Mental Health Services Administration Research Articles

Alcohol Use Disorder (AUD) in New Jersey (NJ): Disparity in Treatment.

Alcohol use disorder (AUD) continues to be a threat to public health due to the associated morbidity, mortality, and social and economic impacts. AUD accounts for greater than 85,000 deaths annually in the United States and greater than 1500 deaths annually in New Jersey (NJ). Despite these associated burdens, the treatment of AUD remains unequal among the population, and it is important to identify the factors influencing the disparity in defined population groups such as NJ to drive the appropriate intervention. Data were retrieved from the 2018 Treatment Episode Data Set-Discharges (TEDS-D) of the United States Substance Abuse and Mental Health Services Administration (SAMHSA). Logistic regression analysis was used to predict the odds of receiving treatment based on socioeconomic factors and the type of treatment received. Compared to Asian or Pacific Islanders in NJ, the American Indian [odds ratio, OR=2.12, 95% confidence interval, CI: 1.95-2.31] has the greatest odds of receiving treatment for AUD, followed by the Black or African American [OR=1.70, 95% CI: 1.65-1.75], the Alaska Native [OR=1.67, 95% CI: 1.42-1.96], and then the White [OR=1.31, 95% CI: 1.12-1.52]. Those who are retired or on disability [OR=0.88, 95% CI: 0.82-0.94] have lower odds of receiving treatment than those on salary or wages. Those with AUD in NJ have a lower odd of receiving detoxification treatment in a 24-h hospital inpatient setting [OR=0.88, 95% CI 0.82-0.95] and a higher odd of receiving detoxification treatment in a 24-h service, free-standing residential setting when compared to the treatment received in a rehabilitation/hospital (other than detoxification) setting. This study shows that disparity exists in relation to the type of treatment received and the setting of treatment for AUD in NJ in addition to disparity based on the sociodemographic factors.

SAMHSA awards $18.9 million for services to youth and families

This month the Substance Abuse and Mental Health Services Administration (SAMHSA) announced the award of $18.9 million to 35 community organizations for the Enhancement and Expansion of Treatment and Recovery Services for Adolescents, Transitional Aged Youth, and their Families, otherwise known as the “Youth and Family TREE” program. According to SAMHSA, this program enhances “comprehensive treatment, early intervention and recovery support services for adolescents, ages 12 to 18, and transitional aged youth, ages 16 to 25, with substance use disorders and/or co‐occurring substance use and mental disorders, and their families and primary caregivers.”

VP Harris meets with 8 AGs to discuss illicit fentanyl chain

Last week, Vice President Kamala Harris convened attorneys general from seven states and the District of Columbia for a conversation about federal and state efforts to disrupt the illicit fentanyl supply chain, and at the same time expand access to care for individuals at risk of an overdose. Exactly why the AGs, but not state health officials, were included to discuss how to expand treatment was not clear, and when asked for an explanation, ADAW received merely a readout of the entire meeting. However, the vice president announced that almost $50 million would be awarded in grants by the Substance Abuse and Mental Health Services Administration (SAMHSA) last week, as well.

Kent on OTPs and new regulations: Promise for the future

“The new rules will help opioid treatment programs,” said Rob Kent, former counsel for the Office of National Drug Control Policy (ONDCP) and the New York state Office of Addiction Services and Supports (OASAS), now a consultant, in an interview with ADAW last month. He was referring to the SAMHSA [Substance Abuse and Mental Health Services Administration] proposed regulations to modernize methadone treatment (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33643), which have nothing to do with the proposed bills to allow office‐based physicians to prescribe methadone to people with opioid use disorder (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33720). In fact, Kent said he supports making methadone treatment easier to access, but has concerns about the proposals, supported by the American Society of Addiction Medicine and almost all other medical societies, to allow patients to be treated outside of the OTP [opioid treatment program].

988's first anniversary reveals progress, CCBHC support and 911 partnerships

July 16 marked the one‐year anniversary of the 988 Suicide & Crisis Lifeline that allows callers experiencing a mental health crisis to connect with a crisis counselor. Since its implementation, the 988 Lifeline data for May 2023 revealed an increase in overall volume compared to May 2022, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).

