Reports

The Central East Addiction Technology Transfer Center (CE-ATTC), funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and operated by The Danya Institute, partnered with The College for Behavioral Health Leadership (CBHL) to develop a report describing and defining Equity Grounded Leadership for use by behavioral health leaders in Health and Human Services Region 3 states. This report builds on the Institute’s ongoing efforts to improve diversity, increase cultural competency, and address population-specific needs of people receiving and delivering behavioral health services in Region 3.

While developed based on the experiences of Region 3 leaders, the recommendations are applicable to leaders across the country.

CBHL partnered with Just Health Collective and the Prevention Institute to develop this report. The purpose is to define and describe equity-grounded leadership, incorporating the experiences and perspectives of Region 3 behavioral health leaders via a survey, key informant interviews, and focus groups; make the case for the importance of focusing on equity as an foundational element of leadership; and offer recommendations for local, state, and national leaders and policy makers.

This publication was prepared for the Central East Addiction Technology Transfer Center (CE-ATTC) under a cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this publication, except that taken directly from copyrighted sources, is in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. Do not reproduce or distribute this publication for a fee without specific, written authorization from the CE-ATTC. At the time of this publication, Miriam E. Delphin-Rittmon, PhD, served as Assistant Secretary of Mental Health Services and Substance Use and the Administrator of SAMHSA. The opinions expressed herein are the view of CE-ATTC and the authors and do not reflect the official position of the Department of Health and Human Services (HHS), SAMHSA. No official support or endorsement of HHS, SAMHSA for the opinions described in this document is intended or should be inferred.

As communities are preparing for the 988 launch nationwide, work is prioritized at the local and state levels for the effective coordination of crisis response services. In partnership with national experts in behavioral health, each Think Bigger Do Good paper is focused on the challenge, and provides clear, actionable solutions to our audience. This paper offers resources and serves as a tool for communities to use in developing and enhancing call centers, mobile teams, and crisis care facilities to create better outcomes for people in crises.

Across the nation, communities of color have experienced enduring health disparities due to systemic racism, which have been exacerbated by disproportionate physical, social, and economic impacts from the COVID-19 pandemic.

State Medicaid and public health programs — working within their own agencies and collaboratively — have great potential to advance health equity for the communities they serve, especially for people of color. Given Medicaid’s role in delivering care to individuals with low incomes, including many from communities of color, the program is uniquely situated to address health disparities.2 Public health agencies are responsible for improving population health for their communities, with a particular focus on addressing social determinants of health and advancing equity.

With support from the Robert Wood Johnson Foundation, the Center for Health Care Strategies (CHCS) and the Association of State and Territorial Health Officials (ASTHO) led a national scan to identify health equity priorities that state agencies can advance in the next two years — especially those shared across agencies. The exploration also sought opportunities to center community voices as part of these efforts. Activities included a literature review and more than 20 interviews with representatives from
state Medicaid agencies, public health departments, Offices of Health Equity, member advocacy groups, community-based organizations, and health equity experts. Drawing from this national analysis, this brief summarizes opportunities to advance health equity in three areas:

1. Advancing internal-facing health equity work;
2. Leveraging data to drive health equity efforts; and
3. Engaging community members authentically

CFOs are building the financial framework for achieving health equity.

A Unified Vision for Transforming Mental Health and Substance Use Care  calls for policy, programs and standards that prioritize mental health care and address the social and economic conditions – including racism and discrimination – that disproportionately impact people of color and people whose incomes are below the federal poverty threshold, and result in inadequate and inequitable access to effective, humane treatment.

“The importance of aligning agendas and working together across sectors cannot be understated if we are to make real changes to our mental health and substance use care system. The systemic transformation we are embarking on will take a new kind of leader – prepared to innovate, transform and lead us into the future.  CBHL is pleased to support the Unified Vision and stand ready to take the important steps in actualizing it.” – Holly Salazar, CEO, The College for Behavioral Health leadership

A collaboration of mental health and substance use disorder organizations – the American Psychiatric Association, the American Psychological  Association, the Massachusetts Association for Mental Health, Meadows Mental Health Policy Institute, Mental Health America, the National Association for Behavioral Healthcare, the National Alliance on Mental Illness, the National Council for Behavioral Health, One Mind, Peg’s Foundation, the Steinberg Institute, The Kennedy Forum, the Treatment Advocacy Center and Well Being Trust – developed the roadmap as a response to the pandemic, which has greatly exacerbated the fault lines in an already fractured mental health system and heightened mental health issues across our nation – including anxiety, depression, isolation, addiction, domestic abuse, and suicide.

Just as the public health care system was unprepared for a pandemic, an unprecedented mental health crisis afflicting half of all Americans has overwhelmed the mental health care system. Since the onset of the pandemic, prevalence of depression symptoms have jumped three-fold, overdose deaths have increased in 40 states, and the CDC reports that 25 percent of young adults struggle with suicidal ideation.

The strategic plan offers tried-and-tested “pathways for success” across seven critical policy areas identified as:

1. Early identification and prevention, especially for families and young people;
2. Rapid deployment of emergency crisis response and suicide prevention;
3. Leveling inequities in access to care;
4. Establishing integrated health and mental health care to ensure “whole-person” well-being;
5. Achieving parity in payment by health plans for mental health and substance-use coverage;
6. Assuring evidence-based standards of treatments and care; and,
7. Engaging a diverse mental health care workforce, peer support and community-based programs.

Included in the vision is a detailed proposal for how the new Administration, Congress, Governors and state and local lawmakers must work in tandem with the business community and the non-profit sector to promote systemic changes in the mental health care system.

Among the seven suggestions are a number of ideas that can be implemented quickly, such as, embracing telehealth, and implementing strategic shifts to early intervention that can help provide relief by bringing telehealth outside of a clinical setting – and into schools, community centers, prisons; fast-tracking new emergency response systems, such as the new “988” National Suicide Prevention Lifeline, for immediate access on mobile carriers; and, engaging a diverse mental health care workforce, providing additional support means by expanding access to peer support groups and community based programs.