COVID Emergency Ends but Mental Health Issues Remain

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Mark Masselli ( 00:04 ):
There are more Americans dying of drug overdoses than at any time in modern history. Research shows
over five million Americans are struggling with an opioid addiction.

Miriam Delphin - Rittmon, PhD ( 00:15 ):
We're working with states on naloxone distribution plans as part of their state opioid response funding
and work. So the goal there is to work with states to develop naloxone distribution plans and to provide
support around disseminating naloxone broadly.

Margaret Flinter ( 00:34 ):
Dr. Miriam Delphin - Rittmon is the assistant secretary for substance abuse with the U.S. Department of
Health and Human Services, and the administrator of SAMHSA, the agency that's empowered to address
these challenges. And this is Conversations on Health Care.

Mark Masselli ( 00:57 ):
Well, Dr. Delphin - Rittmon, welcome to Conversations on Health Care.

Miriam Delphin - Rittmon, PhD ( 01:02 ):
Oh, thank you so much for having me. Good to see you both.

Mark Masselli ( 01:05 ):
That's great. You testified at the Senate hearing about a continued rise of overdose deaths linked to
fentanyl. And I think one thing that was striking was the number of times the hearing circled back to
blaming China for making fentanyl and Mexicans for helping to get it across our borders. It just seems
like denial to view this as mostly a border security problem doesn't really do justice. It goes a lot deeper.
I wonder if you could share with our listeners your thoughts.

Miriam Delphin - Rittmon, PhD ( 01:37 ):
Yeah. I mean, certainly what we're seeing is that fentanyl is increasingly contributing to the overdose
deaths and the really troubling patterns and trends that we're seeing. We know that fentanyl is, it's easy
to manufacture, easy to access unfortunately, and our data shows that it is significantly contributing to
the most recent patterns and transit we're seeing. The thing that we've been focusing on certainly, or
certainly one thing anyway, is just increasing access to treatment, letting people know that services and
supports are available. But as part of that also, working to distribute naloxone far and wide. In fact,
we're working with states on naloxone distribution plans as part of their state opioid response funding
and work. So the goal there is to work with states to develop naloxone distribution plans and to provide
support around disseminating naloxone broadly. In fact, we'll be doing a policy academy later in the
summer to bring states together to share lessons learned, what's working. What they're seeing around
naloxone distribution is certainly is just one strategy to address the patterns and trends that we're
seeing.

Margaret Flinter ( 02:55 ):
Well, Dr. Delphin - Rittmon, the COVID pandemic certainly brought us a lot of bad news over these last
couple of years, but there was one sort of bright spot positive development that we've read about the
percentage of young people who report drug use dropped significantly in 2021. Officials have said the

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pandemic led to teens spending less time with the so - called bad influences at school, maybe more time
with parents. Do you agree with that? Are there lessons here for us that come out of the pandemic?

Miriam Delphin - Rittmon, PhD ( 03:28 ):
There are definitely lessons from the pandemic that we're leveraging and working to sort of build some
of our programming and thinking around. For example, I mean, one thing that we're finding is that some
young people did report having troubles through the pandemic and still experiencing some of those
ripple effects. Some of our data showed that young people were reporting higher rates of anxiety,
higher rates of depression. So certainly, some of our programming and resources and funding. In fact,
the president also in his last two State of the Unions mentioned that focusing on mental health,
particularly for young people, is a priority for the administration. It's certainly one of the SAMHSA
priority areas and something we're focusing on to really be able to strengthen the overall health and
wellness of children, youth, and families across the nation.

Mark Masselli ( 04:23 ):
Well, really focusing on children's well - being, I'm wondering if you could fill us in on your agency's new
report that provides really a comprehensive overview about LGBTQI+ youth. The researchers found that
the pervasive discrimination, rejection, and bullying of youth has led to a nationwide mental health
crisis, but your agency really has some resources for bullying prevention. I'm wondering if you could
share your strategy on this intervention.

Miriam Delphin - Rittmon, PhD ( 04:56 ):
Yeah, absolutely. So for one, I encourage folks do check out our website. We have a broad range of
resources and content related to LGBTQ mental health. We most recently put out a report related to
SOGIE, positive change efforts and approaches to working with LGBTQ youth. But certainly, our website
has a broad range of content there. We know bullying is real. We know young people report just a range
of impacts related to bullying in terms of impacts on self - esteem, impacts on some sense of self,
contributing to thoughts of suicide.
( 05:43 ):
One thing that we've put in place specifically related to LGBTQ youth is, if young people dial 988, so
that's our new suicide prevention crisis lifeline, if they dial 988 or chat and of course text, they can be
connected into the LGBTQ specific 988 network. So it's a press - three option. If they dial 988, press three,
or of course chat and text, they can be connected to someone who will work with them in a
compassionate way to manage whatever they're experiencing. But we do have a specific subnetwork
that we're piloting currently around LGBTQ youth mental health through the 988 crisis lifeline.

