Mark Salzer who gets funds from SAMHSA supports SAMHSA

Mark Salzer, Ph.D., who is Chair of the Department of Rehabilitation Sciences at Temple University wrote a surprising oped for the Philiadelphia Inquirer. It claimed, “SAMHSA has clearly served people with serious mental illnesses” and “The elimination or curtailment of SAMHSA would be a major blow to progressive mental-health policies in the United States.”

There were no real specifics and the massive evidence documenting problems at SAMHSA shows eliminating it and transferring it’s responsibilities elsewhere would likely improve services for the most seriously mentally ill. So Mental Illness Policy Org. decided to look into what might have led Dr. Salzer come to his conclusion.

Dr. Salzer’s CV shows that he and his projects receive over $4 million directly from SAMHSA.

It is not known if this financial support from SAMHSA influenced his high opinion of SAMHSA or he really believes what he wrote. It is not known if he disclosed what most would consider a serious conflict to the editors before submitting his oped. The oped itself made no disclosure.

Almost all the support, the only support, for SAMHSA seems to come from those who receive money from it or benefit from it. It is not surprising they want their sugar daddy to stay in existence. 

Following are the grants Dr. Salzer lists on his CV. Over $4 million are identified by him as coming from SAMHSA.

• Principal Investigator. Evaluation of Friends Connection. SAMHSA CMHS Consumer-Initiated Services Collaborative Agreement (SM52355; $2,267,034; 9/98-9/03).
• Principal Director. DELCO (PA) Self-Directed Care Project. Transformation Technology Transfer Initiative, SAMHSA. ($221,000; 5/1/14 – 6/30/15).
• Principal Director. Enhancing the role of Pennsylvania’s Statewide Network of Certified Peer Specialists. SAMHSA Transformation Transfer Initiative ($107,000; 1/12 – 9/12).
• Evaluation Co-Director. CABHI-States. SAMHSA States CABHI Initiative, subcontract to Mental Health Association of Southeastern PA. (1H79TI025346-01; $1,500,000; $156, 354 subcontract; 10/13 – 9/16).
• Evaluation Co-Director. Philadelphia Homeless Initiative. SAMHSA CABHI Initiative, subcontract to Mental Health Association of Southeastern PA. (TI23520; $1,500,000; $150,000 subcontract; 7/12 –6/15).
• Consultant. Infusing Peer Specialists into Pennsylvania’s Behavioral Health Crisis Services System. Transformation Technology Transfer Initiative, SAMHSA. ($221,000; 1/1/15 – 9/30/15).
• Evaluation Consultant. Certified Peer Support Specialists as Healthcare Navigators and Wellness Coaches Within Federally Qualified Health Centers. SAMHSA Transformation Transfer Initiative to Michigan ($221,000; 1/12 – 8/12).
• Evaluator and proposal consultant. Pennsylvania Statewide Consumer Network Grant. (Mary Kohut, PI). Funded by SAMHSA/CMHS (SM56338-01; $70,000; 10/1/04 – 9/30/06).
• Principal Consultant. National Mental Health Consumers’ Self-Help Clearinghouse. Funded by SAMHSA/CMHS (SM56065-01 - Joseph Rogers, PI). ($495,000; 10/1/03 – 9/30/04).
• Evaluator. Family Ties (Training, Instruction, Empowerment, and Support). Funded by PEW Foundation to Mental Health Association of Southeastern Pennsylvania ($210,000; 4/1/10 – 3/31/13)
• Evaluation Director and consultant. National Mental Health Consumers’ Self-Help Clearinghouse. Funded by SAMHSA/CMHS (Joseph Rogers, PI). ($1,200,000; 10/1/07 – 9/30/10).
• Evaluator. Keystone Pride Recovery Initiative. Funded by SAMHSA Consumer Network grant (5SMO59833-02) to the Pennsylvania Mental Health Consumers Association ($70,000; 10/10 – 9/13).

 He also does work for other entitites that get their own funds from SAMHSA. These are just a few. 

• Consultant. Promoting Olmstead in Pennsylvania. Advocates for Human Potential ($20,000; 1/12 – 9/12).
• Program Director. Philadelphia Disaster Response Network. Contract with Mental Health Association of Southeastern Pennsylvania ($22,751; 9/1/02 – 4/1/03).
• Evaluation Director and consultant. National Mental Health Consumers’ Self-Help Clearinghouse. Funded by SAMHSA/CMHS (Joseph Rogers, PI). ($1,100,000; 10/1/04 – 9/30/07).

