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Will we see involuntary confinement return, and what does that mean for mental health services grant writers?

The Atlantic has a long book excerpt titled “American Madness: Thousands of people with severe mental illness have been failed by a dysfunctional system. My friend Michael was one of them. Twenty-five years ago, he killed the person he loved most.” The story is about a brilliant man named Michael Laudor, who was also a schizophrenic and as a consequence of schizophrenia killed his pregnant fiancee while in the grips of delusion. The story is partially about what the author, Jonathan Rosen, calls “the wreckage of deinstitutionalization, a movement born out of a belief in the 1950s and ’60s that new medication along with outpatient care could empty the sprawling state hospitals.” Rosen says that:

During the revolutions of the ’60s, institutions were easier to tear down than to reform, and the idea of asylum for the most afflicted got lost along with the idea that severe psychiatric disorders are biological conditions requiring medical care. For many psychiatrists of the era, mental illness was caused by environmental disturbances that could be repaired by treating society itself as the patient

It turns out, however, that many psychiatric disorders are in fact biological conditions, rather than being caused by “environmental disturbances.”* The environment might exacerbate or mitigate some psychiatric challenges, particularly for things like psychopathy, but the psychiatric challenges remain. We’ve written grants for lots of mental healthcare providers that know how mental health challenges exist on a spectrum: someone with ADHD or many forms of depression might be addressable in a straightforward, outpatient manner, but schizophrenics and people suffering from other severe and persistent mental illnesses (SPMI, which is the current descriptor of choice in the grant writing biz) aren’t well suited to basic outpatient treatment. A lot of the online discourse around mental illness concerns people with issues that may be serious, but that are unlikely to result in fundamental breaks with reality, homelessness, and murder.

Rosen reports what I was discussing in the preceding paragraph—that some people don’t fit well into the outpatient model:

One problem was that nobody knew how to prevent severe mental illness; another was that rehabilitation was not always possible, and could only follow treatment, which was easily rejected. And despite having been created to replace hospitals caring for the most intractably ill, community mental-health centers, as their name suggested, aimed to treat the whole of society, a broad mandate that favored a population with needs that could be addressed during drop-ins

People with SPMI who aren’t involuntarily institutionalized often end up on the street, which is obvious to anyone who’s visited San Francisco, or parts of L.A., Denver, Seattle, or any number of other cities, which have been struggling with a combination of high housing costs, limited policing, and few tools to compel treatment. Rosen says that “The biggest improvements in people’s mental health can happen when they are involuntarily hospitalized, a psychiatrist who works with the homeless told me.” A lot of mental health services organizations and homelessness service organizations will admit as much in private—we know, because we’ve been on those calls—but they’ll almost never say so in public. Saying so is too incendiary, and too contrary to the hopeful messages of the ’60s, which still resonate in American culture today.

As a society, for various reasons, we’re not willing to have hard, honest conversations about tradeoffs and challenges. Freddie deBoer has a review essay of Rosen’s book that picks up these threads; he writes that “I look and look for some grappling with the messy, sad, sometimes tragic reality of mental illness in major media and I find nothing.” The reality is often not suited to the dominant narrative, and we’d prefer to ignore the reality. Foster family agencies are similar: they deal with issues that have no good answers and that most people would prefer not to think about. So most people don’t think about them.

Most people prefer not to think too hard about how to deal with SPMI, but reality can find its way through that preference to consider something else. Michael Laudor’s fiancee likely didn’t think she’d die by his hand, and preferred to think that she’d be okay, and that she could save him, when only medication, taken as scheduled, could. The severely and persistently mentally ill generally can’t be confined for more than a few hours or days until they commit a serious crime, even if their journey towards serious crime is evident to their loved ones.

We don’t yet know what happened to Cash App founder Bob Lee, who was murdered on the streets of San Francisco, but chances are SPMI played a role. It’s likely that his murderer, if he’s found, will have a long criminal history as well. The proximate cause will likely be something crime-related, or related to that particular day’s episode, but the ultimate cause will in part be that “dysfunctional system” Rosen writes of. Emergency rooms and police officers aren’t alone going to fix the system we have. Not even federally qualified health centers (FQHCs) and other kinds of behavioral health services providers will, or can. They can be part of the solution, but a big part of the solution has to be something we’ve not been willing to countenance since the ’70s. The alternative is the status quo: more Bob Lees and more murdered girlfriends. While Americans sort this out, the failure to deal directly with SPMI is contributing to the rapid decline of the quality in many cities. While San Francisco and Seattle are very beautiful, many folks will likely think twice before venturing to either for a vacation or conference, as they think: “who needs the risk?”


