books about the opioid crisis to realize some of the parts of this multifaceted crisis.If you were the blind man feeling the economic arm of the opioid crisis, reading Patrick Keefe’s “Empire of Pain: The Secret History of the Sackler Dynasty” will open your eyes. This book recounts the saga of siblings, Arthur, Mortimer, and Raymond Sackler, all well-educated physicians, who bought a small somewhat insignificant pharmaceutical company and cultivated it, with their children and faithful employees, into Purdue Pharma. Mortimer and Raymond focused on growing the company into a money-making powerhouse, peddling powerful analgesics, with the aid of Arthur’s expertise in medical advertising, a potent combination. Relaunching OxyContin treatment, Purdue Pharma executives instructed the company sales representatives to characterize its clinical properties as nonaddicting and more effective with increasing dose regimes. Reading on, the story recounts unscrupulous sales force strategies, such as those brought to the clinical community’s attention in 2009,4 that exploded OxyContin prescriptions yielding total sales of 35 billion dollars from 1996 to the present. As visible through Keefe’s book, the opioid crisis is a catastrophe attributable to the avarice of a family, who rationalized their behavior through their benefactor largesse, working side-by-side with lawyers and corporate executives who prioritized the bottom line, rather than patient benefit priorities.Beth Macy’s “Dopesick: Dealers, Doctors, and the Drug Company That Addicted America” offers a different glimpse of this elephant. This tome recounts the emotionally disturbing saga of people impacted by opioid use disorder. Dopesick is a collection of narratives of the patients and their families and friends who lived and grieved the consequences of the opioid abuse. The narrative expounds the personal stories chronicling the development of the crisis in rural Appalachia, a story universal to all communities attempting to cope with this malady. “Because many die [from opioid abuse] prematurely…surviving family members and communities lose out on benefits from an individual’s lifetime earnings. Opioid use disorder also results in costs associated with added health care expenses, criminal justice, lost productivity, and reduced quality of life. In 2017, these costs totaled an estimated $1.02 trillion—54% was attributed to overdose deaths and 46% to opioid use disorder…”5Keefe writes his text sensing the opioid crisis in a manner focused on and critical of the pharmaceutical industry; Macy writes her text focused on sensing the opioid crisis as a sadly disturbing empathetic concern about the personal stories of the victims. Elements of each author’s perspective appear in each other’s book. It is the emphasis on the economic versus human fallout that urges one to read both books to gain a more complete understanding of the elephant. “Empire of Pain” and “Dopesick” are written to provide astonishing detail that enables the blind man to see the elephant in the room, the opioid crisis.

SAMHSA awards $45.1 million for HIV/AIDS behavioral health needs

The Substance Abuse and Mental Health Services Administration (SAMHSA) is awarding $45.1 million in grants to meet the behavioral health needs of people who either are at risk for contracting or are living with HIV/AIDS. “SAMHSA programs such as these are representative of our commitment to helping America's communities reduce disease transmission,” said HHS Assistant Secretary for Mental Health and Substance Use Miriam E. Delphin‐Rittmon, Ph.D., who leads SAMHSA, in announcing the awards on Sept. 29. “They also help equip communities to facilitate people's access to appropriate treatments and recovery supports for their mental health and substance use disorders,” she added.

‘It’s the same thing as giving them CPR training’: rural first responders’ perspectives on naloxone

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) Harm Reduction grant program expanded access to several harm reduction strategies to mitigate opioid overdose fatalities, including expanding access to naloxone. Interviews with first responders in a frontier and remote (FAR) state were conducted to understand their job responsibilities in relation to overdose response and prevention and their perceptions of training laypersons to administer naloxone. This study includes 22 interviews with law enforcement, EMS and/or fire personnel, and members of harm reduction-focused community organizations. The study finds widespread support for increasing access to naloxone and training laypersons in naloxone administration throughout Montana, due to rural first responders’ inability to meet the needs of residents and an overall lack of resources to address addiction and the effects of fentanyl. Participants from harm reduction-focused community organizations convey support for training lay persons, but also illuminate that real and perceived cultural opposition to harm reduction strategies could reduce the likelihood that laypeople enroll in naloxone training. This study adds to the literature because it focuses on first responders in a FAR area that would benefit from layperson naloxone education and administration training due to its geographic expansiveness and the area’s overall lack of access to medications for opioid use disorder or other treatment services. Expanding harm reduction approaches, like increasing access and training laypersons to administer naloxone, might be FAR residents’ best chance for surviving an opioid overdose.

