(1-3-22) Dr. Miriam E. Delphin-Rittmon, Assistant Secretary for Mental Health and Substance Use and head of SAMHSA, was kind enough to answer four questions for me as we enter the New Year, including a question that asked what drew her into the mental health profession. The same four questions were asked to leaders of several national mental health organizations and their responses will be posted in the coming days. Thank you Dr. Delphin-Rittmon for sharing your responses.
Question One: What was SAMHSA biggest accomplishment during 2021?
First, Pete, allow me to say thank you for the opportunity to share my thoughts in your blog about the work being done by SAMHSA. As you know, our country has been grappling with a behavioral health epidemic long before the COVID-19 pandemic added to the urgency of Americans’ needs. Consequently, I would say, SAMHSA’s biggest accomplishment has been in our work to scale up our policies, responses and resources to better meet those needs.
Through the Biden-Harris Administration, we have added more than $5.5 billion through our Substance Abuse Prevention and Treatment and Community Mental Health Services block grant programs. Part of the Mental Health Block Grant spending has entailed investing $825 million in 231 Community Mental Health Centers throughout the country. We also awarded 100 grants totaling $250 million to increase access to Certified Community Behavioral Health Clinics (CCBHCs) throughout the nation.
The CCBHC expansion grant program increases access to and improves the quality of community mental and substance use disorder treatment services. CCBHCs provide person- and family-centered integrated services, including 24/7 crisis intervention services for individuals with serious mental illness or substance use disorders, including opioid use disorders; children and adolescents with serious emotional disturbances; and individuals with co-occurring mental and substance use disorders.
We know many people who deal with mental health conditions also have co-occurring substance use disorders.
SAMHSA also has been escalating our response to the needs of our communities by becoming increasingly active in harm reduction. We recently announced a $30 million funding opportunity for an unprecedented Harm Reduction Grant Program to be solely dedicated to funding harm reduction services and support for all harm reduction service components, including purchasing supplies and equipment.
This funding – $10 million annually for three years – allows organizations to expand their community-based overdose prevention programs in a variety of ways, including distributing overdose-reversal medications and fentanyl test strips, providing overdose education and counseling, and managing or expanding syringe services programs, which help control the spread of infectious diseases like HIV and hepatitis C.
This vital funding opportunity aligns with the Biden-Harris Administration’s ongoing efforts to combat the overdose crisis and is a key pillar in the multi-pronged Health and Human Services Overdose Prevention Strategy announced in October. Additionally, this year we approved the use of our funds to purchase fentanyl test strips, we waived previous training requirements for health care providers looking to prescribe buprenorphine to as many as 30 people a month and we awarded numerous other grants to community organizations fighting overdose in myriad ways.
Question Two: What are your priorities going into 2022?
We will continue to focus on preventing overdose; promoting children and youth behavioral health; using performance measures, data and evaluation; integrating primary and behavioral health care; and enhancing access to suicide prevention and crisis care. Just a word about suicide prevention – SAMHSA is leading the federal transition of the National Suicide Prevention Lifeline that we operate from its present 1-800 number to an easier-to-remember, three-digit “988” in July 2022.
Of course, 988 will be more than just an easy-to-remember number – it will be a direct connection to compassionate, accessible care and support for all Americans who might be experiencing suicidal thoughts, who are at risk of suicide, or who are struggling with emotional distress. To drive action toward this vision, SAMHSA is first focused on strengthening and expanding the existing Lifeline network, providing lifesaving service to all who call, text, or chat via 988. Longer term, SAMHSA recognizes that linking those in crisis to community-based providers – who can deliver a full range of crisis care services – will be essential to meeting behavioral health crisis needs across the nation.
Earlier this year, SAMHSA announced it is in the process of establishing an Office of Recovery that will infuse recovery as a cross-cutting principle throughout our policies and programs.
The office will have a dedicated team with a deep understanding of recovery from substance use and mental health. I would be remiss to not mention the other cross-cutting principles that also inform SAMHSA’s priorities: equity; workforce expansion and enhancement; and funding those interventions that are known and proven to work.
SAMHSA will focus on implementing the HHS Overdose Prevention Strategy. The strategy is designed to increase access to the full range of care and services for individuals who use substances that cause overdose, and for their families. This new strategy focuses on the multiple substances involved in overdose and the diverse treatment approaches for substance use disorder. It prioritizes four key target areas—primary prevention, harm reduction, evidence-based treatment, and recovery support—and reflects the Biden-Harris Administration principles of maximizing health equity for underserved populations, using best available data and evidence to inform policy and actions, integrating substance use disorder services into other types of health care and social services, and reducing stigma. It also recognizes that the full continuum of integrated care and services are needed to help prevent substance use, expand quality treatment, and sustain recovery from substance use disorders, all while emphasizing the Department’s commitment to helping historically underserved populations.
Question Three: What are the biggest challenges that you currently face?
