Which Path Will Biden’s Nominee To Run SAMHSA Choose? Agency Has Swung Between Anti-Psychiatry & Pro Assisted Outpatient Treatment

(4-26-21) President Joe Biden’s nominee to run the federal government’s mental health and substance abuse programs is largely unknown in Washington D.C. among mental health leaders.

Biden announced on Friday (4-23-21) that he’d chosen Dr. Miriam E. Delphin-Rittmon to be the next Assistant Secretary for Mental Health and Substance Abuse. She currently serves as the Commissioner of the Connecticut State Department of Mental Health and Addiction Services. If her nomination is approved by the U.S. Senate, she will take charge of SAMHSA, with a $6 billion budget, much of which is distributed through block grants to states.

As SAMHSA head, she will spell out priorities for that agency during the next four years.

Asked over the weekend for comments, several leaders of major mental health organizations, replied that they had heard “good things” about the nominee from their members and other contacts in Connecticut, but few had dealt personally with Dr. Delphin-Rittmon.

An exception was former Assistant Secretary Dr. Elinore McCance-Katz, who the nominee will replace.  They worked together at SAMHSA during the Obama Administration. Dr. Delphin-Rittmon spent two years there, according to her official resume released by the White House.

“I met Miriam when I came to SAMHSA as the Chief Medical Officer and she was a Senior Adviser. I liked her very much. She is bright, knowledgeable, and a very nice person. I don’t know what direction she will take as the Assistant Secretary, but I am confident that she will be dedicated to working on behalf of Americans with mental and substance use disorders.

In what direction will SAMHSA go?

Dr. E. Fuller Torrey told me in an email:

I welcome Dr. Dellphin-Rittmon`s  nomination for her strong interest in cultural competence. Mentally ill individuals from minority groups are strongly disproportionately represented among the mentally ill in jails and prisons and among the homeless. Our current system of treatment has failed badly in treating these individuals. If the Assistant Secretary, if she is confirmed, could address this issue it would be a major contribution. Perhaps she could propose special incentives or programs through SAMHSA to recruit more minority mental health workers to treat this population, such as student loan forgiveness. I would hope she would also examine why so many mentally ill individuals from minority groups and up incarcerated or homeless when we have known effective programs, such as assisted outpatient treatment   (AOT), which have been shown in studies to minimize such outcomes.

Meanwhile, Harvey Rosenthal, a leading peer advocate, offered this:

“We congratulate President Biden on his wise choice of Dr. Delphin-Rittmon to lead the nation’s mental health and addiction related policies in the wake of the pandemic. She represents a most welcome course correction in federal behavioral health policy, with a strong record of support for recovery-focused services, peer support, cultural competence and choice and rights protections. We are very encouraged by her commitment to advancing science-based strategies to advance health and racial equity and to address the opioid crisis. We look forward to working closely with the Assistant Secretary Nominee in the areas of peer run crisis innovations, criminal justice reforms and in bolstering our workforce.”

These two comments represent differing views of how SAMHSA should move forward – views that Dr. Delphin-Rittmon will have to navigate.

Obama’s Director Catered to Anti-Psychiatric Crowd; Trump’s Choice Swung The Other Way

President Obama’s SAMHSA head, Pamela Hyde, an attorney by training, led the department from 2009 to 2015 and was heavily criticized for catering to an anti-psychiatry crowd. One of the leading critics of the agency was Dr. McCance-Katz, who served under Hyde for two years as the agency’s first medical director. She penned a scathing critique in Psychiatric Times –The Federal Government Ignores the Treatment Needs of Americans With Serious Mental Illnesswriting that SAMHSA’s leadership questioned whether mental illnesses exist.

When Dr. McCance-Katz took charge in 2016, she immediately began changing the agency’s direction, ending a federally funded Alternatives Conference that had drawn congressional Republicans’ ire, pushing greater use of Assisted Outpatient Treatment, and making it possible for states to seek waivers of the IMD Exclusion.