Communication Access In Mental Health And Substance Use Treatment Facilities For Deaf American Sign Language Users.

Deaf and hard of hearing (DHH) American Sign Language users experience significant mental health-related disparities compared with non-DHH English speakers. Yet there is little empirical evidence documenting this priority population's communication access in mental health and substance use treatment facilities. This study measured mental health and substance use treatment facilities' noncompliance to Section 1557 of the Affordable Care Act (ACA), which requires health care facilities receiving government funds to provide effective communication access, such as a sign language interpreter, to DHH patients. Using nationally representative data from the Substance Abuse and Mental Health Services Administration, we found that 41percent of mental health facilities and 59percent of substance use treatment facilities receiving public funds reported not providing services in sign language in 2019 and were thus noncompliant with the ACA's mandate to provide accessible communication to DHH patients. We mapped these data to display state-level noncompliance, and we make detailed recommendations at the policy, facility, and provider levels. These include monitoring noncompliance among government-funded facilities, expanding state-by-state mental health licensure reciprocity and telehealth policies to improve access to American Sign Language-fluent mental health professionals and addiction counselors, establishing systematic processes to collect information on disability-related accommodation needs, and increasing the workforce of DHH American Sign Language-fluent providers.

Hurricane season and addiction: SAMHSA guidance to OTPs

The Substance Abuse and Mental Health Services Administration (SAMHSA) has said that patient safety comes first, which means that Opioid Treatment Program (OTP) patients may get increased methadone take‐homes even without permission. Preemptive guidance to obtain approval from the OTP's State Opioid Treatment Authority (SOTA) — an office within the state alcohol and drug agency — already has been issued by SAMHSA's Center for Substance Abuse Treatment (CSAT), which regulates OTPs. The SOTA approval to close the OTP can come either via the OTP extranet (an internet that can only be accessed by authorized users), or verbally to the OTP sponsor (owner), said Christopher Garrett, SAMHSA spokesperson. In addition, requests to close may be submitted to SAMHSA retroactively, he told ADAW last week, as Hurricane Ian was bearing down on Florida.

Impact of Medicaid, Race/Ethnicity, and Criminal Justice Referral on Opioid Use Disorder Treatment.

We examined the impact of Medicaid expansion and of race/ethnicity on medication-assisted treatment (MAT) for opioid use disorder among those referred for treatment through the criminal justice system. Using a cross-sectional design, we combined data from the Substance Use and Mental Health Services Administration's Treatment Episode Data Set with data on Medicaid expansion and age-adjusted mortality for drug poisoning deaths. Logistic regression was performed within state panels from 2012 to 2016, with 2014 excluded due to this being the transitional Medicaid expansion year. We found that Medicaid expansion led to an increase in the use of MAT to treat those referred to substance treatment facilities through the criminal justice system. We also identified key racial disparities in the use of MAT for those referred from the criminal justice system, with Blacks and Hispanics less likely to receive MAT than non-Hispanic Whites.

SAMHSA to ask for rulemaking on take‐home methadone doses

The Substance Abuse and Mental Health Services Administration (SAMHSA) is planning a rulemaking on extended take‐home criteria for methadone patients in opioid treatment programs (OTPs). SAMHSA, along with the Drug Enforcement Administration, regulates OTPs. And OTPs, in their turn, not only are in favor of the proposed changes, but have also advocated for them. ADAW learned about the plan earlier this month (see “SAMHSA chief medical officer on methadone THs and ODs,” ADAW Sept. 12, https://onlinelibrary.wiley.com/doi/10.1002/adaw.33547).

Use of machine learning to examine disparities in completion of substance use disorder treatment.

The objective of this work is to examine disparities in the completion of substance use disorder treatment in the U.S. Our data is from the Treatment Episode Dataset Discharge (TEDS-D) datasets from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) for 2017–2019. We apply a two-stage virtual twins model (random forest + decision tree) where, in the first stage (random forest), we determine differences in treatment completion probability associated with race/ethnicity, income source, no co-occurrence of mental health disorders, gender (biological), no health insurance, veteran status, age, and primary substance (alcohol or opioid). In the second stage (decision tree), we identify subgroups associated with probability differences, where such subgroups are more or less likely to complete treatment. We find the subgroups most likely to complete substance use disorder treatment, when the subgroup represents more than 1% of the sample, are those with no mental health condition co-occurrence (4.8% more likely when discharged from an ambulatory outpatient treatment program, representing 62% of the sample; and 10% more likely for one of the more specifically defined subgroups representing 10% of the sample), an income source of job-related wages/salary (4.3% more likely when not having used in the 30 days primary to discharge and when primary substance is not alcohol only, representing 28% of the sample), and white non-Hispanics (2.7% more likely when discharged from residential long-term treatment, representing 9% of the sample). Important implications are that: 1) those without a co-occurring mental health condition are the most likely to complete treatment, 2) those with job related wages or income are more likely to complete treatment, and 3) racial/ethnicity disparities persist in favor of white non-Hispanic individuals seeking to complete treatment. Thus, additional resources may be needed to combat such disparities.

