Behavioral Health: Challenges and Opportunities in Indian Country

2. Behavioral Health: Challenges and Opportunities in Indian Country Pamela S. Hyde, J.D. SAMHSA Administrator National Indian Health Board (NIHB) 40th Anniversary Celebration 29th Annual Consumer Conference Denver, CO • September 25, 2012

3. CONGRATULATIONS NIHB AND SAMHSA

4. SAMHSA’S ROLES Leadership and Voice Funding - Service Capacity Development Information/Communications Regulation and Standard setting Practice Improvement Data and surveillance

5. CHALLENGES IN AI/AN COMMUNITIES Higher rates of substance dependence and abuse Higher past month binge alcohol use Higher past month illicit drug use Higher current tobacco use Higher youth suicide rates Higher adolescent death rates Higher sexual assault rates against females Higher homicide rates against women Higher rates of intimate partner violence against women Higher rates of incarceration and arrest Higher rates of historical trauma

6. Fig 7.1 Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older: 2002-2011 Numbers in Millions 22.5+ 22.7+ 22.6+ 22.4+ 22.4+ 22.2+ 22.2+ 22.0+ 21.6 20.6 Both Alcoholand Illicit Drugs Illicit Drugs Only Alcohol Only + Difference between this estimate and the 2011 estimate is statistically significant at the .05 level. Note: Due to rounding, the stacked bar totals may not add to the overall total. 6

7. 2011 RATE OF SUBSTANCE DEPENDENCE OR ABUSE 12 AND ↑: RACE/ETHNICITY SAMHSA, CBHSQ, 2011 NSDUH

8. 2011 RATE OF BINGE ALCOHOL USE 12 AND ↑: RACE/ETHNICITY SAMHSA, CBHSQ, 2011 NSDUH

9. 2011 RATE OF CURRENT ILLICIT DRUG USE 12 AND ↑: RACE/ETHNICITY SAMHSA, CBHSQ, 2011 NSDUH

10. 2011 RATE OF CURRENT TOBACCO USE 12 AND ↑: RACE/ETHNICITY SAMHSA, CBHSQ, 2011 NSDUH

11. Fig 7.10 Past Year Perceived Need for and Effort Made to Receive Specialty Treatment among Persons Aged 12 or Older Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use: 2011 Did Not Feel They Needed Treatment Felt They Needed Treatment and Did Not Make an Effort 95.3% 3.3% 1.5% Felt They Needed Treatment and Did Make an Effort 19.3 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use 11 Note: The percentages do not add to 100 percent due to rounding.

12. NEED FOR AND RECEIPT OF TREATMENT FOR AN ILLICIT DRUG OR ALCOHOL PROBLEM PAST YEAR, AGED 12 ↑: DEMOGRAPHIC CHARACTERISTICS 2011: Percent Needed but Did Not Receive Treatment 2011: Percent Needed Treatment SAMHSA, CBHSQ, 2011 NSDUH

13. SUICIDE AND SUICIDE PREVENTION • Over 11 million Americans seriously consider suicide each year and over 38,000 died (2010) from this public health issue • America loses approximately 100 people every 24 hours • Suicide: 2nd leading cause of death for AI/AN youth in the 15-24 age group, 2.5x national rate for this age group • Higher risk: young and middle-aged AI/AN • Ages 15 – 24: Rates of 31.59 per 100,000 • Ages 40 – 59: Rates of 19.43 per 100,000 • National Action Alliance for Suicide Prevention – part of National Prevention Strategy • June 26th: Summit , updates from all 14 Task Forces • June 27th AI/AN research subcommittee Mtg at IHS Conf • NSSP released by SG on Sept 10, 2012 • HHS Secretary Sebelius announced $55.6 million in new grants; under the GLS Memorial Act; partially funded by ACA • Last year’s GLS grants included a new cohort of 38 grants; 22 were Tribal grantees

