1 ADVANCING THE BEHAVIORAL HEALTH OF THE NATION TOGETHER Pamela S. - PowerPoint PPT Presentation

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ADVANCING THE BEHAVIORAL HEALTH OF THE NATION – TOGETHER Pamela S. Hyde, J.D. Administrator Substance Abuse and Mental Health Services Administration North Carolina’s Evidence Based Practices Center 10 th Anniversary Celebration Raleigh, NC • September 18, 2014

TODAY’S DISCUSSION 3 NATIONAL BH AND NC BH BAROMETER ACA CHANGING THE BH LANDSCAPE WORKFORCE – ACA IMPACT, CULTURAL COMPETENCY, EBPs SAMHSA’s ROLE IN LEADING CHANGE

4 BEHAVIORAL HEALTH: THE NATIONAL PICTURE

2013 NSDUH: SUBSTANCE DEPENDENCE OR ABUSE, PAST YEAR, 12 AND ↑ 5  SA/Dependence – 21.6 M (8.2 percent) • Same as 29 M (9.3 percent) with diabetes  Non-medical use of pain relievers  from 2.1 percent in 2009 to 1.7 percent in 2013  Heroin comparable to 2012 rates, But… • # of past year users almost doubled 2007 – 2013 (373K to 681K) • Past month heroin use has risen as well but at a lower rate – from a low of 119,000 in 2003 to 289,000 in 2013  Cocaine/Meth amphetamine ↓

2013: MARIJUANA AND ALCOHOL USE 6  Alcohol – most commonly used substance • 136.9 M (52.2 percent) reported past month use • 60.1 M (22.9 percent) reported binge drinking • 16.5 M (6.3 percent) reported heavy use  Marijuana – most commonly used “illicit” drug • 19.8 M (7.5 percent) past month users,  from 5.8 percent in 2007 • Daily use ↑ from low of 3.1 percent to 5.7 percent in 2013 • 2002 – 2013, use 20+ days per month ↑ from 4.8 percent to 8.1 percent

2013: FIRST SPECIFIC DRUG ASSOCIATED W/INITIATION OF ILLICIT DRUG USE, PAST YEAR, 12 AND  7

BY AGE . . . YOUTH 8  Youth aged 12 to 17: • Illicit drug use continues to fall from 2009 (10.1 percent) to 2013 (8.8 percent) • Marijuana, psychotherapeutics, inhalant, and hallucinogen use down over last several years.

BY AGE . . . YOUNG ADULTS 9  Aged 18 to 25, the news is not so good: • Illicit drug use overall, no change from 2009 (21.4 percent to 21.6 percent) • Marijuana use ↑ from 2008; flat since 2010 • Therapeutic and cocaine use ↓ • Hallucinogen use – fairly stable since 2002 • Heavy and binge drinking high or increasing

BY AGE . . . BABY BOOMERS 10  Aged 50-64 – Past month use of any illicit drug has continued to trend upward over last 10 years • 50 – 54: 3.4 percent in 2002 to 7.9 percent in 2013 • 55 – 59: 1.9 percent in 2002 to 5.7 percent in 2013 • 60 – 64: 1.1 percent in 2003 to 3.9 percent in 2013

> 20.2 MILLION AMERICANS W/ SUDs UNTREATED IN 2013 – ABOUT 90 PERCENT 11 2.9% 1.6% Didn't feel they needed Tx 95.5% Felt they needed Tx but made no effort Felt they needed Tx and made effort Individuals >12 years old

2013 NSDUH: MENTAL HEALTH PAST YEAR & RECEIVED TREATMENT 12  CAVEAT – Non-institutional, civilian populations • Not jails, prisons or juvenile justice detention centers • Not active military  Any Mental Illness: ~ 43.8 M (18.5 percent) • Represents 1 in 5 adults, as compared to 11.3 percent of adults (26.6 million) diagnosed w/heart disease • Only 44.7 percent received treatment in specialty care facility/program  Serious Mental Illness: ~10 M (4.2 percent) • Only 68.5 percent received MH services in specialty care facility/program

MH PAST YEAR AND RECEIVED TREATMENT (Cont’d) 13  Major Depressive Episode (Adolescents 12-17): ~ 2.6 M (10.7 percent) • Represents 1 in 10 adolescents • 38.1 percent received treatment • 45 percent with severe impairment received treatment • Months or years after first symptoms (compared to days or weeks after first symptoms of physical health conditions)  Suicide: 39,500 deaths in 2011; more than homicides, traffic accidents, HIV/AIDS. • Almost 1/3 have BAC level above legal limit; growing understanding of connection to other drugs • 9.3 M (3.9 percent) adults had serious thoughts ; over 2.5 M young people in grades 9 – 12 (high school age) have serious thoughts • 2.7 M adults (1.1 percent) made a plan • 1.3 M adults (0.6 percent) attempted

BH BAROMETER – SA NORTH CAROLINA, 12 AND  : 2008-2012 14  Alcohol Dependence/Abuse: Rate was lower than national rate; ~ 398,000 (5.1%)  Tx for Alcohol Dependence/Abuse: Rate was similar to national rate; ~ 35,000 (8.7%)  Illicit Drug Dependence/Abuse: Rate was similar to national rate; ~ 220,000 (2.8%)  Tx for Illicit Drug Dependence/Abuse: Rate was similar to national rate; ~24,000 (11.0%)