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

Utilizing SBIRT as a Framework for Transforming How We Think About Prevention and Early Intervention for Youth and Young Adults

SAMHSA chief medical officer on methadone THs and ODs

ADAW talked to Neeraj Gandotra, M.D., chief medical officer of the Substance Abuse and Mental Health Services Administration (SAMHSA) last week about the connection between liberalized methadone take‐homes from opioid treatment programs (OTPs) and methadone overdoses (ODs). First, methadone OD deaths did not increase as a result of liberalized take‐homes, as reported by the Centers for Disease Control and Prevention (see No rise in methadone OD deaths with new take‐home rules, ADAW July 25; https://onlinelibrary.wiley.com/doi/10.1002/adaw.33506). But where did this information come from, and is there any information about increases in methadone nonfatal ODs, or methadone diversion, in the wake of the liberalized policy?

AAP receives $2M grant from HHS for new MH center

As part of the Biden Adminis‐tration's strategy to address the National Mental Health Crisis, the U.S. Department of Health and Human Services, through the Substance Abuse and Mental Health Services Administration (SAMHSA), has awarded $2 million in funding to the American Academy of Pediatrics to establish a National Center of Excellence on Social Media and Mental Wellness, Healthcare Finance reported Sept. 6. The purpose of the center is to develop and disseminate information, guidance and training on the impact — including risks and benefits — that social media use has on children and young people, especially the risks to their mental health. It will also examine clinical and social interventions that can be used to prevent and mitigate the risks. Dr. Miriam E. Delphin‐Rittmon, HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA, said the establishment of the new center was spurred in part by the increasing numbers of young people being diagnosed with anxiety, depression and other mental health conditions. “Prior research has indicated that social media may be harmful, particularly to children and young people,” she said. “We expect this new center to shed light on this challenge and provide us with best practices and guide us in protecting young people.”

Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH), a Peer-Led Patient Navigation Intervention for Racially and Ethnically Minoritized Veterans in Veterans Health Administration Mental Health Services: Protocol for a Mixed Methods Randomized Controlled Feasibility Study.

BackgroundMental health care disparities are persistent and have increased in recent years. Compared with their White counterparts, members of racially and ethnically minoritized groups have less access to mental health care. Minoritized groups also have lower engagement in mental health treatment and are more likely to experience ineffective patient-provider communication, which contribute to negative mental health care experiences and poor mental health outcomes. Interventions that embrace recovery-oriented practices to support patient engagement and empower patients to participate in their mental health care and treatment decisions may help reduce mental health care disparities. Designed to achieve this goal, the Proactive, Recovery-Oriented Treatment Navigation to Engage Racially Diverse Veterans in Mental Healthcare (PARTNER-MH) is a peer-led patient navigation intervention that aims to engage minoritized patients in mental health treatment, support them to play a greater role in their care, and facilitate their participation in shared treatment decision-making.ObjectiveThe primary aim of this study is to assess the feasibility and acceptability of PARTNER-MH delivered to patients over 6 months. The second aim is to evaluate the preliminary effects of PARTNER-MH on patient activation, patient engagement, and shared decision-making. The third aim is to examine patient-perceived barriers to and facilitators of engagement in PARTNER-MH as well as contextual factors that may inhibit or promote the integration, sustainability, and scalability of PARTNER-MH using the Consolidated Framework for Implementation Research.MethodsThis pilot study evaluates the feasibility and acceptability of PARTNER-MH in a Veterans Health Administration (VHA) mental health setting using a mixed methods, randomized controlled trial study design. PARTNER-MH is tested under real-world conditions using certified VHA peer specialists (peers) selected through usual VHA hiring practices and assigned to the mental health service line. Peers provide PARTNER-MH and usual peer support services. The study compares the impact of PARTNER-MH versus a wait-list control group on patient activation, patient engagement, and shared decision-making as well as other patient-level outcomes. PARTNER-MH also examines organizational factors that could impact its future implementation in VHA settings.ResultsParticipants (N=50) were Veterans who were mostly male (n=31, 62%) and self-identified as non-Hispanic (n=44, 88%) and Black (n=35, 70%) with a median age of 45 to 54 years. Most had at least some college education, and 32% (16/50) had completed ≥4 years of college. Randomization produced comparable groups in terms of characteristics and outcome measures at baseline, except for sex.ConclusionsRather than simply documenting health disparities among vulnerable populations, PARTNER-MH offers opportunities to evaluate a tailored, culturally sensitive, system-based intervention to improve patient engagement and patient-provider communication in mental health care for racially and ethnically minoritized individuals.Trial RegistrationClinicalTrials.gov NCT04515771; https://clinicaltrials.gov/ct2/show/NCT04515771International Registered Report Identifier (IRRID)DERR1-10.2196/37712

