Kana Enomoto, Acting Administrator of SAMHSA

Kana Enomoto – SAMHSA

Mark Masselli: This is Conversations on Health Care , I’m Mark Masselli.

Margaret Flinter: And I’m Margaret Flinter.

Mark Masselli: Well Margaret quite a powerful announcement from The White House
President Obama announced plan s to tackle America’s gun violence epidemic.

Margaret Flinter: And the President was flanked by a number of parents who lost
children to the Sandy Hook massacre, roughly 33,000 Americans killed by guns every
year. And as the president said, we can no long er accept this as the status quo .

Mark Masselli: Statistics show that when guns are present in the home, the likelihood of
injury or death goes up significantly. For instance in domestic violence situations
people are 12 times more likely to be killed if there is a gun in the home, it debunks the
notion of keeping a gun for protection in fact the data shows quite the opposite.

Margaret Flinter: Well the President is seeking primarily to make background checks a
mandatory aspect of all gun purchasers. An d he also wants to increase the FBI’s roster
of personnel who carry out these background checks, really trying to make the process
more streamlined and more efficient.

Mark Masselli: Many of the nation’s gun deaths are actually accidental and all too ofte n
these gun incidents involve children. It's an avoidable tragedy that needs to be
addressed.

Margaret Flinter: And I note that President also touched on the need to enhance the
nation’s behavioral health system, suicides account for two - thirds of the na tion’s annual
gun deaths and we know from statistics again when there is a gun in the house a
person is far more likely to carry through with suicide, also a clear factor behind cases
such as the Sandy Hook massacre. So we are pleased to hear the Presiden t promising
more resources for behavior al health services and that is something our guest today is
very knowledgeable about.

Mark Masselli: Kana Enomoto is the acting administrator of SAMHSA, the Substance
Abuse and Mental Health Service Administration wh ich is responsible for improving
access to care for those most in need of mental health and addiction services.

Margaret Flinter: And Lori Robertson will check in, the managing editor of
FactCheck.org, she is always on the hunt for misstatements spoken ab out health policy
in the public domain. And no matter what the topic, you can hear all of our shows by
going to chcradio.com.

Mark Masselli: And as always if you have comments, please email us at
[email protected] or find us on Facebook or Twitter; we love hearing from you.

Kana Enomoto – SAMHSA

Margaret Flinter: We will get to our interview with Kana Enomoto in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

(Music)

Mariann e O'Hare: I'm Marianne O'Hare with these health care headlines. The
President’s proposal to increase restrictions on gun purchases to those who can pass a
background check as drawn as expected ire from gun right supporters. Republicans
such as House Speaker Paul Ryan calling the measure overreach but the President
said that 33,000 annual gun deaths in America must be addressed and Americans
apparently agree, 70% of those polls felt stricter gun la ws were a necessary route to
curbing gun violence and the President was justified in overriding congress with an
executive action on the matter.

Public health officials have been marking for some time the effect of overuse of
antibiotics, now there is conc ern about overuse of CT scans, 85 million of which occur in
a given year, and experts warn there is a real risk of overexposure to radiation from so
much testing. CT scans use ionizing radiation which can damage DNA and cause
cancer. The FDA reports an e stimated 30% to 50% of imaging tests are believed to be
medically unnecessary.

Kids and nutrition, thanks to a law passed in 2012 kids are getting more nutrition out of
their school lunches. The Health y Hunger - Free Act mandated more whole grains, fruits
a nd vegetables in school lunches as well as a reduction of fat and calories, tracking
school meals across a number of schools in Washington State the study showed before
the law passed the meals had about 58% of the six essential nutrients required for a
ba lanced meal, within a year after the law went into effect, that percentage jumped to
almost 80%.

And more attention is being paid to the importance to the brain gut connection and
when it comes to the difficult to treat irritable bowel syndromes psychother apy may have
a lasting impact. In a recently published study spanning 41 clinical trials those suffering
from irritable bowel syndrome who received psychotherapy showed a marked
improvement in holding symptoms at bay about 75% improved and the effects las ted for
up to a year after therapy ended. Those in the control groups who did not receive
psychotherapy fared worse in their prevalence of IBS symptoms. I am Marianne O'Hare
with these health care headlines.

