SAMHSA has let us down—Part Two

This agency discovers public relations and “social marketing”

We're commenting on the way SAMHSA- the US Substance Abuse and Mental Health Services Administration in Washington--has set out to spend our money. This is put forth in a strategy statement on its website that shows you some of the political and pro-business sides of the agency. To continue with my remarks from Part One, we pick up with item four on their list of key strategies.

4.Health care reform—by which it means “broaden health coverage to increase access to appropriate high quality care and to reduce disparities that exist.” Well, we can agree with that. This is simply jumping on the bandwagon—we already have a nationwide health care reform law and we have a federal health insurance parity law that the administration takes credit for. This item rehashes the added health care measures and opportunities afforded the public under the health care reform act and protections gained under the parity bill. However, as we see, this is a work in progress. Some of the reform act's provisions don't come into place until 2014.

5.Housing and homelessness—SAMHSA wants to “provide housing and reduce barriers to accessing effective programs that sustain recovery for individuals with mental and substance use disorders.” Yes, but it also says homelessness can be prevented and that's stretching the agency's credibility. It calls for affordable housing and rent assistance to low income families and rapid re-housing of individuals who become homeless. This would be done by collaboration with state, federal and local governments and business. That may be so, but in this economic climate in NY State, housing for the mentally ill is not being built and the ranks of the homeless must be growing with home foreclosures and family bankruptcies. The agency really has little to do with housing the homeless in New York or elsewhere.

6.Health information technology, electronic health records and behavioral health—SAMHSA puts a lot of stock in this, a boon to computer and data processing companies and an additional layer of trained workers in hospitals and offices. It wants to “ensure the behavioral health provider network, including prevention specialists and consumer providers, fully participate with the general health care delivery system in the adoption of health information technology (HIT).” In my opinion we should avoid what has become a mindless spread of electronic medical records in hospitals, clinics and anywhere else.

The new record keeping systems are extremely costly and don't really benefit the patient. We shouldn't want detailed medical records kept on us over a lifetime by impersonal agencies. Their purpose, as related to me by nurses at Ellis Hospital, is to protect doctors, the hospital and insurance companies from liability for poor medical practices and other sources of lawsuits. Electronic medical records don't help you get better any faster or reduce your chances of getting sick. Confidentiality rules still get in the way when the records have to be shared and the computer systems used by the different agencies, hospitals and professionals are sometimes incompatible. Nurses and therapists tell us the extra record keeping is a time-taking nuisance that keeps them from providing bedside care, which they prefer to do.

7.Data, outcomes and quality; demonstrating results—SAMHSA wants an “integrated data strategy” that “informs policy, measures program impact, and results in improved quality of services and outcomes.” This appears to be an add-on for private company managements. We don't need it. It would tell management people what they already want to see. It pays off the data processing industry, the same as for electronic medical records. While I may sound cynical, this is another example of how a government agency in Washington and big business feed off one another, spending our tax money. The agency is also retreating from its mission to seek better treatment for patients through direct care and better medicines and therapies--the old fashioned way.

8. Public awareness and support—this is the worst of SAMHSA's proclamations, in my view. It calls for “social marketing” to see that people buy into the latest goals and strategies of the agency—such as touting recovery of seriously mentally ill people, shifting costs, shifting the record keeping burden and involving private business more in mental health care. It's like the advertising and marketing department. “There will be a target audience,” the agency states, “to voluntarily accept, reject, modify or abandon a behavior for the benefit of individuals, groups or society as a whole.” This is more than public relations. It's a devious way to self-promote and work hand in glove with private business to persuade people to buy into what they are doing, for better or worse, I believe. (Roy Neville)