Mark Masselli ( 06:36 ):
That 988 crisis line is so important. Maybe talk a little bit about the role you're playing. I'm not sure it's
really caught on as much, but I know the need exists. How's the rollout been going?

Miriam Delphin - Rittmon, PhD ( 06:52 ):
I just have to say, the states have done and the call centers at the local level, it's been such a
collaboration across the local state, certainly federal level. What we find is that people are reaching out.
They are reaching out to connect to the lifeline. When we look at the first six months, so for example, it
launched in July, so July last year, so if we look at July to the end of the year, July to December, and

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compare that same time period, the previous year, we had 892,000 additional calls, texts, and chats that
came in. So 892,000 additional calls, texts, and chats. And what we found is that the texts of the chats
were by and large, when we look at some of the content that we have there, was by and large young
people. So it's heartening to know that folks are reaching out to get the support that they need, but the
numbers certainly let us know that there is a real need there and that people are struggling.

Margaret Flinter ( 07:56 ):
Dr . Delphin - Rittmon, it ties to a question I wanted to ask you. There was an article in New York
Magazine that sort of tried to figure out why we're facing a rise in teen suicide. Is it the pressures of
social media? Was it the isolation of the pandemic, weak social safety net? And after a lot of detail, the
author more or less concluded, we just don't know. I wonder, are you learning anything from the
experience of these 800,000 calls? I know they're not all teens, but are you getting a clear picture? This
must be very high on the things that you worry about on a daily basis at SAMHSA.

Miriam Delphin - Rittmon, PhD ( 08:34 ):
Yeah, it certainly is something that we're very concerned about. In fact, we've been, whenever we can,
leveraging opportunities to connect with young people. In fact, last year we convened a Black youth
suicide panel. We've done a number of panels with young people just to see what are their experiences,
what are their recommendations as it relates to mental health. So I think the report you mentioned, all
of the above. I mean, young people talk about certainly experiencing or still struggling with some of the
impacts of the pandemic in terms of the rhythms of daily life, still experiencing some impacts there. But
social media, we know plays a significant role. I mean, there's a lot of stress. In fact, bullying, that
happens through social media or can happen through social media. So there are just a range of stressors
that young people experience.
( 09:34 ):
Some of what we're working on is trying to create multiple entryways into care and trying to create
opportunities for people who connect with young people to recognize when they might be struggling, to
be able to know how to navigate care and connect them to services and supports. And then of course,
there are a number of programs for young people specifically. So Project Aware, for example, is one of
our school - based grants that is geared towards trainee school personnel and others around recognizing
when young folks are struggling, but also then building sustainable infrastructures that are geared
towards being able to support children, youth, and family mental health in fact.

Mark Masselli ( 10:16 ):
Assistant Secretary, I know this is something very important to you. Certified Community Behavioral
Health Clinics, and for folks who may not know what they are, they're really required to serve anyone
who want care for mental health or substance abuse regardless of their ability to pay their community
based. You've called them transformative. Why is this model working and how is it expanding?

Miriam Delphin - Rittmon, PhD ( 10:43 ):
Yes, it's working because I think it's truly about creating no wrong door, no wrong door into care and
just creating multiple opportunities and entryways. Currently, we have about 500 CCBHCs across the
country. So it's been just a pleasure and we've been thrilled to be able to see and receive the resources
to be able to expand them across the country. But I think they're working also because they provide
wraparound services and support. So for example, they provide crisis care 24 hours a day, seven days a

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week, and so easy access to crisis care. There's mental health services, substance use services, lifespan
care, so support for children, for families. So it's a whole health model of care. There's also primary care
screening and linkage to primary care supports as needed.
( 11:38 ):
So I think it's a model of care because it takes that whole health total person approach and it addresses
the access issue by having flexible and broad range hours and quick access. People are typically
connected in some instances the same day, many CCBHCs have same - day access. But then if not that,
then within a short period of time, 10 days or less, people are connected to care. So I think you put all
that together and it's a community - based model that is about meeting people where they're at
regardless of their ability to pay or their insurance status. Our data is showing that it's making an impact
in terms of addressing behavioral health and access to care.

