Psychiatr News August 4, 2006
Volume 41, Number 15, page 2
© 2006 American Psychiatric Association
Departing SAMHSA Head Describes Challenges Successor Will Face
Rich Daly
Continued improvement in the nation's mental health system in an era of
ever-tightening budgets is among the most daunting challenges confronting the
next leader of a key government mental health agency.
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SAMHSA Administrator Charles Curie, M.A., departs in August after five
years at the agency. courtesy of SAMSHA
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Although APA leaders praised the departing administrator of the leading
federal mental health care agency, both he and they acknowledge that
substantial challenges loom on the horizon for the new leader.
Charles Curie, M.A., administrator of the Substance Abuse and Mental Health
Services Administration (SAMHSA), will step down August 5 after five years at
the helm. Eric Broderick, D.D.S., acting deputy administrator and a rear
admiral in the U.S. Public Health Service, will lead the agency until a
permanent administrator is selected.
Among the most difficult tasks for the next administrator, Curie said in an
interview with Psychiatric News, will be implementation of workforce
development initiatives to increase the number and quality of personnel
trained to provide mental health care, including substance abuse treatment.
Such efforts are included as a priority part of SAMHSA's matrix, or strategic
plan, to develop an action plan that can show results within two years.
Complicating SAMHSA programs, Curie said, is that the agency will have to
work within a federal budget that will flatline or even shrink for
nonmandatory spending in coming years.
Mental health advocacy groups may have greater success maintaining existing
federal spending or adding new funding, Curie said, if they have a unified,
consistent message and communicate the common ground they share.
"When the field is united, it is remarkable what can be
accomplished," Curie emphasized.
He cited the example of substance abuse care advocates in Pennsylvania
during his term as deputy secretary for mental health and substance abuse
services in the state's Department of Public Welfare, in which the advocates
united to seek a carveout of Medicaid dollars for substance abuse treatment
and give counties more control over the funds. He noted that similar efforts
in other states failed—even when supported by the governor—when
advocates did not show a united front.
Another challenge for the future SAMHSA administrator is the ongoing
implementation of the recommendations of the President's New Freedom
Commission on Mental Health. Curie and leaders in psychiatry count his efforts
to establish the commission and implement its recommendations as among his
most important accomplishments.
"Although implementation of [the recommendations of] this report has
been delayed by the Bush administration, the report itself will continue to
provide momentum for further development of the public mental health
system," said Darrel Regier, M.D., M.P.H., director of APA's Division of
Research and the American Psychiatric Institute for Research and Education.
Although some mental health advocates have criticized the federal government
for not fully implementing the commission's recommendations, Curie said that
the goal is to create "actual changes on the ground" within three
years.
Based on the commission's recommendations, the agency aims to better
coordinate mental health financing between itself and the Centers for Medicare
and Medicaid Services.
Among the changes he hopes to see is a clear focus on suicide
prevention.
"Another example would be potentially seeing some creative approaches
for implementing evidence-based practices by using Medicaid dollars and
[having] a clear pathway for states to be able to achieve that," Curie
said.
Psychiatrist Anita Everett, M.D., SAMHSA's senior medical advisor, said one
of the commission's most significant long-term impacts may be in
"mainstreaming" consumer involvement in developing funding
priorities for the government, which Curie has encouraged. Previously, mental
health policymakers were reluctant to seek out or listen to the opinions of
people with mental illness when deciding where to target funding.
Immediate past APA President Steven Sharfstein, M.D., also noted Curie's
"willingness to hear all points of view" as a critical component
of his leadership style.
Another part of his legacy he hopes will continue to drive the agency is a
strategic mental health plan that links funding areas (such as those for
homelessness and older Americans) with the priorities for each area. The
approach has established funding consistency in an area of government not
known for that.
"It provides a framework around which projects of priority are
developed in mental health," Everett said.
A continuing challenge for both SAMHSA and APA is the further adoption of
office-based opioid treatments, which has lagged expectations of many mental
health clinicians.
Ongoing congressional efforts to lift individual clinicians' 30-case limit
on such treatment require expanded support, he said, in addition to continued
training of physicians who often find that this treatment option becomes an
important part of their practice.
"Very aggressive training efforts are going to continue to be
critical," Curie said.
Effort is also needed to lift the stigma surrounding mental illness, he
emphasized. Continued societal education is needed so people with mental
illness no longer feel as if they can't seek help without enduring stigma and
discrimination.
Curie's biography is posted at
<www.samhsa.gov/about/bio_curie.aspx>.
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