SAMHSA issues TIP on incorporating peers into treatment

Last week the Substance Abuse and Mental Health Services Administration (SAMHSA) issued TIP (Treatment Improvement Protocol) number 64. This TIP is devoted to integrated peer support services into clinical treatment for substance use disorder (SUD). Coming on the heels of its model standards for peers (see https://onlinelibrary.wiley.com/doi/10.1002/adaw.33806), the TIP will provide useful information for treatment programs seeking to use peers, especially during a time of workforce inadequacy. The 237‐page document includes many useful resources, as well, but ultimately, states will have to rely on their own systems for reimbursement.

In Case You Haven't Heard…

For those readers who are NSDUH (National Survey on Drug Use and Health) nerds, the Substance Abuse and Mental Health Services Administration (SAMHSA) has a new, second survey. The Mental and Substance Use Disorders Prevalence Study (MDPS) includes gaps not covered by the NSDUH: Those who do not reside in households; including homeless, institutionalized or incarcerated populations. These populations, according to SAMHSA, have disproportionately high rates of mental health and substance use disorders. Between October 2020 and October 2022, this study, conducted in partnership with the research organization, RTI International, conducted 5,679 clinical interviews among 18–65‐year‐olds, including those living in households, prisons, state psychiatric hospitals and homeless shelters. For the MDPS, released last week, click HERE.

HHS publishes national model standards for BH, family peer worker certifications

The U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA), on June 6 published its National Model Standards for Peer Support Certification for substance use, mental health and family peer workers, an HHS news release stated. The national model standards were created to accelerate universal adoption, recognition, and integration of the peer workforce across all elements of the health care system. “These new national standards will help advance President Biden's strategy to tackle the nation's behavioral health crisis,” HHS Secretary Xavier Becerra stated in the release. “We can improve health outcomes for people with behavioral health issues by better integrating the peer workforce into our health care system. Getting help from a person who has been successful in the recovery process can be life‐changing.” SAMHSA collaborated with federal, state, tribal, territorial and local partners, including peer specialists, and also requested and incorporated public comments to develop the national model standards.

SAMHSA finds sexual minority adults more likely to use substances

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), data shows that lesbian, gay, and bisexual adults are more likely than straight adults to use substances, as well as to experience mental health conditions.

Introduction to the Coproduction of Supervision Standards for Digital Peer Support: Qualitative Study.

Digital peer support enhances engagement in mental and physical health services despite barriers such as location, transportation, and other accessibility constraints. Digital peer support involves live or automated peer support services delivered through technology media such as peer-to-peer networks, smartphone apps, and asynchronous and synchronous technologies. Supervision standards for digital peer support can determine important administrative, educative, and supportive guidelines for supervisors to maintain the practice of competent digital peer support, develop knowledgeable and skilled digital peer support specialists, clarify the role and responsibility of digital peer support specialists, and support specialists in both an emotional and developmental capacity. Although digital peer support has expanded recently, there are no formal digital supervision standards. The aim of this study is to inform the development of supervision standards for digital peer support and introduce guidelines that supervisors can use to support, guide, and develop competencies in digital peer support specialists. Peer support specialists that currently offer digital peer support services were recruited via an international email listserv of 1500 peer support specialists. Four 1-hour focus groups, with a total of 59 participants, took place in October 2020. Researchers used Rapid and Rigorous Qualitative Data Analysis methods. Researchers presented data transcripts to focus group participants for feedback and to determine if the researcher's interpretation of the data match their intended meanings. We identified 51 codes and 11 themes related to the development of supervision standards for digital peer support. Themes included (1) education on technology competency (43/197, 21.8%), (2) education on privacy, security, and confidentiality in digital devices and platforms (33/197, 16.8%), (3) education on peer support competencies and how they relate to digital peer support (25/197, 12.7%), (4) administrative guidelines (21/197, 10.7%), (5) education on the digital delivery of peer support (18/197, 9.1%), (6) education on technology access (17/197, 8.6%), (7) supervisor support of work-life balance (17/197, 8.6%), (8) emotional support (9/197, 4.6%), (9) administrative documentation (6/197, 3%), (10) education on suicide and crisis intervention (5/197, 2.5%), and (11) feedback (3/197, 1.5%). Currently, supervision standards from the Substance Abuse and Mental Health Services Administration (SAMHSA) for in-person peer support include administrative, educative, and supportive functions. However, digital peer support has necessitated supervision standard subthemes such as education on technology and privacy, support of work-life balance, and emotional support. Lack of digital supervision standards may lead to a breach in ethics and confidentiality, workforce stress, loss of productivity, loss of boundaries, and ineffectively serving users who participate in digital peer support services. Digital peer support specialists require specific knowledge and skills to communicate with service users and deliver peer support effectively, while supervisors require new knowledge and skills to effectively develop, support, and manage the digital peer support role.