Mark Masselli ( 12:21 ):
Well, it's so important, and really I wanted to follow up about the two models. You've got that model
and also the Federally Qualified Health Center model. How do the two of them work together? Because
it seems like there is a lot of seam of opportunity to be collaborative.

Miriam Delphin - Rittmon, PhD ( 12:39 ):
Yeah, yeah. I mean, one thing we're finding is that there are many FQHCs, Federally Qualified Health
Centers, that are also CCBHCs.

Mark Masselli ( 12:39 ):
Right.

Miriam Delphin - Rittmon, PhD ( 12:48 ):
So that's one scenario that we're seeing increasingly across the country. So that allows for full integrated
care because of course the FQHC provides a primary care and CCBHC, behavioral health as well as
primary care screening. So it really allows a full integrated care approach when there are CCBHCs that
are also FQHCs. In the absence of that though, many communities or many states have sites that are
CCBHCs and others that may be FQHCs. And certainly, the FQHCs can be a really important linkage site
for individuals that may be screened and identified to have primary care areas of concern. The FQHC can
then be the site where the person is connected for primary care support. So there is a natural
connection there, and in fact, we are seeing that in many communities and many states as well.

Mark Masselli ( 13:46 ):
That's great.

Margaret Flinter ( 13:48 ):
Well, certainly a big focus of concern and interest must be the workforce, the health care workforce, the
mental health care workforce, whether in the community clinics, the FQHCs, or just about any place
else. And I know your agency has this pulse on that. We'd love to hear about some of the programs that
you have for workforce training, both today and tomorrow's mental health care workforce. And also, I
know you have an interesting history with your agency's minority fellowship program, so share a little
bit about that and your other workforce training initiatives with us.

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Miriam Delphin - Rittmon, PhD ( 14:25 ):
Yeah, yeah, happy to do that. I mean, workforce is definitely one of our key priority areas. In fact, we
moved it in our current strategic plan, which it out for public comments. I'd encourage folks take a look
at that. Please do send in public comment. Workforce was a cross - cutting area now, it's one of our key
priority areas. So we're taking, I would say, a multipronged approach there. We have programs that are
geared towards strengthening the existing workforce, so offer a broad range of training and technical
assistance to the existing workforce through our center of excellence, our grantees, as well as our
training and technical assistance grantees as well. So we have training and technical assistance sites in
terms of mental health, substance use prevention.
( 15:16 ):
We have an African American Center of Excellence, Older Adult Center of Excellence, about to award
soon a Latino American Center of Excellence, and any one of the tribal center of excellence in training,
technical assistance center as well. They're available to do training and technical assistance to the
existing workforce. We know that's a really important thing to ensure that the existing workforce is
poised and ready to meet with the individuals who they may encounter. But then, we're also geared and
working at attracting and expanding the current workforce. We know that there's a HRSA data that
shows that by 2025, we might be upwards of 31,000 FTE short in terms of behavioral health
professionals.
( 16:01 ):
So through the minority fellowship program as one example, we fund fellowship spots in psychology,
psychiatry, marriage and family therapy across behavioral health to folks at the master's or doctoral
level. And as you mentioned, that program is near and dear to my heart. I'm a fellow of the Psychology
Minority Fellowship program. I went through 1990 to '93. And the thing personally that I loved about
the program is, there was a payback agreement. So I had to work in a site that serves diverse groups,
and ultimately that's what the fellowship is geared towards: training individuals to be culturally
responsive and to work in communities that serve diverse groups. So I did my payback work at the Yale
Department of Psychiatry at the Connecticut Mental Health Center, and ultimately ended up staying on.
And we find that often trainees will stay in the area where they do some of their trainings. So fellowship
programs can make a real meaningful difference in terms of expanding the existing workforce.

Mark Masselli ( 17:10 ):
They really can. I want to talk a little bit about intervention strategies. I read recently a psychiatrist
wrote a provocative op - ed in the Wall Street Journal where she stated that maybe those dealing with
stress and depression do not need a therapist, and that we are placing all of our eggs in one basket by
thinking therapy is the answer for everyone. Maybe we need more peer groups and peer mental health
training. What's your thought about this thought, but also about the broader way that we might
approach this burgeoning need that we're seeing all across America?

