Interview with SAMHSA Administrator Pamela Hyde, JD

While at the Voice Awards, I had the opportunity to sit down and chat for a few minutes with the head of the Substance Abuse and Mental Health Services Administration (SAMHSA), Administrator Pamela Hyde, JD.

Ms. Hyde is an attorney and comes to SAMHSA with more than 30 years experience in management and consulting for public healthcare and human services agencies. She has served as a state mental health director, state human services director, city housing and human services director, as well as CEO of a private non-profit managed behavioral healthcare firm. You can learn more about Ms. Hyde here.

Dr. John Grohol: So I wanted to understand a little bit better how the Voice Awards originated. What was the motivation behind coming up with this novel sort of way of recognizing both consumers and Hollywood contributions to mental health and substance abuse issues?

Pamela Hyde:  Well, let me start by just saying SAMHSA’s role in the federal government is to be the voice for people with mental health and substance abuse service needs and for people who might be at risk of those needs. So that means that part of our job is to try to educate the public and to try to provide information, provide materials, and just get the right information out.

So, as a part of that effort over the last many years, I think there’s been a variety of ways of trying to do that, and there’s no question that the entertainment industry has a profound impact on people’s understanding and perceptions of lots of things.

Dr. Grohol: Sure.

Pamela:  And in this case when there are misperceptions that are commonly held and are reinforced through media by having inaccurate or misunderstandings about people with behavioral health needs, that a problem. So I think that… Mark can obviously speak to this better than I, because he was here was here when it started, and I think partly it was his idea to start. But the concept of using that power of message to have a positive message about people with mental health and addictions is just an awesome way to try to get the public to understand and accept people better.

Dr. Grohol:Do you think it’s had a sort of reinforcing effect by having this awards ceremony take place that we’re now perhaps encouraging more story lines that explore mental health issues then maybe we would have seen 10‑15 years ago in TV or movies?

Pamela:  Well, I think it’s definitely possible and probable that we are impacting the positive way they’re doing that. When you get rewarded for something, and you see other people getting rewarded for something, even though this is an industry that gets awards a lot, I think this is kind of a unique one. And I think to the extent that people see that people are watching, and that people care about how people are being portrayed, and the fullness of their humanity and just the illness that may be taking them for a ride at the moment, then I think that is definitely reinforcing for story lines and others.

I think especially true right now, frankly, when there’s a lot of discussion about military families and their issues in dealing with things like PTSD and substance abuse and other things like that.

I think people are sensitive to it right now, and I think the industry is wanting to portray some of those issues. And I think they want to portray people in a positive way and help support our military families in their struggles as they return.

Dr. Grohol:Where did the idea for honoring the military come from for this year’s theme?

Pamela:  That’s a great question. Actually SAMHSA been going through a process where we’ve been identifying strategic initiatives, and we decided that military families was an important strategic initiative this year. We have eight of them, and that’s one of them. And part of the reason for that is that they have increased risk for substance abuse, for mental health issues, for prevention issues. Children of military families sometimes have harder times in school because of the separation of the parents or separation from parents.

There’s evidence that army wives, for example, just a study done on that group, had a more difficult time with depression and some other issues like that.

So, there are unique things about being in the military, whether it is separations, or whether it is moving a lot, or whether it is just the pressure on people, or literally being in combat. Those things have special behavioral health needs, and that are being recognized.

I think we’re also seeing a growth in things like suicide among active military individuals. We’re seeing huge numbers of homeless individuals who are veterans.

And I think all of those things right now, the whole United States ‑ the public, Congress, the president, everybody ‑ is just saying, “This is just not OK when we have so many people out there fighting or being on call for our country. They need to be treated in a way that is appropriate.”

The other reason, frankly, is just there’s so many of them. We’ve been in war for a lot longer than we ever have. We have National Guard people who’ve been going, being deployed in numbers that they never have. We have reservists and veterans in huge numbers.

You put all that together, and we’ve got tens of millions of Americans who have served or serving, and we just need to recognize their needs. And then you add all that to their families, the numbers of their families, and there are a lot of people. So that’s a special interest of ours at this point.

Dr. Grohol:Besides proper funding, what do you see as some of the biggest challenges facing mental healthcare in America today?

Pamela:  Well, I think there are several things. One is I think the attitudes that people have and the misperceptions that people have. We have some sayings or some messages that we really try to get across, one of which is that “behavioral health is part of health,” so trying to get people to understand that you’re mental health and your emotional health is just as important as your physical health. So that’s one issue. There’s more and more mental health and behavioral health and addiction treatment that’s going on in primary care settings as well.

The second message we have is that “prevention works.” The science is clearer, but I think people are not quite as aware of that. They know a little bit more about what it takes to prevent diabetes and to prevent heart disease and things like that. They don’t know so much about what does it take to prevent mental illness or prevent an addiction. So getting that word out is really important, because that’s a barrier.

Another of our messages is that “treatment works.” There’s a number of folks who don’t understand that either. Or people, because of the discrimination or the social exclusion of people with addiction and mental health issues, are afraid to come forward and say, “I need help.” So it’s really important for us to help people understand that if they go seek help, it really works.

And then the final one is that “people recover.” And that’s also a barrier is when people see or the public see people with mental health issues or addictions as just somebody who really can’t really be helped, or “Isn’t it sad?” or they see just the illness and not the whole person and not the person who can be and is in recovery, and the strength that it takes to get there. That’s a barrier.