HHS awards funding to states, tribes and colleges to prevent youth suicide

The U.S. Department of Health and Human Services (HHS) on June 1, through the Substance Abuse and Mental Health Services Administration, awarded $5.9 million to states, tribes and college campuses for youth suicide prevention programs. Of the total $5.9 million, $3.6 million was awarded to states and tribes under the Garrett Lee Smith (GLS) State/Tribal Youth Suicide Prevention and Early Intervention Program. The remaining $2.3 million was awarded to college campuses under the GLS Campus Suicide Prevention Program, which enhances mental health services for all college students, including those at risk for suicide, depression, serious mental illness/serious emotional disturbances, and/or substance use disorders that can lead to school failure.

National, State-Level, and County-Level Prevalence Estimates of Adults Aged ≥18 Years Self-Reporting a Lifetime Diagnosis of Depression - United States, 2020.

Depression is a major contributor to mortality, morbidity, disability, and economic costs in the United States (1). Examining the geographic distribution of depression at the state and county levels can help guide state- and local-level efforts to prevent, treat, and manage depression. CDC analyzed 2020 Behavioral Risk Factor Surveillance System (BRFSS) data to estimate the national, state-level, and county-level prevalence of U.S. adults aged ≥18 years self-reporting a lifetime diagnosis of depression (referred to as depression). During 2020, the age-standardized prevalence of depression among adults was 18.5%. Among states, the age-standardized prevalence of depression ranged from 12.7% to 27.5% (median=19.9%); most of the states with the highest prevalence were in the Appalachian* and southern Mississippi Valley† regions. Among 3,143 counties, the model-based age-standardized prevalence of depression ranged from 10.7% to 31.9% (median=21.8%); most of the counties with the highest prevalence were in the Appalachian region, the southern Mississippi Valley region, and Missouri, Oklahoma, and Washington. These data can help decision-makers prioritize health planning and interventions in areas with the largest gaps or inequities, which could include implementation of evidence-based interventions and practices such as those recommended by The Guide to Community Preventive Services Task Force (CPSTF) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022

Although telehealth services expanded rapidly during the COVID-19 pandemic, the association between state policies and telehealth availability has been insufficiently characterized. To investigate the associations between 4 state policies and telehealth availability at outpatient mental health treatment facilities throughout the US. This cohort study measured whether mental health treatment facilities offered telehealth services each quarter from April 2019 through September 2022. The sample comprised facilities with outpatient services that were not part of the US Department of Veterans Affairs system. Four state policies were identified from 4 different sources. Data were analyzed in January 2023. For each quarter, implementation of the following policies was indexed by state: (1) payment parity for telehealth services among private insurers; (2) authorization of audio-only telehealth services for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries; (3) participation in the Interstate Medical Licensure Compact (IMLC), permitting psychiatrists to provide telehealth services across state lines; and (4) participation in the Psychology Interjurisdictional Compact (PSYPACT), permitting clinical psychologists to provide telehealth services across state lines. The primary outcome was the probability of a mental health treatment facility offering telehealth services in each quarter for each study year (2019-2022). Information on the facilities was obtained from the Mental Health and Addiction Treatment Tracking Repository based on the Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Service Locator. Separate multivariable fixed-effects regression models were used to estimate the difference in the probability of offering telehealth services after vs before policy implementation, adjusting for characteristics of the facility and county in which the facility was located. A total of 12 828 mental health treatment facilities were included. Overall, 88.1% of facilities offered telehealth services in September 2022 compared with 39.4% of facilities in April 2019. All 4 policies were associated with increased odds of telehealth availability: payment parity for telehealth services (adjusted odds ratio [AOR], 1.11; 95% CI, 1.03-1.19), reimbursement for audio-only telehealth services (AOR, 1.73; 95% CI, 1.64-1.81), IMLC participation (AOR, 1.40, 95% CI, 1.24-1.59), and PSYPACT participation (AOR, 1.21, 95% CI, 1.12-1.31). Facilities that accepted Medicaid as a form of payment had lower odds of offering telehealth services (AOR, 0.75; 95% CI, 0.65-0.86) over the study period, as did facilities in counties with a higher proportion (>20%) of Black residents (AOR, 0.58; 95% CI, 0.50-0.68). Facilities in rural counties had higher odds of offering telehealth services (AOR, 1.67; 95% CI, 1.48-1.88). Results of this study suggest that 4 state policies that were introduced during the COVID-19 pandemic were associated with marked expansion of telehealth availability for mental health care at mental health treatment facilities throughout the US. Despite these policies, telehealth services were less likely to be offered in counties with a greater proportion of Black residents and in facilities that accepted Medicaid and CHIP.