14. SAMHSA TRIBAL EFFORTS AND INTIATIVES – FULFILLING FEDERAL TRUST RESPONSIBILITIES • STAC and SAMHSA TTAC (webcast on August 24th) • Tribal Law & Order Act (TLOA): HHS (IHS, SAMHSA), DOI (BIA,BIE), DOJ • IASA Intradepartmental Coordinating Committee – Meets monthly • Rodney Robinson, Northern Cheyenne, new Director of OIASA • SA prevention, intervention, and treatment – most recently TAPs w/set of tribes in Montana • OIASA website with newsletter at http://www.samhsa.gov/tloa • TLOA webinars: MOA & TAPs (9/12) and Tribal Justice Plan (9/19) • Behavioral Health –Tribal Prevention Grant (BH-TPG) • First proposed in President’s FY 12 Budget • No appropriation in FY 12 ; is in FY 13 Budget request

15. SAMHSA BEHAVIORAL HEALTH – TRIBAL PREVENTION GRANT (BH-TPG) FOCUS ON PREVENTION OF SUBSTANCE ABUSE AND SUICIDE SAMHSA coordinates w/IHS to implement community-based prevention strategies that complement clinical services provided by IHS-funded providers Non-competitive application process for all federally recognized tribes who want the funds “Application” every 3 years with annual reporting Formula to be determined based on 2011 consultations w/ tribal leaders – base amount + additional $ based on formula Flexibility for tribes to use their approaches 15

16. CHANGES TO BLOCK GRANT APPLICATION PROCESS • Changes to SA and MH Block Grant app’s driven by TLOA, ACA, and MHPAEA • Trying to ensure SMHAs/SSAs are well positioned during FY 2014 and FY 2015 • Both MHBG and SABG applications due on same date – April 1, 2013 • 30 day FRN soon – out to states Nov/Dec 2012 • Option to do joint or two separate applications • Reports and reporting periods now same for both MHBG and SABG • Annual report due dates and annual expenditure reporting periods consistent across both • Plan will cover a two year period (7/1/13-6/30/15) – W/option to amend • Strongly encouraged to show evidence of tribal consultation or must show evidence of tribal input

17. BG APP IN 3 MAJOR SECTIONS: INTRODUCTION, IMPLICATION, AND PLANNING • Trauma • Justice • Parity Education • Primary and BH Care Integration Activities • Health Disparities • Recovery • Prevention • Children and Adolescents BH Services • Health Reform • Coverage of M/SUD services • Affordable Insurance Exchanges • Use of Evidence in Purchasing Decisions • Program Integrity • Tribes • Quality EACH SECTION INCLUDES SUBSECTI0NS

18. OTHER EXAMPLES - SAMHSA TRIBAL EFFORTS, INITIATIVES, AND ACTIVITIES • Improving access to grants • ICNAA Matrix of funding opportunities; Tribal eligible programs • August 2012: Tribal grant-writing webinar • SAMHSA roundtable on improving access planned for this fall • E.g., Project LAUNCH – Linking Actions for Unmet Needs in Children’s Health • CA w/awards up to $850,000 for up to 5 years • RFA included 5 point preference for Tribal applicants • Text was re-written to align w/Tribal Governance infrastructures • Prior only 1 Tribal grantee; 46 percent of this year’s applicants were from tribes; in FY 12, 6 of 11 new awards will go to tribes

19. SAMHSA TRIBAL EFFORTS, INITIATIVES, AND ACTIVITIES (CONT’D) • SAMHSA AI/AN Team (SAIANT) – meets monthly; cross coordination on AI/AN efforts • Annual Project Officer training; rescheduled to October 24th – 26th • Planning fall Tribal Policy Academy on strategic planning use of Tribal facilities • On-gong: Audits/complaints • SAMHSA’s Office of Behavioral Health Equity (OBHE) • Coordinates agency efforts to ↓ BH disparities for diverse populations • NNED - National Network to Eliminate Disparities in BH • July 2012: ICRC training webinar to support Prevention Specialist Certification for Ho-Chunk and Navajo Nation; also statewide Tribal representatives meeting w/Wisconsin BH • September 2012: SAMHSA’s Native American Center for Excellence webinar on Native Two-Spirit (LGBT) issues; over 680 participants; recorded and will be available on-line