(Music)

Kana Enomoto – SAMHSA

Mark Masselli: We are speaking today with Kana Enomoto, acting administrator of the
Substance Abuse and Mental Health Service Administration an agency within the
Department of Health and Human Services which seeks to advance the behavioral
health of the nation. Previously Ms. Enomoto served as both deputy administrator as
well as the director of the Office of Policy, Planning and Innovation at SAMHSA. She
earned her master ’ s in clinical psychology from UCLA and is a graduate of the Senior
Managers in Government Program at Harvard ’s Kennedy S chool. Administrator
Enomoto, welcome to Conversations on Health Care .

Kana Enomoto: Thank you so much Mark and Margaret.

Mark Masselli: You know it's estimated that 1 in 4 Americans will experience some form
of mental illness, and most of whom receive little or no care but SAMHSA has really
played a key role in addressing mental health and addiction issues. And you are not
alone in this, wonder if you could talk to our listeners about the role SAMHSA is playing
in this arena and how SAMHSA is focused o n helping to fill the mental health gap in the
American health care system.

Kana Enomoto: Sure . So SAMHSA is an operating division of the Department of
Health and Human Services so we are sister agency to CDC, FDA, NIH and we work
across the department t o help l ead on behavioral health issues. And so the secretary
has tasked us with making sure that all of HHS’ investments in this area are aligned and
focused on providing impact for the American people but SAMHSA has a number of
roles that people don’t know about.

We provide leadership invoice on behavioral health issues both within the HHS across
the administration but also for the nation. So we do a lot of surveillance, we fund the
largest household survey in the country in drug use and health and we do a great deal
of other data work through our statistical unit. We support public awareness activities to
support prevention treatment and recovery with right now a great campaign that you will
see in bus stations and airports and all over called, “ Talk . They Hear You .” which is
encouraging parents to talk to their children about underage drinking because we know
that parents make the biggest difference in their kids’ lives.

We also do practice improvements for folks who are already in the field and we do
standard setting in a number of areas workplace drug testing is an important one,
medication assisted treatment as well as privacy protections for people in treatment for
substance use disorders in particular. We are really thrilled that the nation is sh owing
so much interest in these issues. We think we are positioned really well to make an
impact for the nation.

Margaret Flinter: Well I was thinking as you spoke that virtually everything you said is
front page news across the country in terms of issue s of paramount concern to

Kana Enomoto – SAMHSA

Americans right now. And I want to talk a little bit about the mental health side of the
work that you are doing, we had couple of years ahead congressman Patrick Kennedy
on our show and he was stressing the importance of the men tal health parity laws.
Now, we still find something of a chasm between the patients who are within sometimes
fragmented health care system and getting access to the behavioral health care that
they need, maybe you could describe how the enhancement of Th e Mental Health
Parity Act has or hasn’t addressed that challenge.

Kana Enomoto: Right. Under ACA and Mental Health Parity and Addiction Equity Act
about 62 million people have increased access or coverage at parity to insurance
coverage for behavioral h ealth services. So we are thrilled at that potential but you are
absolutely right, it is potential and we have to make sure insurers and purchasers have
the facts so they know what parity really means for them and you know health insurance
and coverage ar e complicated and so many people have difficulty understanding the
benefits to which they are entitled and it's really important for people who think they
might not be getting coverage that they deserve under parity to contact the state health
insurance co mmissioners or The Department of Labor which, for us at SAMHSA we
have been very very invested in parity implementation and doing everything we can to
make sure that that’s happening.

We have met with stakeholders pretty recently from outside organizations as well as
other federal agencies to get feedback on what needs to get done, where the gaps are,
and we are continually engaging with our stakeholders for opportunities to support
implementation of parity protections. We know that in some states, states attorney
generals and insurance commissioners are getting together to have these
conversations because it is largely going to be a state issue at the point of enforcement
but clearly to the degree we can facilitate people having the right information upfro nt we
want to do that.