Most of the studies which Dr. Salzer is associated with above, seem to focus on peer support. SAMHSA’s own review of the research shows: “The literature [on peer support] that does exist tends to be descriptive and lacks experimental rigor." We don't know if SAMHSA was referring to this research. SAMHSA funds other research.

The well-respected Cochrane Collaborative reviewed all the high- and low-quality data on peer support and concluded: 

Involving consumer-providers in mental health teams results in psychosocial, mental health symptom and service use outcomes for clients that were no better or worse than those achieved by professionals employed in similar roles, particularly for case management.

Another study, also not by Salzer, "adds to the evidence suggesting no short-term incremental benefit (or harm) from peer services beyond usual care.” 

In spite of this research casting doubt on peer support, SAMHSA continues to fund it. Is that why SAMHSA supported researchers and consumer groups want to preserve SAMHSA?  

SAMHSA FAILS SERIOUSLY MENTALLY ILL

A bill in Congress (HR3717, the Helping Families in Mental Health Crisis Act) would change SAMHSA and some wonder why change is needed. SAMHSA (Substance Abuse and Mental Health Services Administration) was created by Congress to “reduce the impact of…mental illness on America’s communities” and “target … mental health services to the people most in need”. SAMHSA has failed to do either. SAMHSA refuses to require its funds reach the most seriously ill and enacts policies to see they don't.

SAMHSA largely ignores the most significant impacts of mental illness on the communities, specifically violence, incarceration, hospitalization, homlessness and suicide. Instead, SAMHSA focuses on improving metrics like 'feeling of empowerment' 'hopefullness' and other softer outcomes.

Wellness Recovery Action Plan (WRAP) Lacks Independent Verification and is not Evidence Based

WRAP labeled as 'evidence based' by SAMHSA. 

But is it?

When we ask “is a program evidence-based’, at Mental Illness Policy Org we break that question down into three components:

1.  Does it help people with serious mental illness (ex. schizophrenia, bipolar, major depressive disorders) or is it a program designed to improve the mental health of anyone who feels their mental health can be improved. 
2. Does the program improve a meaningful outcome? To be evidence based, we require it to improve a meaningful independent measure such as reducing suicide, homelessness, hospitalization, violence, substance abuse, arrest, incarceration, etc. Self reports of greatier happiness (“improved mental health”) are not sufficient or unique to WRAP
3. What is the quality and independence of the research.

WRAP (Wellness Recovery Action Plan) has been certified by SAMHSA National Registry of Evidence Based Practices and Programs (NREPP) as an evidence-based intervention. This certification encourages states to implement it. But the evidence is not clear that WRAP improves any meaningful measure like decreasing hospital days, decreasing incarceration, decreasing homelessness or that it is for people with serious mental illness. The certification of unproven programs leads states to waste money.

Representative Tim Murphy Calls out SAMHSA For Failure to Help Seriously Mentally Ill

Opening Statement of the Honorable Tim Murphy Subcommittee on Oversight and Investigations Hearing on “Examining SAMHSA’s Role in Delivering Services to the Severely Mentally Ill”

May 22, 2013
(As Prepared for Delivery)

Since I became the Chairman of the Subcommittee on Oversight and Investigations, shortly after the December 14, 2012, elementary school shootings in Newtown, we began looking into the federal programs and resources devoted to mental health and mental illness. We did so to ensure federal dollars devoted to mental health are reaching those individuals with serious mental illness and helping them obtain the most effective care.

One lesson we must immediately draw from the Newtown tragedy is that we need to make it our priority to get those with serious mental illnesses, who are not presently being treated, into sound, evidence- based treatments.

In 2009, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that about 11 million U.S. adults had serious mental illness, and 40 percent of these individuals did not receive treatment. While the vast majority of individuals with a mental health condition are nonviolent, Director of the National Institute for Mental Health, Dr. Thomas Insel, told this subcommittee at our March 5 public forum that effective treatments, which include medication adherence and evidence-based psychosocial therapy, can reduce the risk of violent behavior fifteen-fold in persons with serious mental illness.

Getting these individuals into treatment is a crucial first task and SAMHSA, as the federal agency whose mission includes reducing the impact of mental illness on America’s communities, should be playing a central role in this effort. But based on our work to date, SAMHSA has not made the treatment of the seriously mentally ill a priority. In fact, I’m afraid serious mental illness such as schizophrenia and bipolar disorder may not be a concern at all to SAMHSA.