SAMHSA, Behavioral Health and the National HIV/AIDS Strategy (Part I)

As the recently appointed Federal inter-agency liaison for HIV/AIDS at the Substance Abuse and Mental Health Services Administration (SAMHSA), I am pleased to join the discussion here on the HIV.gov blog about how the National HIV/AIDS Strategy (NHAS) is being implemented across the Federal government. In support of the NHAS, SAMHSA is engaged in a variety of activities that address the behavioral health needs of people at high risk for or living with HIV/AIDS as well as efforts to improve coordination across the government and with State, Tribal and community partners. In this post, I’ll highlight just a few of these activities but I’ll be blogging again soon with more information about other NHAS-related activities underway at SAMHSA.

Behavioral Health and HIV/AIDS

As part of the U.S. Department of Health and Human Services (HHS), SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. SAMHSA’s new strategic plan, “Leading Change: A Plan for SAMHSA’s Roles and Actions 2011-2014,” aims to improve the Nation’s behavioral health, transform health care in America, and achieve excellence in operations. Strategic Initiative 5, Health Reform, specifically addresses the behavioral health problems of people at highest risk for or living with HIV/AIDS and emphasizes SAMHSA’s commitment to implementing the NHAS. In fiscal year 2011 and beyond, SAMHSA remains committed to addressing the behavioral health problems that can put individuals at greater risk for HIV infection or that co-occur with HIV infection and can hinder access to treatment and maintenance in care.

The phrase “behavioral health problems” refers to substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicidal ideation, and mental and substance use disorders. Behavioral health can also refer to emotional health and the choices/actions that affect wellness.

Substance Abuse Prevention and Treatment Block Grant HIV Set-Aside

SAMHSA administers the Substance Abuse Prevention and Treatment Block Grant (SABG), which provides approximately $1.8 billion in resources to States. Since 1993, Congress has authorized a set-aside of 5 percent of these block grant funds for early HIV intervention services in “designated States.” As currently defined in the legislation, a designated State is one with a case rate of 10 persons living with AIDS for every 100,000 people. In FY 2010, 19 States used set-aside dollars for early intervention services including: HIV risk assessment, pre-test counseling, HIV testing, post-test counseling, referrals for treatment, and testing for other infectious diseases (such as Hepatitis C).

As part of HHS-wide efforts to intensify HIV prevention in communities where HIV is most heavily concentrated, SAMHSA is working with the HHS Assistant Secretary for Health, the Assistant Secretary for Legislation, and Office of the General Counsel to develop a strategy for updating the funding criteria that allow States to use SABG funds for HIV/AIDS services. These resources represent a significant portion of SAMHSA’s “HIV/AIDS budget.” As such, we want to ensure that the provisions governing their use are consistent with the current epidemic and support States in using evidence-based prevention interventions for people at risk for or living with HIV/AIDS who have mental and/or substance use disorders

12 Cities Project

SAMHSA also is actively involved in supporting the HHS 12 Cities Project in these 12 jurisdictions to support this project. We are also working to engage the Single State Authorities (i.e., the State agency responsible for distributing the SABG funds for services and treatment for mental and substance use disorders), and SAMHSA grantees to support this project in each of the states where the 12 cities are located. As the project continues in the months ahead, SAMHSA will explore the feasibility of developing a treatment-on-demand referral network of substance abuse treatment providers who can collaborate with local HRSA and CDC grantees in some or all of the 12 jurisdictions.

In my next blog post, I will provide information on SAMHSA’s proposed activities in the FY 2012 Congressional Justification as well as discuss more about how SAMHSA is working to achieve the goals of the NHAS. You can read more about SAMHSA’s NHAS implementation activities in the HHS NHAS Operational Plan.