New Mental Health Czar Faces Huge Challenges In Focusing SAMHSA On Serious Mental Illnesses


New Assistant Secretary for Mental Health and Substance Abuse is sworn in by Secretary Tom Price while her husband holds bible.

9-14-17) Dr. Elinore McCance-Katz, who was sworn in earlier this week as our nation’s first Assistant Secretary for Mental Health and Substance Abuse, is going to need a tremendous amount of support from families and mental health advocates if she is to change the course of the Substance Abuse and Mental Health Services Administration, a federal agency with a budget of about $3.6 billion a year, most of it dispensed in grants to help states pay for mental health and addiction treatment.

Reforming SAMHSA is the mandate that both Congress and the White House have given her, but the road to accomplishing that is filled with minefields.

She is taking charge at a time when SAMHSA has been under intense fire voiced during congressional hearings held by Rep. Tim Murphy’s (R.-Pa.) leading up to passage of the law during the Obama administration that created Dr. McCance-Katz’s new job.

But Rep. Murphy’s harsh critique was hardly the only voice clamoring for change.

For years, Dr. E. Fuller Torrey has lashed out against SAMHSA. Among his criticism: that SAMHSA failed to employe a single psychiatrist, funded groups that were outspokenly anti-psychiatry and anti-medication, and issued a three year planning document that was 41,804 words in length but didn’t include a single mention of schizophrenia, schizoaffective disorder, bipolar disorder, autism or obsessive disorder. Instead, he said, SAMHSA frittered away millions on feel good programs for the worried well. As an example, Rep. Murphy and Dr. Torrey cited SAMHSA’s funding of an “Unleash the Beast” program that promised to help attendees learn about mental illness by studying animal movements.

Even SAMHSA’s own employees were unhappy. A 2015 study by a non-partisan watchdog group ranked SAMHSA at 317 out of 320 federal agencies when it came to employee job satisfaction.

Among the SAMHSA’s harshest critics was Dr. McCance-Katz herself.

In an earlier incarnation, Dr. McCance-Katz served as SAMHSA’s first chief medical officer but left after only two years. Once out the door, she blew the whistle on SAMSHA, writing in an April 2016 Psychiatric Times article that at SAMHSA:

 There is a perceptible hostility toward psychiatric medicine: a resistance to addressing the treatment needs of those with serious mental illness and a questioning by some at SAMHSA as to whether mental disorders even exist—for example, is psychosis just a “different way of thinking for some experiencing stress?”

All of which, now begs a question that needs to be answered.

Changing the top leader at a federal agency doesn’t change the career employees who have been sailing the ship for the past decade.

Put bluntly, the folks who preached that schizophrenia was a social construct, a gift, and simply an alternative way of thinking are still working at their desks inside SAMHSA. The leaders who funded the “alternatives conference” – a yearly event that was popular with some consumer groups but especially irked Rep. Murphy and Dr. Torrey — are still on the federal payroll, still approving grants, still in leadership positions.

How will Dr. McCance-Katz deal with them and them with her?

The new Assistant Secretary faces another unlikely Game of Thrones like hurdle.  The congressman most responsible for creating her job didn’t want her to get it.  Rep. Murphy pushed his own candidate, but was overridden by the Trump White House and his Senate colleagues.

Her friends praise her as a quiet, honest leader who listens to all points of view but has a firm understanding of her new role and a steely resolve to improve SAMHSA. They report she is willing to work with the left-overs from the rudderless Pamela Hyde administration, and especially eager to cooperate with Rep. Murphy.

All she needs is a chance.

Dr. McCance-Katz deserves everyone’s support. Those working in SAMHSA who don’t agree with her marching orders need to rethink their positions or move on to other jobs because both Republicans and Democrats in Congress and Secretary Tom Price have sent the agency a clear message.

It’s time for a change of course at SAMHSA.

Rep. Murphy’s amendments introduced this week to put money into programs authorized by the Helping Families in Mental Health Crisis programs:

Murphy Amdt. #155 – Assisted Outpatient Treatment $5 million increase, $20 million total.

This amendment increases court-ordered Assisted Outpatient Treatment (AOT) by $5 million to meet the fully authorized amount of $20 million in support of the severely mentally ill, thereby allowing them to get treatment in the community without incarceration or hospitalization. AOT reduces incarceration, homelessness, and emergency room visits by upwards of 70 percent.

Murphy Amdt. #175 – Infant and Early Childhood Mental Health Promotion, Intervention and Treatment- $5 million

This amendment provides $5 million for grants to develop, maintain, or enhance infant and early childhood mental health promotion, intervention, and treatment programs, including programs for infants and children at significant risk of developing, showing early signs of, or have been diagnosed with mental illness, including a serious emotional disturbance. These programs are to be evidence based models and practices that can be replicated in other appropriate settings.

Murphy Amdt. #176 – Increasing Access to Pediatric Mental Health Care – $9 million

Provides $9 million in grants to improve access to behavioral health integration in pediatric primary care by supporting the development and improvement of statewide or regional pediatric mental health care telehealth access programs, and further develop regional pediatric mental health teams to provide consultative support for pediatric primary care.

Murphy Amdt. #177 – Strengthening the Mental and Substance Use Disorders Workforce- $10 million

Provides $10 million for a training demonstration program that awards grants to train medical residents and fellows to practice psychiatry and addiction medicine, nurse practitioners, physician assistants, health service psychologists, and social workers who provide mental and substance use disorders services. Recipients will integrate primary care with mental and substance use disorder care services in underserved and community-based settings.

Murphy Amdt. #178 – National Mental Health and Substance Abuse Policy Lab – $5 million

Provides $5 million for the creation and operation of a National Mental Health and Substance Use Policy Laboratory to encourage innovation and evidence based practices. The Policy Laboratory will further develop, expand, and improve evidence based programs while analyzing and disseminating appropriate data.

Murphy Amdt. #179 – Strengthening Community Crisis Response Systems – $10 million

In order to strengthen community crisis response systems, this section provides $10 million in grants to develop, maintain, or enhance a database of inpatient psychiatric facilities, crisis stabilization units, and residential community mental health and residential substance use disorder treatment facilities. This amendment will address a pronounced lack of inpatient psychiatric beds. Grant applicants will develop crisis response plans to promote integration and coordination between local public and private entities, including first responders, emergency health care providers, primary care providers, law enforcement, and behavioral health providers.

About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.