Update on funding IPS supported employment services in the IPS learning community.

Individual placement and support (IPS) is the evidence-based supported employment approach for people with serious mental illness. Because funding is the major barrier for states to implement IPS and increase access, the IPS Learning Community collected information about sources of IPS funding from 24 member states. In early 2020, IPS employment leaders from the public mental health authority and the state vocational rehabilitation (VR) authority completed a questionnaire identifying sources of funding for IPS in their states. The main sources of funding were Medicaid, Substance Abuse and Mental Health Services Administration (SAMHSA) block grants, state and county government, the Ticket to Work program, and the federal-state VR programs. Funding IPS services requires braided funding from multiple sources. This complicated method limits scaling up services statewide. Solving this funding problem would require coordinated action from federal and state agencies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Spatial analysis and modelling of depression relative to social vulnerability index across the United States.

According to the Substance Abuse and Mental Health Services Administration, about 21 million adults in the US experience a major depressive episode. Depression is considered a primary risk factor for suicide. In the US, about 19.5% of adults are reported to be experiencing a depressive disorder, leading to over 45,000 deaths (14.0 deaths per 100,000) due to suicides. To our knowledge, no previous spatial analysis study of depression relative to the social vulnerability index has been performed across the nation. In this study, county-level depression prevalence and indicators were compiled. We analysed the geospatial distribution of depression prevalence based on ordinary least squares, geographically weighted regression, and multiscale geographically weighted regression models. Our findings indicated that the multiscale model could explain over 86% of the local variance of depression prevalence across the US based on per capita income, age 65 and older, belonging to a minority group (predominantly negative impacts), and disability (mainly positive effect). This study can provide valuable insights for public health professionals and policymakers to address depression disparities.

Concern About Past Trauma Among Nursing Home Admissions: Report From Screening 722 Admissions.

Major life changes can trigger a traumatic stress response in older adults causing trauma symptoms to resurface. In 2019, the Centers for Medicare and Medicaid Services released the requirement, without specific guidance, for trauma-informed care (TIC) as part of person-centered care in long-term care. Observational, cross-sectional. A total of 722 new admissions at one nursing home in metro Atlanta between November 2019 and July2021. We developed a "TRAUMA" framework for TIC screening based on Substance Abuse and Mental Health Services Administration resources. The admissions nurse conducted TIC screening within 48hours of new admissions, including reported trauma and necessary modifications to care plans. Demographic information was derived from electronic records. Analysis included independent sample t-tests, binary logistic regression, and χ2 tests. All data were analyzed using SPSS v.28. Of 722 new admissions, 45 (6.2%) indicated experiencing trauma. There was no significant association with being Black or non-White and experiencing trauma, but there was a significant association with being female and experiencing trauma (χ2 (1)= 5.206, P= .022). Only men reported child physical abuse and war trauma and only women reported adult sexual assault, child sexual assault, adult domestic violence, school or community violence, adult nonintimate partner violence, and other trauma. There was a small, significant negative association of age and trauma (β=-0.037; SE= 0.11; P < .001). The most-reported trauma category was medical trauma, including COVID-related trauma. More than half (51%) requested spiritual intervention and only 2 requested medical intervention with medication as initial interventions. Our experience suggests that knowing the patient and their trauma history allowed the admissions nurse and interdisciplinary care team to modify the person-centered care plan to best meet the patient's needs. Our results also emphasize the need for using universal trauma precautions in all interactions.