'Mental Health Czar' Bullish on Prevention, Mental Health Issues

Deborah Brauser

July 18, 2018

America's so-called mental health czar is pushing forward with her commitment to help develop initiatives focused on both substance abuse prevention and severe mental illness, including overseeing a new grant awarded to the American Psychiatric Association (APA).

Appointed last year, Elinore McCance-Katz, MD, PhD, assistant secretary for mental health and substance use in the US Department of Health and Human Services (HHS), said during an interview that she'll be involved with several projects currently gaining traction.

Dr Elinore McCance-Katz. Deborah Brauser/Medscape

Among her federal responsibilities, McCance-Katz oversees the Substance Abuse and Mental Health Services Administration (SAMHSA).

In addition to accepting applications for nearly $1 billion for state opioid response grants, SAMHSA has opened up new grants to state and local governments, universities, community organizations, and federally recognized tribal organizations to set up regional technology transfer centers (TTCs). These centers will provide evidence-based training and technical assistance on substance use prevention and mental illness within a national network, said McCance-Katz.

"I want to make sure we are covering a broad spectrum of need," she told Medscape Medical News. "These centers will focus on the community and providers in communities."

In addition, the APA announced last week that it has been awarded a 5-year, $14.2 million grant from SAMHSA to create a clinical support system for serious mental illness (CSS-SMI). The system will offer consultation and education on disorders such as schizophrenia, bipolar disorder, and major depression.

"This grant will allow the APA to take a leading role in addressing serious mental illness in this country," APA President Altha Stewart, MD, said in a release.

"Striking a Balance"

Before being named as the first assistant secretary for mental health and substance use under the HHS, McCance-Katz was chief medical officer for the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospital and a professor of psychiatry and human behavior at Brown University, Providence, Rhode Island.

She also served as chief medical officer of SAMHSA from 2013 to 2015.

Her current position was created as part of the 21st Century Cures Act of 2016 under President Obama. In addition to overseeing SAMHSA, she coordinates mental health service at other federal agencies, including the Centers for Medicare & Medicaid Services (CMS) and the US Food and Drug Administration (FDA).

During her Senate confirmation hearing, she stressed the importance of striking a balance between providing early treatment options and making sure these services are available for at-risk populations.

In 2016, SAMSHA put into place addiction-focused TTCs. Now, the organization wants to concentrate on TTCs for prevention interventions for substance problems and for severe mental illness in order to train and provide information on these areas to "doctors in the field, preprofessionals, and others in the community," McCance-Katz told Medscape Medical News.

Some of these centers will concentrate on specialized topics, such as working with the justice system, treating children and families that have been affected by substance problems, and providing early childhood mental health consultations.

New Initiative

In addition, McCance-Katz noted that the grant to develop a national CSS-SMI awarded to the APA will be used for training and to provide "documents, brochures, papers, and treatment-improvement protocols" as resources to help implement the best approaches for helping patients.

She added that the process is akin to an old-school library with a high-tech upgrade.

"The project will use sophisticated web and app-based technologies, including the use of APA's PsychPRO mental health registry," the organization said in its press release.

"In addition to the APA, 29 partnering organizations and individuals...will provide expertise on clinical content, educational resources, and strategic guidance on the project's Advisory Board," they added.

Overall, "the CSS-SMI project will help us disseminate best practices for treating people who have serious mental illness and increase their access to care," noted Stewart.

"I am excited to see the project unfold over the next 5 years," she said.

Public Health Emergency

Another strong focus for McCance-Katz is the ongoing opioid epidemic in the United States.

"I would say that there is a public health emergency. At this point, we are really bringing everything we have to bare with HHS and with the federal government to try to address this," she said.

"The president and the congress have come together to work on this collaboratively and have provided a substantial amount of new funding to us," she added.

This includes earmarking $930 million for state response grants, including $50 million specifically to help tribes combat the opioid crisis "because tribal nations have been severely impacted," she noted.

"There are several new areas that we need to focus on immediately, and one is getting that money out to states so that they can provide the prevention, treatment, and recovery services that their people need," McCance-Katz said.

"The second is to make sure that that's done in a way that uses evidence-based practices. It's not enough to simply refer people to existing facilities if they're not using best practices. So we're working very hard on that at my agency."

That includes partnering with CMS on how best to pay for all of this.

"How do we do this in a way that makes sense for providers so that they can provide these services — and do it in a way that allows them to at least make back their costs? That's important," said McCance-Katz.

"These are complex people," she added. "There are often issues of co-occurring mental illness and co-occurring substance use disorders that need attention as well. These are people that require a lot of care and services, which is why it's important to train our workforce on best practices and have them work collaboratively."

Key Partnerships

She added that SAMHSA also works with the FDA and the National Institutes of Health (NIH) to look into possibly fast-tracking "medications that might be useful in this epidemic."

"NIH is an important partner in research to do several things. One, what's really working in our communities and what can we disseminate across the nation? And two, funding studies looking for new medication treatments, both things like analgesics or pain medications that do not have the abuse liability of opioids but are effective pain relievers, and more potent formulations of naloxone to reverse these very high-potency opioids that kill quickly," she said.

Last month, SAMHSA published an updated version of its opioid overdose prevention toolkit.

Overall, McCance-Katz said she's optimistic about finding solutions to the current opioid epidemic.

"I feel very confident that we, our administration, will get the problem under control — although it's not going to be tomorrow. This is something that's been brewing since the release of very potent opioids back in the mid 90s. So it's not going to get solved in a year, even 2 years. But we will get it solved," she said.

"However, it would be naive for anyone to think that that would be the end of substance problems in this country," she said.

The assistant secretary said that it's important to ensure that curing opioid problems doesn't lead to problems with other substances. "That's what we're going to do our very best to avoid."

As an addiction psychiatrist for 22 years, she has treated all types of substance dependence. "So I know very well what to expect. We need to address the here and now, the urgent issues, but also prepare our behavioral health workforce to continue interventions that are going to be needed going forward," she said.

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