* Very few people today take Freud seriously, except as a storyteller, for obvious reasons.

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The end of SAMHSA’s “waivered prescriber” MAT requirement: a grant writer’s farewell

You could easily have missed it: in January, SAMHSA ended its waivered-prescriber requirement due to an obscure section of the recently passed Bipartisan Infrastructure Bill (BIL). Those of you who aren’t involved in the minutia of healthcare service provision and medication-assisted treatment (MAT) may read the preceding sentence and think: “What’s that about, and why does it matter?”* Until this year, the Drug Enforcement Agency (DEA) required that doctors and nurse practitioners (NPs) / physicians assistants (PAs) who prescribe buprenorphine—the key medication used to treat persons with what SAMHSA and HRSA like to call “opioid use disorder” (OUD)—get a special DEA waiver. This “waivered prescriber” requirement had the effect of severely limiting the number of doctors and other healthcare providers who could offer MAT. So you’d have situations where a doctor could prescribe potentially addictive opioid painkillers like oxycodone, but not the buprenorphine that is used to treat OUD. Welcome to the upside-down world of American healthcare.

This waivered-prescriber process always seemed baffling, and it turns out that I’m not the only person who wondered about what’s so special about Suboxone and similar drugs: back in 2015, for example, Scott Alexander wrote that any doctor should be able to prescribe it, and he observed that Suboxone, the “(generally safe) treatment for addiction[,] is more highly regulated than the (very dangerous) addictive drugs it is supposed to replace.” MAT works way better than non-medication efforts, although not perfectly.

Dr. Alexander** notes that:

Suboxone treatment isn’t perfect, and relapse is still a big problem, but it’s a heck of a lot better than most rehabs. Suboxone gives people their dose of opiate and mostly removes the biological half of addiction” and that “Some people stay on Suboxone forever and do just fine – it has few side effects and doesn’t interfere with functioning. Other people stay on it until they reach a point in their lives when they feel ready to come off, then taper down slowly under medical supervision, often with good success.

So maybe taking a daily dose of Suboxone isn’t ideal, but it’s a big improvement on OUD. How many people reading this have a daily dose of coffee, tea, Yerba Mate, or some other caffeinated substance? Sure, we can say that tea makes us more productive, but, compared with street and prescribed opioids, doesn’t Suboxone?

Probably the “waivered-prescriber” thing should have ended much sooner—but that’s far from the DEA or FDA’s most egregious blunder in recent times. Studies find that “FDA Deregulation Increases Safety and Innovation and Reduces Prices.” Maybe we should collectively think more seriously as a society about the costs of government paternalism. The supplement industry, while not exactly a shining star of excellence, works okay without the FDA. People who find FDA approval valuable could choose to only buy substances with FDA approval; those who are FDA skeptics could choose not to. Most supplement buyers don’t appear to care about FDA proof.

In the meantime, regarding OUD and MAT, sudden deaths from fentanyl remain high in NYC—and fentanyl is often accidentally or intentionally mixed with non-opioid drugs like cocaine. This could be a legalization or decriminalization argument: black-market items rarely follow Good Manufacturing Practices (GMP).

Oh yeah, and it looks like naltrexone curbs binge drinking, apart from severe alcoholics. Estimates vary but most find that around 10% of Americans have an alcohol problem. There are also indications that semaglutide reduces the appeal of alcohol (here is one clinical trial examining that subject). In the last links post, we mentioned a monoclonal antibody that reduces amphetamine effectiveness. Although none of the anti-addiction medications s mentioned in this post are likely to alone solve concomitant addiction crises, they’re likely to help. We as a society have at least 50 years of experience in trying to resolve addiction crises without extensive medication-assisted treatment, and the results are apparent. The “War on Drugs” hasn’t worked. Talk therapy and 12-Step programs are better than nothing but don’t work all that well on their own. I guess we’re now at the stage where we’re trying MAT more seriously, and soon we’ll be at the stage where we try psychedelic therapy (sample clinical trial, but there are many others). Trying something new when the old isn’t working makes sense at a personal and a societal level.