Miriam Delphin - Rittmon, PhD ( 17:47 ):
Yeah. I mean, I think what we hear, and we hear this a lot from people in recovery, and certainly we've
witnessed this in my own work over the years, is that everyone's recovery journey is different. People
connect with and find recovery or move through their wellness in different ways. So certainly, at
SAMHSA, what we're committed to doing is, just as I mentioned before, creating multiple entryways and
opportunities for people to experience and find recovery and ultimately live full home meaningful lives
along with any mental health or substance use challenges that may be experiencing. So we're working to

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develop and expand certainly the peer recovery workforce and peer recovery services and supports. We
are thrilled to launch our Office of Recovery two years ago now, but as of last September, we
announced that it is fully funded. We have a director of the office fully staffed, recently put out the peer
certification model standards that closed recently for public comment. So that's a robust area of work
that we're really excited about.
( 18:59 ):
But then we know, of course, other people may connect with or find recovery through traditional
mental health or substance use related services. And certainly, peer support can be an adjunct or a part
of that, part of the wraparound services and supports that a person may experience. So we've seen the
full gamut in terms of what makes a difference and what helps people move into recovery. Some say
just connecting with another person with lived experience made the difference for them, it helped give
them hope. It helped them to understand and see that recovery is real and recovery is possible, and we
see all combinations of people connecting with various forms of support, both formal and informal,
which ultimately helps to help some other recovery journey.

Margaret Flinter ( 19:53 ):
Well, Dr. Delphin - Rittmon, it takes resources to do all of the things that you're trying to do. President
Biden's asking for a big increase in your budget to address the mental health and addiction crisis in
America, but it appears Republicans want to cut what they see as discretionary programs. How are you
going to thread this needle as you move forward during this period?

Miriam Delphin - Rittmon, PhD ( 20:18 ):
What I can say is, I just so appreciate this administration's support for mental health and substance use.
The president mentioned it in his most recent State of the Union, we've got work to do, the job is not
done. So I appreciate the current president's budget. Our budget goes from about 7.2, give or take, to
10.8 billion. And those resources we know are much needed. Our most recent national survey in drug
use and health shows troubling patterns and trends, and ultimately the resources that the president has
proposed in the current budget to include increases in our state opioid response grant, to include
increases in our mental health and substance use block grant, as well as other discretionary grants, that
all of those grants and programs ultimately are geared towards helping to improve the behavioral health
of the nation. So I appreciate that the president's budget includes that increase, and I'm optimistic that
the president's budget is ultimately where we'll end up.

Mark Masselli ( 21:25 ):
Assistant Secretary Delphin - Rittmon, you lead what's officially called Substance Abuse and Mental
Health Service Administration, but you want to update SAMHSA's name to remove what's called a
stigmatizing label of substance abuse. And as you know, this change will require Congress to give its
okay. Why is the change important to you and how do you answer critics?

Miriam Delphin - Rittmon, PhD ( 21:52 ):
Language matters, and so substance use certainly is less stigmatizing than substance abuse.

Mark Masselli ( 21:59 ):
As you think about that change, is that one that is part of this agenda going forward this year, or do you
think it will have a longer road to see it to fruition?

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Miriam Delphin - Rittmon, PhD ( 22:15 ):
We're optimistic in terms of the changes we've proposed related to language. We think all of that makes
a difference, and so certainly it's something that we'll continue to put forward and pay attention to as
we've put forward our programs and initiatives.

Margaret Flinter ( 22:34 ):
We've addressed a lot of different populations and age groups in the course of our conversation, but I
wonder if I could ask you to comment. I was really delighted to see that SAMHSA also has initiatives to
fund looking at the mental health of very young children, children who are in our healthy starts, in our
early development centers. I'll give a shout - out here in Connecticut to a successful project that we're
involved in, down in the Fairfield County portion of the state. And I was curious about that. Has that
always been part of SAMHSA's work or is this a new initiative to focus on the youngest among our
people and try and make a positive impact there and their families of course?

Miriam Delphin - Rittmon, PhD ( 23:16 ):
So we do have a number of programs that focus on the younger children, really young children, and
ultimately our aim is to address lifespan, address behavioral health across a lifespan. So we do have a
number of programs, some of which we've had, others which are newer, but we're looking to expand as
well.

Margaret Flinter ( 23:39 ):
Well, we're really delighted to see it. Getting to those young kids is very important, so congratulations
on that good work.

Miriam Delphin - Rittmon, PhD ( 23:46 ):
Thank you. Thank you.

Mark Masselli ( 23:47 ):
Doctor, here in Connecticut, of course we know you from your great work leading Connecticut State
Mental Health and Addiction Services, but I'm wondering, when you were working in Hartford, did you
ever think, "I just wish the feds in Washington understood what we're going through at the state level"?
And how is it that experience informing your leadership now that you're in one of those hot seats?