Veterans’ views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study

ObjectiveIn this study, we report on participants’ experiences of PARTNER-MH, a peer-led, patient-navigation intervention for racially and ethnically minoritized patients in Veterans Health Administration mental health services aimed at improving patient engagement in care and patient-clinician communication. Participants described their views of PARTNER-MH, barriers and facilitators to the intervention’s implementation, and their application of varied intervention concepts to improve engagement in care and communication with their mental health clinicians. MethodsThis is a qualitative analysis of the PARTNER-MH pilot randomized controlled trial. Participants participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Rapid data analysis approach was used to analyze the data. ResultsParticipants (n = 13) perceived PARTNER-MH as an acceptable intervention, and viewed use of peers as interventionists, long-term outreach and engagement efforts, and navigation services favorably. Barriers to implementation included limited flexibility in peers’ schedules and lack of peer/participant gender concordance, as well as limited options for program delivery modality. Three main themes summarized participants’ views and perceived benefits of PARTNER-MH that contributed to improved patient-clinician communication: 1) increased patient engagement, 2) improved patient-clinician relationship, and 3) enhanced communication self-efficacy. ConclusionsParticipants viewed PARTNER-MH as beneficial and identified several intervention components that contributed to improved engagement in care, communication self-efficacy, and patient-clinician communication. Practice implicationSome patients, especially minoritized patients and those who have been disenfranchised from healthcare systems may benefit from peer-led interventions that facilitate engagement in care and communication self-efficacy to improve patient-clinician communication and healthcare outcomes. Trial registrationClinicalTrials.gov NCT04515771.

SAMHSA and FDA move toward medication only for buprenorphine

Receiving buprenorphine should not be contingent upon receiving counseling as well, the federal government has said in a “Dear Colleague” letter issued May 9. The letter, from the Food and Drug Administration and the Substance Abuse and Mental Health Services Administration (SAMHSA, states that “an often‐cited barrier to prescribing buprenorphine for the treatment of OUD [opioid use disorder] is the perception that patients must engage in counseling and other services in order to start or continue receiving the medication,” and goes on: “This letter serves to clarify the importance of counseling and other services as part of a comprehensive treatment plan, but to also reiterate that the provision of medication should not be made continent upon participation in such services.”

In Case You Haven't Heard…

Last week the Substance Abuse and Mental Health Services Administration (SAMHSA) released guidelines, called “national standards,” for a peer workforce in substance use disorders and mental illness. The standards are not meant to be adopted by states for certification, according to SAMHSA (although they could be), but rather just as guidelines, SAMHSA noted. One sentence in the announcement grabbed our attention: “A peer worker is someone who, through their own lived experience of addressing a substance use or mental health issue, works to help others.” ADAW would love to see the word “lived” eliminated from the definition. Just “experience” should be enough. Once “lived experience” becomes codified, it will be just another stigma‐based euphemism in a field that has too many of them already. Also important to note: The peer definition combines peer workers in substance abuse, mental illness and families. For the announcement, go to https://www.samhsa.gov/newsroom/press‐announcements/20230606/hhs‐publishes‐national‐model‐standards‐substance‐use‐mental‐health‐family‐peer‐worker‐certifications.

