, took her place as principal deputy administrator for the Substance Abuse and Mental Health Services Administration (SAMHSA) 1 year ago, after Pamela Hyde, JD, as administrator following a blistering critique of how the agency was spending taxpayer dollars. Enomoto is the agency's de facto administrator until a permanent replacement for Hyde is installed.
In this interview with 鶹ý, Enomoto, who joined SAMHSA in 1998, spoke of her efforts to rebrand and rebuild the agency during a period of relentless criticism. "I felt like we were under fire from every direction," she said.
Q: You took the acting administrator post at a really rough time for the agency. What was one of your hardest days at work?
One of the earliest weeks, after former administrator Hyde left and I had started, there was a negative editorial in a major news publication [and] a reported findings of an investigation they had done without a balanced perspective of what our reply had been, and there were some internal difficulties, which we were being held accountable for. It was just an incredibly stressful week. I felt like we were under fire from every direction.
Also, at one point, half of our senior executive team positions were vacant and we also had a 25% vacancy rate of our staff.
Q: How did you move forward?
One of the first things I did was appoint as chief of staff.
We also made a real investment in engaging our stakeholders, including the Hill [Congress], differently. In the last year, we went around talking to people asking them, "Where do you see our shortcomings? Where do you see our strengths? How we could be communicating or partnering better with you?"
It's taken a lot of work to share information with people to give them data, to show them our evidence-based practices and policies, to show them how we audit our grants, how we hold them accountable, and how we train our practice officers.
Some of the criticisms and the complaints were legitimate. Some were based on a lack of information. Some, I would say, were not true. We needed to be clearer and to establish some credibility, so that people would listen to us when we provided data or clarification to the contrary.
Q: What were people reporting that was not true?
One of the things that has been perpetuated is that we spend most of our mental health dollars on the "worried well" and that is not accurate. Our mental health block grant, which is 50% of our mental health appropriations, is exclusively for children with serious emotional disturbance and adults with serious mental illness.
And the majority of our mental health programs are dedicated to people with serious mental illness, who are chronically homeless or involved with the criminal justice system, or young people and their families with serious emotional disturbances living in community settings or young people in transition age 16-25 with an early onset serious mental illness.
The things that we do that aren't exclusively tied to serious mental illnesses are things like suicide prevention. And I think everyone can agree that 41,000 suicides a year is too many, and that is in fact something that the lead public health agency on substance abuse and mental illness should be paying attention to.
Q: And what were SAMHSA's critics not reporting?
In the last year, I've spent most of my time trying to share that story about the hundreds of babies that are born to mothers who had been addicted to opioids and the babies who are born drug-free at a healthy birth weight. There's people achieving recovery, there's suicides that are being prevented, there are kids that are staying at home and in school and not getting sent away or to jail, and people that are graduating from drug court programs, which is just about the most inspirational thing you can experience. If you've never been to a drug court graduation, you should. You will cry.
Q: What makes these graduations special?
It is a tremendous experience. These are people who've overcome incredible, incredible challenges in the criminal justice system context and their families, the individuals, the community, and the drug court workers, everyone is so excited to see them starting on a path to recovery. And SAMHSA makes that happen.
Q: What are the key elements to reforming mental health in the U.S.?
A: There certainly is an issue about not being able to get people who need the safety and security of a bed or of a medical treatment setting. I also think the solution is probably more complex than just more beds.
I think we need to do more and better crisis management. Police officers are begging for more technical assistance and training on how to do things like [Crisis Intervention Teams]. They are asking for more crisis access points, so they're not spending so much "wall time" waiting in emergency departments or taking people that they know need treatment to jail.
And I think we do need things like Certified Community Behavioral Health Clinics and an enriched community-based service array for people with serious mental illness or youth with serious emotional disturbance.
The other big thing is housing. Part of why we can't get access for those who need a bed is because people who can't get safe and stable housing are occupying those beds.
Q: What are you most proud of having accomplished in the last year?
I love SAMHSA. It's the only job I've ever really had. I am so proud that this organization has weathered a storm of controversy, of constant threat of annihilation and of being dismantled. Our work force is so passionate, so committed that people just put their nose to the grindstone. We doubled down on our efforts, and we pulled through with a great grant year.
The president's proposed FY 2017 budget includes a $600 million increase for SAMHSA. Regardless of whether or not you think it's going to happen it demonstrates a huge vote of confidence.
We were excited that we were able to get the "bupe rule" out. We're excited that [the Comprehensive Addiction and Recovery Act] passed and that we've increased the provider pool [for those who can prescribe medication assisted treatment] by adding nurse practitioners and physician assistants. And I think is moving in a positive direction that elevates SAMHSA.
There was a time when it felt like maybe it would just be easier to blow it up and start over. But we didn't. And we're now in a different place in 2016.