Miriam Delphin - Rittmon, PhD ( 24:16 ):
Yeah, great question. That experience very much has, it certainly has helped in terms of my role and
current role. When we hear from states or communities about ideas or recommendations or thoughts
they have, it often sort of sparks some of the experiences that I'm aware of or that I'm bringing with me
from Connecticut. So all of that I think contributes to a approach to leadership. I love hearing from
states and from community members and grantees about what's working, what's not working. And
that's something that I loved when I was commissioner as well. So I think that's an important part of the
work.
( 25:00 ):
I'm a clinical community psychologist by training, and so I certainly have taken that with me, whether it's
in my role as commissioner or my current role as assistant secretary, that there's a collaborative

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element to this work that is this vital. We ultimately are all moving forward, the behavioral health
system across the nation together. The relationships and work we're doing with our grantees is just so
vital. We know that we can't do this work alone. So that's why I often look for opportunities to hear
directly from young people or to hear directly from community members and grantees at the local level
or state level. So all of that, I think, makes a difference and contributes to my vision and approach to the
work to include those experiences I had taking that approach in Connecticut as well.

Margaret Flinter ( 25:50 ):
Well, we really appreciate and admire that ability to travel that line between the micro and the
community level to the macro level and the policy level. One of those programs that I know you've been
engaged with this, SAMHSA has been engaged with I think for over 20 years, that we just see play out,
certainly hear about it from our school - based health center programs is the issue of bullying in schools.
And I think ties back to a lot of the issues we talked about a little bit earlier. 20 years as a SAMHSA
initiative, what have we learned? What's involved in that work? Any signs of effectiveness, success,
metrics that we can point to around that just painful issue that kids often face?

Miriam Delphin - Rittmon, PhD ( 26:37 ):
Yeah. It is a painful issue. One thing that we're working at right now, we recently funded the Social
Media Center of Excellence. And we know bullying, one space, unfortunately, where that happens and
where we're seeing challenges there is on social media. So one of the things that our Social Media
Center of Excellence is working on is developing strategies and approaches for schools, for families, for
young folks around using social media in a way that's positive and strategies around managing and
navigating and negotiating some of the more challenging aspects of social media to include bullying. So
that's one recent initiative that we're really excited about. We awarded that Center of Excellence earlier
in the year. It was actually mentioned as the president's mental health strategy. So we're really excited
about that work because we know what we hear from young folks is that often social media is one space
where bullying happens, unfortunately to include others, but we're looking to sort of develop strategies
and approaches for young folks in terms of social media and navigating bullying and challenges there.

Mark Masselli ( 27:54 ):
Assistant Secretary, let me get in one last question. I think there are so many natural disasters, school
shootings that are going on, other crisis events, and maybe some people think that FEMA's there, but I
think also SAMHSA has a role that it's playing, and I'm not sure people understand the importance that
you bring to these traumatic events where people are facing anxiety, worry, insomnia, and the others.
Maybe talk a little bit about, as we wrap up here, the critical role that SAMHSA plays all across America.

Miriam Delphin - Rittmon, PhD ( 28:30 ):
Yeah, no, thank you for that question. I mean, especially now, as often, springtime is a really tough time
of year for weather events, but we also run the National Disaster Distress Helpline. So that is a helpline
that's available for people that are experiencing challenges related to natural disasters. Another
resource that often is real valuable there is the National Child Traumatic Stress Network. That network
includes a whole range of resources for children and families related to managing and negotiating
traumatic stress or traumatic events.
( 29:09 ):

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So between the Disaster Distress Helpline as well as the National Child Traumatic Stress Network, there
are a range of resources that are available for communities and children and families related to
managing traumatic events. We also have a grant that is available in addition to some of the specific
FEMA or other grants. There's a grant that we have for communities that have experienced... It's called
ReCAST. It's for communities that have experienced traumatic events related to cultural or community
unrest, community violence, or even natural disasters. And it's about forming coalitions and other
approaches and strategies geared towards promoting resilience, resilience for communities
experiencing stress and trauma.

Margaret Flinter ( 30:05 ):
Assistant Secretary Delphin - Rittmon, thank you for leading this fight and for joining us. And thank you to
our audience. There's more online about Conversations on Health Care, including a way to sign up for
our updates. Our address is chcradio.com. Dr. Delphin - Rittmon, we can't thank you enough for joining us
today. Continued good luck.

Miriam Delphin - Rittmon, PhD ( 30:25 ):
Thank you so much. Thank you for having me on.

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