Racial, Ethnic, and Sex Differences in Methadone-Involved Overdose Deaths Before and After the US Federal Policy Change Expanding Take-home Methadone Doses

In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) permitted states to relax restrictions on take-home methadone doses for treatment-adherent patients to minimize COVID-19 exposures. To assess whether the methadone take-home policy change was associated with drug overdose deaths among different racial, ethnic, and sex groups. Interrupted time series analysis from January 1, 2018, to June 30, 2022. Data analysis was conducted from February 18, 2023, to February 28, 2023. In this population-based cohort study of drug overdose mortality including 14 529 methadone-involved deaths, monthly counts of methadone-involved drug overdose deaths were obtained for 6 demographic groups: Hispanic men and women, non-Hispanic Black men and women, and non-Hispanic White men and women. On March 16, 2020, in response to the first wave of the COVID-19 pandemic, SAMHSA issued an exemption to the states that permitted up to 28 days of take-home methadone for stable patients and 14 days for less stable patients. Monthly methadone-involved overdose deaths. From January 1, 2018, to June 30, 2022 (54 months), there were 14 529 methadone-involved deaths in the United States; 14 112 (97.1%) occurred in the study's 6 demographic groups (Black men, 1234; Black women, 754; Hispanic men, 1061; Hispanic women, 520; White men, 5991; and White women, 4552). Among Black men, there was a decrease in monthly methadone deaths associated with the March 2020 policy change (change of slope from the preintervention period, -0.55 [95% CI, -0.95 to -0.15]). Hispanic men also experienced a decrease in monthly methadone deaths associated with the policy change (-0.42 [95% CI, -0.68 to -0.17]). Among Black women, Hispanic women, White men, and White women, the policy change was not associated with a change in monthly methadone deaths (Black women, -0.27 [95% CI, -1.13 to 0.59]; Hispanic women, 0.29 [95% CI, -0.46 to 1.04]; White men, -0.08 [95% CI, -1.05 to 0.88]; and White women, -0.43 [95% CI, -1.26 to 0.40]). In this interrupted time series study of monthly methadone-involved overdose deaths, the take-home policy may have helped reduce deaths for Black and Hispanic men but had no association with deaths of Black or Hispanic women or White men or women.

Trauma-Informed Psychosocial Screening and Care Planning: A Patient-Centered Improvement Project in a Midwife Clinic.

Traumatic stress is associated with increases in preterm birth, low birth weight, and other perinatal complications. Yet the identification of patients with traumatic stress and intervention for traumatic stress prevention or treatment remain low. Locally in this university hospital-based midwife clinic, a health records review found that trauma exposure was documented in 5% of patient records, and no records had a diagnosis of posttraumatic stress disorder (PTSD). This is lower than research-based population estimates of 25% to 50% for trauma exposure and 8% for PTSD during pregnancy. The clinic staff did not screen for posttraumatic stress, and exposure screening was limited to intimate personal violence. Staff had not been trained in trauma-informed care (TIC) as defined by the Substance Abuse and Mental Health Services Administration. The aim for this improvement project was to provide trauma screening and trauma-related care planning, collectively referred to as trauma-informed psychosocial care, to midwifery patients 85% of the time. Interventions were implemented over 4 plan-do-study-act (PDSA) cycles. These included staff training in TIC; written screening at the new prenatal, third trimester, and postpartum visits; verbal broad inquiry at every visit; and bidirectional trauma-specific care planning emphasizing patient and provider input into treatment choice. The clinic flow was changed to create privacy for patient-staff interaction at every visit. Field notes and data were analyzed every 2 weeks and iterative changes applied. Trauma disclosure increased from 5% to 30% and identification of PTSD from 0% to 7%. Bidirectional care plan documentation increased from 8% to 67%. Staff rated the workload as reasonable. Redesigning psychosocial screening to align with TIC principles increased the discovery of trauma to levels consistent with research-based population estimates. Gains were made in bidirectional care planning. This project illustrates practical methods of implementing TIC principles.

Encouraging Improvements to Opioid and Substance Use Disorder Care Quality in Nursing Homes

Encouraging Improvements to Opioid and Substance Use Disorder Care Quality in Nursing Homes

SAMHSA continues methadone take‐home flexibility

Below is information from the Substance Abuse and Mental Health Services Administration (SAMHSA) on guidance for opioid treatment programs (OTPs) on exemptions from the take‐home regulations. The exemptions continue for one year beyond the end of the COVID‐19 emergency. It ended on May 11, 2023. So OTPs can continue to provide flexible take‐homes to methadone patients, providing the appropriate criteria (listed below) are met.