Mark Masselli: You know Kana I know that President and the secretary have great faith
in SAMHSA and certainly have, wanted to give additional resources, I don’t know how
you ended up in the final budget reconciliation, but I think o ur listeners would be
interested in that. And then you know there are four key areas that your organization is
addressing strengthening the crisis system, combating opioid abuse and building a
stronger behavioral health workforce and increase attention on tribal health issue. So
could you start off talking about this first initiative strengthening the crisis system and
the initiatives that SAMHSA has underway ?

Kana Enomoto: Well I have to say we are plus $160 million last time that I checked for
the Omni bus.

Mark Masselli: Yee - haw.

Kana Enomoto – SAMHSA

Kana Enomoto: We are just bursting with attitudes to our colleagues on the hill for
seeing the need to invest strongly in mental health and substance abuse. On the crisis
front you know it's in the headlines all too frequent ly people having psychiatric
emergencies, people overdosing, people getting boarded in hospital emergency rooms.
We know that no one is doing it on purpose but in fact we need to help the multiple
systems who deal with people experiencing a behavioral hea lth crisis to coordinate and
collaborate and communicate with one another whether that’s law enforcement, whether
that’s emergency care, whether that’s the mental health department. It's very easy for
folks to fall through the cracks.

And we have seen som e communities that have designed crisis systems that are more
seamless and have better idea sharing and collaboration so that they can stabilize
individuals in psychological distress, engage them in the most appropriate course of
treatment whether that’s i n - patient or out - patient. And then get people to be supported
in their own communities with the right continuous services, through that not only can
we deescalate the immediate crisis but prevent future crisis down the line.

Margaret Flinter: Well Kana l et me take a look down at the next issue, the issue of
opioid addiction, 250 million opioid prescriptions prescribed by medical professional in
the past decade alone, a 150,000 deaths from overdoses, maybe you could just tell us
everything in a nutshell th at you are doing to target the issue of opioid addiction and
overdoses at SAMHSA.

Kana Enomoto: Well so FY 2016 budget has great news for us. So we already have I
think 12 states with targeted capacity expansion for prescription drug overdose and
addicti on treatment. We are going to be adding to that list of states. This year we are
trying to get funds to the states with the highest rates of in - patient admissions and
overdose. We are also seeing money been added to the block grants and SAMHSA
has sent out Dear Commissioner letters or Dear SSA letters to let folks know that they
can use their funds for medication assisted treatment for example. We also have new
money for Naloxone distribution and public education for first responders .

Margaret Flinter: Great.

Kana Enomoto: As well as, and we are very thrilled to see this, Strategic Prevention
Framework Rx because to increase awareness of the potential for opioid misuse, abuse
and dependence. So we are trying to tackle this issue at every point of the continuum
both from, all the way from primary prevention to recovery supports over this fatality
prevention. So this is a huge issue, more people dying from this than from diabetes for
example and I think Americans are really waking up to it and SAMHSA is part of the
secretary’s opioid imitative.

Kana Enomoto – SAMHSA

Mark Masselli: We are speaking today with Kana Enomoto acting administrator of the
Substance Abuse and Mental Health Service Administration which seeks to advance
the behavioral health of the nation. Ms. Enomoto served as both deputy administrator
as well as the director of the Office of Policy, Planning and Innovation at SAMHSA as
well you know innovation has been something that we have tried to highlight here on the
show, and you served in the innovation role a t SAMHSA and maybe talk to our listeners
about the kinds of innovation in care delivery and treatment options that you see on the
horizon.

Kana Enomoto: One of the things that we are excited about are these collaborative
practices models. So in addition to telehealth which we know is a good thing, there are
also technological requirements for that and legal issues around that when we have you
know a specialty provider in one city if they are doing telehealth they can reach people
in other places but they can only reach as many people as that they can reach as a
person and with some of these collaborative practice models like Project ECHO where
we can have the specialist providing mentorship and instruction to the non - specialist
and we think we can expand r each of the kind of quality of care that we need to
exponentially and we are very excited about looking at that as an expansion to
behavioral health both for cutting edge interventions as well as some very traditional
evidence based interventions which sti ll haven’t gotten the reach that they need.