Just how Dr. Delphin-Rittmon will respond to pressures from the Hyde crowd versus McCance-Katz supporters is anyone’s guess. Connecticut is one of three states that doesn’t authorize AOT and while Connecticut’s mental health system has been judged better than most, one long time advocate pointed out that is a low bar.

Connecticut Senator Chris Murphy (D.) joined Sen. Bill Cassidy (R.-La.) in writing and pushing through legislation that created the Assistant Secretary position and, its likely that Sen. Murphy played a key role in Dr. Delphin-Rittmon’s nomination.

Like others in Washington D.C., I’ve had no contact with Dr. Delphin-Rittmon.

The fact that she has not been a nationally recognized figure in calls for an end to the inappropriate incarceration of those with serious mental illnesses concerns me.

I was told by insiders that it was likely Biden would chose someone from a state mental health/substance abuse agency, and likely someone of color.

A number of veterans had sought the job. Miami Dade Judge Steven Leifman had been my choice. A week before the White House revealed its nominee, Judge Liefman was part of a team that released a groundbreaking report – Roadmap To The Ideal Crisis System – that spelled out steps communities and the nation should take in creating an “ideal” response system.

Nominee Should Consult With Judge Leifman & Reappoint Dr. Minkoff to ISMICC

Assuming Dr. Delphin-Rittmon sails through the confirmation process, she should familiarize herself with that report. She also would be wise to reach out to Judge Leifman, who has helped transform Miami-Dade mental health services, for advice and guidance.

Dr. Delphin-Rittmon should also re-appoint Dr. Ken Minkoff to the Interdepartmental Serious Mental Illness Coordinating Committee.  Dr. Minkoff was largely responsible for writing much of ISMICC’s first report to Congress which listed recommendations for improving cooperation between government agencies. Titled: The Way Forward: Federal Action for a System That Works for All People Living With SMI and SED and Their Families and Caregivers, the report offered 45 recommendations in five categories, that were drafted by ISMICC’s fourteen public members.

ISMICC was sidelined during the final years of the Trump administration but, by law, it must submit a final report to Congress in December 2022. Without Dr. Minkoff reinstated, I question whether ISMICC and its recommendations will have any real impact.

That would be a shame, especially since ISMICC was created by the same law that created the Assistant Secretary Position.

Here’s the nominee’s official resume via the White House.

Miriam Delphin-Rittmon, Nominee for Assistant Secretary for Mental Health and Substance Use, Department of Health and Human Services
Dr. Miriam E. Delphin-Rittmon is currently the Commissioner of the Connecticut State Department of Mental Health and Addiction Services. She was appointed in March 2015 and previously held the positions of Deputy Commissioner, Senior Policy Advisor and Director of the department’s Office of Multicultural Health Equity. In her role as Commissioner, Dr. Delphin-Rittmon has been committed to promoting recovery oriented, integrated, and culturally responsive services and systems that foster dignity, respect, and meaningful community inclusion. In addition, through her 20 year career in the behavioral health field Dr. Delphin-Rittmon has extensive experience in the design, evaluation and administration of mental health, substance use and prevention services and programs has received several awards for advancing policy in these areas. Most recently, she received the 2019 State Service Award from the National Association of State Drug and Alcohol Directors and the 2016 Mental Health Award for Excellence from the United Nations Committee on Mental Health. 

In May 2014, Dr. Delphin-Rittmon completed a two-year White House appointment working as a Senior Advisor to the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA) with the U.S. Department of Health and Human Services. Dr. Delphin-Rittmon currently holds an Associate Adjunct Professor position with the Yale University Department of Psychiatry where prior to her role as Commissioner was an Assistant Professor and served as Director of Cultural Competence and Health Disparities Research and Consultation with the Program for Recovery and Community Health since 2003. Dr. Delphin-Rittmon received her B.A. in Social Science from Hofstra University in 1989, her M.S. and Ph.D. in Clinical Psychology from Purdue University 1992 and 2001, respectively, and completed a postdoctoral fellowship in clinical community psychology at Yale University in 2002.


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.