First, the overdose epidemic remains one of the biggest challenges. According to Centers for Disease Control and Prevention data, for the first the time ever, overdose deaths in this country exceeded 100,000 over a 12-month period, from April 2020 to April 2021. Synthetic opioids such as fentanyl, stimulants such as methamphetamine and cocaine – and other drugs – are harming Americans at an alarming rate. This is the driver of the Overdose Prevention Strategy, HHS’s policies promoting harm reduction, and the unprecedented funding I referenced in earlier responses.
Second, stigma continues to be a hindrance to people pursuing the help they need – whether that need is tied to mental health conditions, substance use disorders or both. There has been improvement in society at large considering and talking about the value of safeguarding and investing in behavioral health. But we also know the wide-ranging impact of the COVID-19 pandemic means there might be Americans grappling with its impact on their mental health who might be confronting their own needs for the first time – and who might be confronting stigma in this area for the first time, as well. With recovery being attainable, our loved ones deserve nothing short of an unwavering resolve to defeat stigma.
I mentioned workforce is one of our cross-cutting principles. The challenges we face in trying to expand and enhance the nation’s behavioral health and health care workforce cannot be overstated: An individual’s first point of contact with the health system is usually through a primary care provider or emergency department – and routinely isn’t for a substance misuse or mental health concern. During the COVID-19 public health emergency, providers were initially focused on acute medical concerns and were not adequately resourced to consider the mental health effects of the pandemic. Education at the provider and health system level is one way to surmount this. Justifying this requires more than empiric observations.
So, let me emphasize those challenges again: addressing overdose and suicide deaths; overcoming stigma; and expanding and enhancing a national behavioral health and health care workforce.
Question Four: Why did you get involved in mental health?
Several converging experiences have contributed to my passion for and selection of behavioral health as my career path. First, I think the fact that my father practiced as a psychiatrist for more than 50 years sparked some of my early interests in the field. His approach was nontraditional, and I remember early conversations with him sharing about his work, which included incorporating spirituality and such practices as biofeedback, hypnosis and acupuncture, and how he often said that ultimately his work was about helping people to feel better and live more fulfilling lives. That resonated with me and I later took a psychology class in college and ultimately decided to major in psychology. I was also interested in creative writing and thought that psychology would help me with character development for writing short stories and plays – which was as a strong interest at the time.
Also, influencing my career choice was the year I took between college and graduate school to work as a case manager in New York City with individuals who were homeless.
This was in 1989, and as a country we were struggling with the twin challenges of the AIDS and crack cocaine epidemics. The year was challenging but also formative, and I remember feeling privileged to be able to help people connect with what, and in many cases whom, they wanted in their lives. I remember waking up early, sometimes 5 a.m., to stand in line with individuals who wanted to enter detox for the first time and their not necessarily being admitted at the first try; or helping people connect with family members with whom they had been estranged, in one instance for decades; or helping people navigate the maze of attaining benefits or housing; and so appreciating the times we were given free tickets to shows or museums allowing for, among other things, reprieve and the experience of a night or afternoon out in NYC connecting with the arts.
From this experience I developed an interest in cultural competence, community health and, later, health policy overall. I decided to apply for graduate school in clinical psychology and ultimately was accepted to the Purdue University doctoral program in clinical psychology. In addition, I applied for and was awarded the SAMHSA/APA Minority Fellowship, which helped to further develop my interests in psychology and community health through my payback experiences working at a community mental health center.
Finally, early on and throughout my career I have been inspired both personally and professionally by family members, friends, colleagues and acquaintances who, with courage and resilience, have striven for recovery and wellness. Recovery narratives often inspire my own strivings for balance, mindful self-reflection and self-care.
And I have so appreciated the recovery mantra “nothing about us without us” – having throughout my career worked to implement this important reminder from research, policy and system perspectives.
About the Author: (From her official SAMHSA biography) Before being named Assistant Secretary, Dr. Delphin-Rittmon previously served as Commissioner of the Connecticut Department of Mental Health and Addiction Services (DMHAS) and served in this role for six years. Prior positions held at DMHAS include Deputy Commissioner, Senior Policy Advisor and Director of the department’s Office of Multicultural Healthcare Equity. In her role as Commissioner, Dr. Delphin-Rittmon was committed to promoting recovery oriented, integrated, and culturally responsive services and systems that foster dignity, respect, and meaningful community inclusion.
Prior to her current appointment, Dr. Delphin-Rittmon was an Adjunct Associate Professor at Yale University where she served on faculty for the past 20 years. While at Yale Dr. Delphin-Rittmon served as the Director of Cultural Competence and Research Consultation with the Yale University Program for Recovery and Community 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. While at SAMHSA, she worked on a range of policy initiatives addressing behavioral health equity, workforce development, and healthcare reform.
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 systems and 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.
She 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.
Next in the series: Treatment Advocacy Center’s President and CEO Lisa Dailey
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