2. SAMHSA HEALTH REFORM EFFORTS: IMPACTING HIV CARE
Michael Duffy
SAMHSA Regional Administrator
September 7, 2013

3. BEHAVIORAL HEALTH: A NATIONAL PRIORITY3
Vision: SAMHSA provides leadership & devotes its resources toward helping the Nation act on the knowledge that:
Mission: Reduce the impact of substance abuse and mental illness on America’s communities
Behavioral health is essential to health
Prevention works
Treatment is effective
People recover

4. Division of Regional and National Policy Liaison –Team
Represent SAMHSA leadership in the Regions
Establish working relationships with:
HHS OPDIVS
State authorities for mental health & substance abuse, provider groups, stakeholders. health departments.
Coordinate support for State implementation of Health Reform.
Coordinate, as needed, implementation of SAMHSA Strategic Initiatives & technical assistance within the regions.
Help States to coordinate resources across SAMHSA- emerging needs.

5. Region VIII:
Denver CO, MT, ND, SD,
UT, WY Charles Smith, PhD 1961 Stout Street Denver, CO 80294
Region I: Boston CT, ME, MA, NH, RI, VT
Kathryn Power, MEd JFK Federal Building Boston, MA 02203
Region V: Chicago IL, IN, MI, MN, OH,
WI Jeffrey A. Coady,
PsyD 233 N Michigan Ave
Chicago, IL 60601
Region X:
Seattle AK, ID, OR, WA David Dickinson th Ave,
MS RX-02 Seattle, WA
98121
Region II: New York NJ, NY, PR, VI Dennis O. Romero 26 Federal Plaza New York, NY 10278
Region VII:
Kansas City IA, KS, NE, MO Laura Howard, JD 601 East 12th St Kansas City, MO
64106
Region III:
Philadelphia DE, DC,MD, PA,
VA, WV Jean Bennett 150 S. Independence
Mall West Philadelphia, PA 19106
Region IX:
San Francisco AZ, CA, HI, GU, NV,
AS, CNMI,
FSM, MH, PW Jon Perez, PhD 90 7th Street, 8th Floor San Francisco, CA 94103
Region IV:
Atlanta AL, FL, GA, KY, MS,
NC, SC, TN
Stephanie
McCladdie 61 Forsyth Street, S. W. Atlanta, GA 30303
Region VI:
Dallas
AR, LA, NM, OK, TX
Michael Duffy
RN, BSN 1301 Young St, Dallas, Texas 75202

6. WHY DOES BEHAVIORAL HEALTH MATTER IN HIV: MENTAL DISORDERS
CDC estimates: half of all Americans will meet criteria for mental illness at some point in their lives; half of us know someone in recovery from substance abuse
7 percent of the adult population (34 million people), have co-morbid mental/physical conditions w/in a given year
Untreated MH/SUDs among top 5 predictors of poor adherence to HIV/AIDS treatment
~50 % of those in HIV care have a co-morbid mental illness
Mental illness can arise independently of HIV infection; can predispose to HIV (through risk-related behaviors); can be a psychological consequence of HIV (e.g., depression)
Regardless of etiology, co-morbidity of mental disorders/HIV poses special challenges for care.
Depression is the most commonly observed MH disorder in HIV, affecting up to 22% of patients; prevalence even greater in substance users

7. WHY DOES BEHAVIORAL HEALTH MATTER IN HIV: ADDICTIVE DISORDERS
Alcohol and drug abuse linked to poor treatment response and more rapid progression of HIV
Effects of drugs/alcohol alters judgment; people engage in high risk drug use and sexual behaviors contributing to spread of HIV; adherence to treatment difficult
Untreated HIV associated with higher blood alcohol concentrations with potential for increased risk of alcohol-associated diseases and more severe course of HIV disease

8. CHRONIC DISEASES: GLOBAL IMPACT8
World Economic Forum:
Global economic impact of 5 diseases could reach $47 trillion over the next 20 years
BH will account for $16 trillion – a third of cost
Cancer
Diabetes
Behavioral Health Impacts
Heart Disease
Respiratory Disease

9. BEHAVIORAL HEALTH: KEY TO RETENTION IN HIV CARE
2013: Supplements available to 12 Cities grantees:
Within HIV specialty treatment programs:
BH screening
prevention
brief interventions
referral to BH treatment

10. SAMHSA’S ROLE IN NHAS IMPLEMENTATION – Funding (# in millions)
CENTER/PROGRAM
FY 2013 CR
Center for MH Services (CMHS)
Minority Aids Initiative (MAI
$9.3
CMHS S-to-S
$.773
Center for SA Prevention (CSAP) MAI
$41.3
Center for SA Treatment (CSAT) MAI
$65.9
SA Prevention & Treatment Block Grant (SABG)
(HIV Early Intervention Services 5% set aside)
$60.1
Total
$177.4

11. SAMHSA HEALTH REFORM EFFORTS

12. ACA: POSITIVE EFFECT FOR THOSE LIVING W/BH PROBLEMS AND/OR HIV
People w/ BH problems and/or HIV are more likely to be uninsured, to face barriers in accessing medical care, and to experience higher rates of prejudice and discrimination than other groups
ACA expands coverage for BH services: should increase access to services for MH/SUDs for people without access now
ACA supports integrated, coordinated care, especially for people w/ BH and co-occurring health conditions, such as HIV/AIDs
Expands Medicaid for the lowest income people; provides subsidies for lower income Americans to obtain health insurance
Increases access to critical prevention services, including SBIRT and HIV testing
Prohibits discrimination on basis of MH/SUDs and HIV status as pre-existing conditions; bans lifetime limits on insurance coverage
Phases out annual limits in coverage

13. Mental Health Parity & Addiction Equity Act (MHPAEA)
The Mental Health Parity and Addiction Equity Act requires insurance groups that offer coverage for mental health or substance use disorders to provide the same level of benefits that they do for general medical treatment.

14. PREVENTION SERVICES ACA
Under the Affordable Care Act, most health plans must cover certain preventive services without a copayment, co-insurance, or deductible. Covered preventative services include BH services:
Depression screening
Alcohol misuse screening
Alcohol and drug screenings for adolescents
Behavioral assessments for children of all ages
HIV Testing

15. Health Homes
Health Homes for Enrollees with Chronic Conditions letter (PDF | 135 KB)
SAMHSA Consultation Process and Workflow Sample (PDF | 128 KB)
SAMHSA’s Guidance Document and Checklist (PDF | 138 KB)

16. SAMHSA HEALTH REFORM TOOLKITS

17. SAMHSA PUBLICATIONS- SAMHSA.GOV

18. How does all of this relate to People Living with HIV?
Greater Access to Treatment
Now will be possible for medical and BH needs to be addressed in one setting:
Primary care settings
BH settings with coordinated BH and primary care
Effective treatment reduces risk of transmission
Resulting in better outcomes for those living with HIV
Fewer new infections

19. SAMHSA Regional Administrator Phone 214-767-0522
Michael Duffy
SAMHSA Regional Administrator
Phone
(Wagner et al., 2001)