So, all of those messages for us are really to try to overcome some of those messages and help people understand how important it is.

Dr. Grohol: Do you think there’s anything more specific to helping soldiers returning from war and soldiers in the military to seek out treatment because stigma being such a large issue and the negative reinforcement that they get from fear of it hurting their advancements within their career in the military?

Pamela:  I think there has been some of that, and I’m sure it still exists, but that kind of concern exists in the civilian population, too — not wanting to step forward for those reasons.

Dr. Grohol: Sure.

Pamela:  I have to say the Department of Defense, the Secretary of the Army, a lot of the military leaders right now. The head of the Joint Chiefs of Staff, they’re all coming out publicly in the press and other ways and saying, “You know, it takes a real warrior to come forward, a real strong and courageous person to come forward and say, ‘I need some help.'” So, they’re working really hard at getting it more possible and easier for people in the military to seek help and making it clear that that’s not going to impact your career in the military. I think there’s still a lot of concern that it might.

So part of what we’re also working on with the National Guard, the Veteran’s Administration, and others is to make sure the civilian service delivery system understands military culture and military constraints and concerns. So that when people don’t want to go to the military‑provided healthcare, they can go to the civilian healthcare and get some help, either them or their family members.

Dr. Grohol: How closely does SAMHSA work with other government agencies that are also involved in mental health, like the NIMH, and how do you see the roles being different or differentiated?

Pamela:  We work extremely well and a lot with other federal agencies. We’re very clear that we can’t do it all. We’re the federal voice on behavioral health and substance abuse, and that is our role. But we’re a pretty small agency, relatively speaking, so we’re very active with CMS and the Medicaid program, because it provides a lot of funding for people who are low income and need the services that we are concerned about.

We’re doing a lot of work with CDC on prevention efforts in mental health and substance abuse and suicide and other kinds of issues. We’re doing a significant amount of work with military organizations I already told you about.

Tom Insel and I from NIMH just had a meeting not too long ago. We’re really talking about ways that we can collaborate on things. They clearly have the agenda and the responsibility for research, and we have the responsibility for service delivery and practice improvements.

And so we’re working to think about how we can be a better partner in disseminating what they may learn, and how we can also identify things that need to be researched ‑ So a lot of good conversations going on.

We also work really closely with the administration of children and families around emotional health development and early intervention and then some of the trauma and issues that happen for kids who are taken out of the home for various and sundry reasons.

We work a lot with the Department of Justice around things like drug courts, juvenile justice issues, and all the behavioral health issues associated with that ‑ really high numbers of kids in those systems who have substance abuse and mental health issues. So I could go on.

We just have tons of federal partners. And we consider that a major part of our responsibility is to be in other systems and in other agencies working with them to support their efforts.

Dr. Grohol:One last question: What do you see as the most important or exciting advancement in mental health in the past decade ‑ mental health treatment or care?

Pamela:  Well, two come to mind — I don’t know why, but they do. One of which is really more than 10 years, and that is really the consumer movement. I mean that is …and it’s not just the people in recovery. It’s not just in the last 10 years, but people being able to raise their voices and say, “Hey, I’m a human being, and I have family. I have pets. I like to work on the computer. I like to garden. I’m just a human being. And I have an illness, or I have a condition that is not unlike other health conditions.

So that consumer movement and that voice and advocacy is really important. People in recovery from substance abuse, their voices are just incredibly, incredibly important.

And the more that people come forward ‑ you probably know this about any group that’s sort of excluded from the norm ‑ the more you get to know them, the more you know somebody like that, the more it’s going to be an acceptable thing to do.

The other one that comes to mind, and I’m not even sure this is the last 10 years either, but this idea of what we call SBIRT, so it’s “Screening, Brief Intervention, Referral to Treatment Approach.” It started out…the evidence is really mostly around alcohol.

But the idea is to try to do that before people get all the way to addiction. The idea is to identify people who are problem drinkers, for example. And help them understand they’re problem drinkers, because a lot of times they don’t realize they’re drinking too much, and being able to do brief interventions that are proven that can actually to prevent a person moving all the way into alcoholism.

There are some similar but not completely full‑blown yet issues for screening and brief interventions around depression and things of that nature. There’s a lot of work going on around adolescent substance abuse and screening for alcohol abuse.

So, there’s a lot of work going in the institutes, not just NIMH, but also NIDA, and NIAAA, around those issues. I think those are pretty amazing things that are evolving, and I hope we can put into practice. And there’s a lot of work that still needs to happen about that. So those are a couple.

The other one that comes to my mind is what we understand about emotional health development and the prevention of mental health and substance abuse issues. So the IOM put out a report in 2009, which just… it’s just opened all kinds of doors around understanding that you can in fact prevent a lot of these things.

50 percent of adult mental health issues start before the age of 14. And about three‑quarters of them start before the age of 25. That tells you you’ve got to do something very early with the kids in building the emotional health and then giving them the skills to get past some of those issues they may face as they go into adolescence and beyond. So those are three big ones that come to my mind.

Dr. Grohol: Thank you very much for your time today, Administrator Hyde.

Pamela:  My pleasure. Thank you.

Visit the SAMHSA website to learn more about the agency.