BH BAROMETER – MH NORTH CAROLINA, 2008-2012 15  MDE among youths: Rate was similar to national rate; ~ 55,000 youths (7.7%)  Treatment for depression among youths w/MDE: Rate was similar to national rate; ~ 20,000 youths (36.0%)  Adults w/suicidal thoughts: Percentage was similar to national percentage; ~ 237,000 adults (3.4%)  SMI among adults: Rate was similar to national rate; ~ 222,000 adults (3.2%)  MH treatment among adults w/AMI: Rate was similar to national rate; 532,000 adults w/AMI (45.8%)

HEALTH REFORM: A CHANGING HEALTH CARE ENVIRONMENT 16  Prevention and wellness rather than illness – a public health approach • National Prevention Strategy (5 of 7 strategies are about BH)  Recovery rather than chronicity or disability  Integration rather than silo’d care; changes where and who provides treatment • Workforce issue – not just BH and not just primary care  Access to coverage and care rather than significant parts of America uninsured – (Parity issue)

CHANGING ENVIRONENT (Cont’d) 17  Quality rather than quantity; cost control through better care rather than more care (EBPs that produce results) • National Quality Strategy (AHRQ) • National Behavioral Health Quality Framework (SAMHSA)  Role of states increasing; state choices impacting care and outcomes • Participation in duals demos, Medicaid expansion, Medicaid state plan coverage • Exchanges, EHB benchmark plans for parity, MHPAEA enforcement

ACA ACCOMPLISHMENTS SO FAR www.HHS.gov/HealthCare 6 18  > 8 M Americans selected plans in state/federal Marketplaces; 7.3 M paid premiums (357,584 in NC; > 90 percent eligible for subsidies)  7.2 M enrolled in Medicaid or Children’s Health Insurance Program (65,833 in NC; 377,000 IF NC EXPANDED MEDICAID)  7.8 M young adults (to age 26) able to stay on a parent’s health plan (3 M since ACA; 95,000 young adults in NC)  62.5 M eligible for increased or first time BH coverage ( 1.9 M in NC )  8.2 M Medicare beneficiaries rec’d > $11.5 B drug rebates & discounts ($359,091,609 for NC; in 2013, 148,288 NC saved $896 per person; in 2014, 53 percent discount on covered brand name and 28 percent on generic drugs)

ACA ACCOMPLISHMENTS (CONT’D) 19  76 M privately insured gained improved preventive services coverage (2,266,000 in NC; 917,000 women) • Includes screening for depression, behavioral disorders among youth  105 M Americans had lifetime limits removed from insurance (3,091,000 in NC)  All enroll without consideration of pre-existing conditions (4,099,922 non-elderly NC w/ pre-existing conditions; 539,092 children)  Lowest rate ↑s in health/insurance cost in decades (e.g., 80/20 rule alone – 182,517 in NC rec’d $8,488,477 in refunds, averaging $77/family)  Lowest rate of uninsured – 11.5 percent nationally  Number of available plans significantly increased

NEXT OPEN ENROLLMENT: KEY DATES FOR THE HEALTH INSURANCE MARKETPLACE 20  November 15, 2014: Open Enrollment begins – apply for, keep, or change coverage  December 15, 2014: Enroll by the 15 for new coverage that begins on January 1, 2015  December 31, 2014: Coverage ends for 2014 plans; coverage for 2015 plans can start as soon as January 1  February 15, 2015: This is the last day to apply for 2015 coverage before the end of Open Enrollment Coverage to Care Initiative Spring to Fall 2014 www.healthcare.gov and www.cuidadodesalud.gov

PREVALENCE OF BH CONDITIONS AMONG UNINSURED ADULTS AGES 18-34 WITH INCOMES <400% FPL 21 44.0% SMI/ 56.0% SPD/ SUD “Behavioral Health Conditions ” includes serious mental illness (SMI), serious psychological distress (SPD) and substance abuse disorders (SUD) Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013, http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-Conditions-Among- the-Uninsured/PEP13-BHPREV-ACA

PREVALENCE OF BH CONDITIONS AMONG UNINSURED ADULTS AGES 35 AND OVER WITH INCOMES <400% FPL 22 23.8%SMI/ SPD/ SUD 76.2% “Behavioral Health Conditions” includes serious mental illness (SMI), serious psychological distress (SPD) and substance abuse disorders (SUD) Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013, http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-Conditions-Among- the-Uninsured/PEP13-BHPREV-ACA

NC: PREVALENCE OF BH CONDITIONS AMONG Marketplace POPULATION 23 CI = Confidence Interval Sources: 2008 - 2010 National Survey on Drug Use and Health (Revised March 2012) 2010 American Community Survey Source: National and State Estimates of the Prevalence of Behavioral Health Conditions Among the Uninsured, 2013, North Carolina Profile, http://store.samhsa.gov/product/National-and-State-Estimates-of-the-Prevalence-of-Behavioral-Health-C onditions-Among-the-Uninsured/PEP13- BHPREV-ACA