* If you or anyone you know has struggled with what’s now referred to as “opioid use disorder,” it matters a lot.

* He’s a psychiatrist.

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SAMHSA’s “Grants for the Benefit of Homeless Individuals” (GBHI) and grant writers

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Grants for the Benefit of Homeless Individuals” (GBHI) Notice of Funding Availability (NOFO) should appeal to grant writers and grant applicants because the program is offering funding for activities that many homelessness services organizations are already doing—most notably, providing funding for various kinds of substance use disorder (SUD) / opioid use disorder (OUD) treatment, and, in particular, medication assisted treatment (MAT). MAT is also now easier to administer, because the “waivered prescriber” requirement has been waived. In the FY ’23 GBHI NOFO, there’s $75 million available over five years for up to thirty-two awards, and grants go for five years, with half a million per year—overall, it’s a desirable grant program. If your nonprofit organization wants to apply for SAMHSA’s “Grants for the Benefit of Homeless Individuals” program, call us at 800.540.8906 ext. 1, or email us at seliger@seliger.com, for a FREE quote on writing this SAMHSA application, or any other proposal.

The SAMHSA NOFO notes that GBHI applicants should provide a fairly typical suit of services for homeless individuals, including SUD/OUD treatment (likely via MAT, as noted above) and assistance to overcome chronic or episodic homelessness. Nonprofits are eligible. The program should probably include peer workers (often called “community health workers” or similar—”CHWs” is a fine acronym) who are going to liaise with the target population of focus.

The trick for all these programs is outside the ability of applicants to affect: getting enough housing built at all, for anyone and everyone, which is a point we’ve made in “‘Homelessness is a Housing Problem’: When cities build more housing, homelessness goes down.” Building housing for anyone is hard, which means building it for the homelessness (or whatever euphemism one may choose) is even harder. Fortunately, the SAMHSA GBHI program wants to offer help with finding or showing permanent housing through “collaboration,” including with public housing authorities (PHAs). So applicants that are, or can get, a homelessness services provider to help will be aided, even if most of the target population doesn’t wind up with a permanent living situation. Finally, typical case management services are required; for case management, applicant should probably propose an approach in which CHWs will provide warm handoffs to case management professionals. Treatment of substance-use disorder and mental illness itself is also an eligible cost, which will be appealing to healthcare organizations.

Distributing naloxone, opioid test strips, and similar harm reduction supplies are eligible activities. SAMHSA also specifically tells applicants that they need something like a “Participant Advisory Council” (PAC) to offer oversight, but SAMHSA has adopted another term: a “steering committee.” Whatever the name, the purpose is the same, and should be familiar to veteran grant writers. Beyond that, various kinds of other activities are optional, including HIV prevention, and training staff in evidence-based practices (EBPs) like Motivational Interviewing (MI) or Cognitive Behavioral Therapy (CBT). How many of these activities really make it from the proposal world to the actual world? Probably not all of them, but some. SAMHSA also has an EBP warehouse that applicants can choose from, but most EBPs are essentially different routes up the same mountain.

Regardless of the route, the journey is arduous; the number of interventions that it takes to get a homeless person with SUD sober and off the street can number in the dozens, if not hundreds. Outsiders often don’t realize this. If you don’t work in the homelessness-services field, ask someone who works in emergency rooms what the population of focus for the “Grants for the Benefit of Homeless Individuals” (GBHI) program is like. The organizations operating GBHI programs are doing tough work. Grant writers should be able to evoke that work, without being melodramatic about it.

Want that GBHI grant? Contact us, so we can help make it happen. We’re here to help, and to make your life easier.

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What counts as an eligible service area for SAMHSA’s “Resiliency in Communities After Stress and Trauma” (ReCAST) program?