Margaret Flinter: Kana as we look at the unmet needs in behavioral health we always
end up asking the question about workforce. I know that 2016 SAMHSA budget had
outlined some specific goals for the behavioral health workforce making training more
accessible, maybe more affordable and making sure that the content of training and
also the clinical practical experience is being revised to reflect current needs, what's the
role of SAMHSA relative to these efforts?

Kana Enomoto: You know we have in recent years invested pretty significantly in
behavioral health workforce and HRSA is also investing to the National Health Service
Corps where about one - third of the providers are from the behavioral health specialty.
So I think HHS recognizes the need that behavioral health is certainly a growth area
and a shortage set of specialties. I think in the new Omnibus it looks like there is an
additional $15 million for behavioral health workforce that is, to include both ou r minority
fellows as well as masters level, social worker, psychologist, counselors, MSTs and
paraprofessionals .

So I think that’s a great asset to the field that we can look forward to expanding our
capacity especially as our professionals are looking ag reeing as a behavioral workforce
as well as, and as we move into more integrated health systems it's going to be
important to build behavioral health capacity among and we had this conversation I
think at the, when we are on the panel but what I call allie d health professionals is,

Kana Enomoto – SAMHSA

includes doctors, nurses and everyone who is not a behavioral health specialist you
know you are allies and so we need to leverage all of those who are engaged in primary
care as well as specialty care because we know behavioral health issues have
implications across the board.

Margaret Flinter: Absolutely.

Mark Masselli: Well engaging everyone in primary care certainly from the community
health center world we know you worked well with community health center model and
where re ally behavioral health and dental were closely integrated you know this whole
concept that you have behavioralist along side with the primary care provider and I
know SAMHSA has been working on bringing primary care to some of the behavioral
health groups and talk to our listeners more about the types of models, there is a whole
notion that primary care should be integrated and behavioralist s should be somebody
that kids see as much as they see a pediatrician, it's part of someone’s daily lif e, it's not
an exception.

Kana Enomoto: Absolutely. I mean that is sort of fundamental to SAMHSA’s vision is
that behavioral health is essential to health and behavioral health should be part of
people’s health care from early childhood up into being a s enior citizen. We need to
embed the understanding of mental health and substance issues for all of our primary
care partners as well as specialty care because as we know the management of
conditions like diabetes and breast cancer and hypertension are all affected by an
individual’s mental health whether they have you know they are symptomatic and that
has an impact in their ability to adhere to whatever treatment protocols they have.

We have a couple of initiatives in the space primary behavioral health c are and
aggression program where we are bringing primary care into specialty mental health
services because we know people with mental illnesses are very vulnerable to other
chronic health conditions and so there are different studies show that people with
schizophrenia may die up to 28 years earlier. And on the other side we are just
awarded 24 grants to states who applied for planning grants for the demonstration
program for certified community behavioral clinics, also known as the Excellence Act
and tha t gives an opportunity to community behavioral health centers to get reimbursed
in the same ways as community health centers and other opportunity for collaboration
and connections.

Margaret Flinter: Well Kana we know that one thing that has been a big pr oblem over
the years and return to treatment often has been stigma or the fear of stigma and I
would like to give you an opportunity to talk about a new effort that you have launched,
the Science of Changing Social Norms which I think has as an end goal re ducing
stigma. Tell us about that.

Kana Enomoto – SAMHSA

Kana Enomoto: This is a project that we have designed to examine effective strategies
for not only increasing public awareness but as it says changing social norms because
people have negative perceptions in attitudes a bout mental illness and substance use
problems. And they also don’t necessarily see as we just talked about, see as
behavioral health as a health priority or as a public health priority. And so you know
raising public awareness is a first step, reducing negative attitudes is a second step but
then we need to get people over the finish line to sort of changing their values that, such
that if you have a child that’s depressed or anxious you treat it as seriously as if your
child has a fever or an injury.

