National Indian Health Board
The Substance Abuse and Mental Health Services Administration (SAMSHA) Listening Session yesteday morning at the National Indian Health Board (NIHB) National Tribal Health Conference (NTHC), held virtually, provided an opportunity for tribal leaders to meet with Dr. Miriam E. Delphin-Rittmon the Substance Abuse and Mental Health Services Administration Assistant Secretary for Mental Health and Substance Use. Tribal leaders discussed mental health and substance abuse service needs in tribal nations. Dr. Delphin-Rittmon, began with updates and data that will be included in the upcoming 2020 report. “Our data shows that American Indian/Alaska Natives 10% of those 18yo and older have substance use disorder. Alcohol use disorder in the American Indian/Alaska Native population is slightly increased for ages 18-25. Among the American Indian/Alaska Native population aged 12-17, opioid misuse and prescription pain reliever misuse has increased slightly from 2018 but is decreased in all other ages.”
Dr. Delphin-Rittmon continued by sharing the Tribal Behavioral Health Agenda, that includes six cross-cutting components: Youth, Culture, Identity, Individual Self-Sufficiency, Data, and Tribal Leadership. He also mentioned the “Tribal Only” grants: Native Connections — Circles of Care (COC) — Tribal Opioid Response (TOR) and several discretionary grants available to tribes, Tribal organizations, and Urban Indian Health Organizations. COVID-19 related funding such as the CARES, FY 20 with $15 million to address tribal needs related to COVID-19, the Consolidated Appropriations Act, 2021 with $125 million set-aside to address tribal needs related to COVID-19, the American Rescue Plan (ARP) Act of 2021, Substance Abuse and Mental Health Services Administration receiving $3.56 billion, and the Project Aware grant at $24 million which has been disseminated for tribal communities. Substance Abuse and Mental Health Services Administration has a tribal training and technical assistance center and national American Indian/Alaska Native technology transfer center that provide assistance to tribal grantees.
Questions about short- and long-term effects of COVID were heard from tribal leaders. Mental health has been a constant topic during this year’s National Tribal Health Conference with many inquiring about support services and what resources will be available for those experiencing mental or behavioral health impacts from COVID-19 currently and continuing through the pandemic. Leadership also wanted to know if research is being done on the connection to COVID and suicide. Dr. Delphin-Rittmon explained the Center for Disease Control and Prevention (CDC) has reported some increases in suicide and the National Survey on Drug Use and Health should be offering additional information soon including more information about patterns and trends. There are Certified Community Behavioral Health Clinics available across country offering integrated care and links to primary care.
As the discussion continued, tribal leaders expressed concerns. Nick Lewis- Lummi Nation, Vice Chairman National Indian Health Board, Chairman Portland Area Indian Health Board, Substance Abuse and Mental Health Services Administration Tribal Technical Advisory Group representative said, “The competitive grant process pits tribes against each other as they try and secure funding. Further, tribes often must compete against more established entities for significant federal dollars. As a result, we often lose out on those opportunities. We believe that tribes should not have to compete against one another for funding. The competition for funding to address behavioral health needs goes against the trust responsibility.”
Kimberly Beniquez, Public Health Advisor at Substance Abuse and Mental Health Services Administration said they are, “looking at what sister-agencies require for grant applications. What leverage to make, changes in areas. We have started to work more with grantees on small scale- working on core programs to train new staff and hope to broaden to all discretionary and tribal only grants.”
National Tribal Health Conference attendees heard from Sam Moose, National Indian Health Board Treasurer, who made the following recommendations:
- Tribes be exempt from Government Performance and Results Act reporting requirements, so more resources could go directly to services instead of being redirected to culturally oppressive data collection, data entry, and data reporting. Substance Abuse and Mental Health Services Administration should work with tribes to establish meaningful reporting requirements.
- U. S. Department of Health and Human Services agencies, including Substance Abuse and Mental Health Services Administration, align reporting and improve consistency across measures with Health Resources and Services Administration and Indian Health Service Government Performance and Results Act reporting measures to reduce question burden on providers, clients, and patients.
- Substance Abuse and Mental Health Services Administration maintain the ability to collect Government Performance and Results Act data via telephone and other electronic means (e.g., web-based surveys). These questionnaire completion modalities have created easier means for patients and clients to provide information, boosting response rates, and likely improving data reliability overall.
Aaron Payment Chairman Sault Ste. Marie Tribe of Chippewa Indian highlighted the extent to which American Indian/Alaska Natives have been impacted by the opioid epidemic. A national study reported that American Indian/Alaska Natives experienced the highest prescription opioid death rate of any demographic in 2017. He recommended:
- Increase access to residential youth transitional systems.
- Blend behavioral health healing methods with promising traditional practices.
- Substance Abuse and Mental Health Services Administration’s Substance Abuse Prevention and Treatment Block Grant (SABG).be opened for more tribal participation.
- Create templates for implementation.
- Clarity and flexibility on how opioid response implementation grants can be used.
- Set aside funding when possible.
- Restructure program to be formula based.
Before ending the listening session National Indian Health Board Chairman William “Bill" Smith had two requests concerning mental health-suicide prevention:
- Substance Abuse and Mental Health Services Administration sound continue its support to for the American Indian/Alaska Native Suicide Prevention Initiative. Tribes have requested that current funding get tripled (from $5M to $15M) for FY23 due to the tremendous need. Also, continue to expand tribal access to the Garrett Lee Smith suicide prevention grant program.
- Further, Substance Abuse and Mental Health Services Administration should do everything possible to allow tribes to access the Community Mental Health Services Block Grant, which provide billions of dollars each year to states and territories. Can the agency provide any information on what needs to happen to allow tribes access?
Concluding, Dr. Delphin-Rittmon reiterated the Substance Abuse and Mental Health Services Administration is looking at many funding mechanisms and are working on an initiative around a suicide prevention, initiative (9-8-8) will launch in July 2022 as a nationwide effort to increase access to service.
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