We don’t necessarily have that approach right now for behavioral health conditions and
I don’t think it's because they bore ill intention they think it's just that that’s not the norm
in our society and we need to use data, we are working with the National A cademy of
Sciences to say, how they have done this in other country, how they done this in certain
communities, what do the data tell us are the very best approaches and how might we
invest our time, our energy, our resources so that we can also move the n eedle.

Mark Masselli: We have been speaking today with Kana Enomoto acting administrator
of the Substance Abuse and Mental Health Service Administration which seeks to
advance the behavioral health of the nation. You can learn more about their work by
go ing to samhsa.gov, Kana thank you so much for joining us today on Conversations on
Health Care .

Kana Enomoto: Thank you so much. It's been a great conversation.

(Music)

Mark Masselli: At Conversations on Health Care , we want our audience to be truly in
the know when it comes to the facts about health care reform and policy. Lori
Robertson is an award - winning journalist and managing editor of FactCheck.org, a
nonpartisan, nonprofit consumer advocate for voters that aim to reduce the level of
deception in US politics. Lori what have you got for us this week?

Lori Robertson: “Have drug prices doubled in the last seven years?”, that’s what the
Hillary Clinton TV ad airin g in Iowa claimed. But a report provided by her campaign
says, brand name drug prices on average have more than doubled, not all drug prices
and more than 80% of b illed prescriptions are generic, those prices have declined 62%
the same report says.

In fact the Centers for Medicare & Medicaid Services says in the latest National Health
Expen diture Report that the shift to cheaper generic drugs is responsible for historically
low rates in prescription drug spending growth. The Clinton camp point s to a report by
Express Scripts, one of the nation’s largest pharmacy benefits manager which found a

Kana Enomoto – SAMHSA

127% increase in brand name drugs from January 2008 through December 2014, but
generic prices the report shows have dropped by more than half.

We also consulted Glen T. Schumock, with the University of Illinois at Chicago who has
written extensively about drug costs. He too knew of no data that could conclusively
answer the question of how much consumer drug prices have increased. Clinton ad
mentioned specific conditions including heart disease, asthma and diabetes. The
Express Scripts report does have data on drugs used to treat those conditions. It shows
year - over - year price increases for the top hand traditional therapy classes that combine
both generic and brand name drugs.

Diabetes was the only one that saw price i ncrease in 2014 while drug cost for asthma
declined 14.9%, and those for hea r t disease declined 12.6%. And that’s my fact check
for this week, I am Lori Robertson Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email u s at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Health Care .

(Music)

Mark Masselli: Each week Conversations highlights a bright idea about how to ma ke
wellness a part of our communities and everyday lives. For all the people in the world
without limbs acquiring prosthetics can be costly and out of reach. It's especially
challenging to make prosthetics for children since they are in constant state of growth.
Rochester Institute of Technology scientist Dr. Jon Schull stumbled upon a clever and
affordable solution, provided online open source templates to anyone, anywhere in the
world who has access to a 3D printer and provide prosthetic hands for next to nothing.

Dr. Jon Schull : I have made this Google maps mashup if you have a 3D printer and you
would like t o help put yourself on this map and if you know someone who needs a hand
put yourself on this map.

Mark Masselli: So he founded the e - NABLE netw ork which has massed thousands of
volunteer makers in upwards of 40 countries around the world providing cheap but
functional prosthetics for children in need.

Dr. Jon Schull : We know that we have delivered about 800 hands and we suspect that
this compara ble number had been downloaded by people we can’t track because we
have put all of our design on the Internet.

Kana Enomoto – SAMHSA

Mark Masselli: The simple limb designs have become more sophisticated as recipients
of the prosthetic devices provide feedback for designers to make more efficient devices.

Dr. Jon Schull : These things grip or un - grip, that’s all they do. So they are much less
functional than our biological hand and they are also less functional than a fancy
myoelectric hand but for kids it's huge because those expensive devices is typically out
of reach for children who would outgrow them so it doesn’t make sense for them to get
a $5,000 or $10,000 hand and they look like superhero or ironman hand.

Mark Masselli: e - NABLE a global collaborative network of open s ource designs linking
to makers with 3D printers to provide low cost prosthetic limbs to children and adults
around the world, now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Health Care , I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care , broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.