Long ago, we wrote about what grant writers and applicants should do when confronted by a poorly organized RFP; because little external pressure pushes federal agencies to write RFPs that make sense, one finds too many RFPs that leave a lot of questions. SAMHSA’s “Resiliency in Communities After Stress and Trauma” (ReCAST) Notice of Funding Opportunity (NOFO) is a case in point: eligible applicants are those “communities that have recently faced civil unrest, community violence, and/or collective trauma within the past 24 months.” Okay: the NOFO will surely get more specific, right? But the ReCAST NOFO says that “Community violence is defined as the exposure to intentional acts of interpersonal violence committed in public spaces by individuals who are not related to the victim.” Okay: but how much violence? Do two murders count? Do two instances of battery count? Almost every city of any size has likely experienced at least two “intentional acts of interpersonal violence” committed by strangers in the prior 24 months. So how much is enough? Is more better, for purposes of being funded by this program? How are applicants to judge the feasibility of being funded? Being able to have some sense of eligibility is key, because preparing and submitting a SAMHSA application isn’t a minor endeavor.

Then there is the issue of “collective trauma.” Do natural disasters count? I’ve read the definitions of “collective trauma” on pages 8 – 9 of the ReCAST NOFO, and I’ve gone through all 41 uses of the word “trauma,” but I don’t see an answer to that specific question. Natural disasters are violent and often cause injury and death, which makes me lean towards “yes,” but the emphasis on “civil unrest” seems to point to a very specific set of issues that SAMHSA has in mind.

So I sent an email to the SAMHSA contact person, Jennifer Treger, asking her a version of the above. She wrote back: “Thank you for your inquiry. Please refer back to the definition that you have pointed out on pages 8-9 of the funding opportunity. If you determine your community meets the eligibility based on the definitions, please feel free to submit an application.” But how am I, or anyone else, supposed to judge whether a specific community is eligible based on that vague definition? I tried asking her in another version, and she reiterated, unhelpfully, that “We can only respond to what is in the NOFO.”

She also wrote that: “You can determine if you feel your community meets the definition for Collective Trauma as stated in the NOFO.” But the problem is that how I “feel” doesn’t matter at all to SAMHSA in determining eligibility; only SAMHSA’s judgments matter (SAMHSA has the money). It’d be useful for SAMHSA to list, in its view, which communities have had sufficient “civil unrest, community violence, and/or collective trauma within the past 24 months” to qualify for ReCAST. Or, alternately, what metrics they’d use. An FBI Uniform Crime Rate (UCR) of x per 1,000 people, for example, would be a specific metric.

Too many federal agencies love the latitude that vagueness implies. It’s hard to advise our clients on whether they should apply to ReCAST without more specifics, but those specifics evidently aren’t going to be forthcoming. I guess we’ll have to try to look at our feelings and our client’s feelings, and hope SAMHSA feels what we feel.

For more on similar matters, see RFP Lunacy and Answering Repetitive or Impossible Questions: HRSA and Dental Health Edition.

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“Health insurance security” and FQHCs

I hesitate to post this, because it’s a bit more political than the topics we typically cover, but it’s explanatory more than partisan: “The 2018 Elections Were Not About Obamacare–They Were About Health Insurance Security.” In it, Bob Laszewski describes how “In March of 2016, there were 20.2 million people covered in the individual health insurance market,” but by “March of 2018 the count was 15.7 million.” Why? Because individual market “premiums and deductibles are sky high–for all but the lowest income participants.” Consider this data:

In Northern Virginia, for example, the cheapest 2019 Obamacare individual market Silver plan for a family of four (mom and dad age-40) making a subsidy eligible $65,000 a year costs $4,514. That plan has a $6,500 deductible meaning the family would have to spend $11,014 on eligible health care costs before collecting other than nominal first dollar benefits.

That same family, but making too much for a subsidy, as 40% of families do, and a typical family in the affluent Virginia 10th, would have to spend $19,484 in premiums plus a $6,500 deductible, for a total of $25,984 in eligible costs before they would collect any meaningful benefits.

Those are shocking numbers, no? Yet we rarely see them, or numbers like them, in the larger media landscape. Many people have individual experiences of such things, including me; I’m covered by a small group employer plan, not an individual market plan, but my own deductible is now about $5,000. Two years ago, it was $4,500, and when I had a minor procedure to fix a toe I’d dropped a pan on, I spent $4,500 out of pocket almost immediately. Not only that, but when I saw podiatrists to get fee quotes on the procedure, most could not or would not give them to me. Even people who say they want to pay in cash often cannot find out how much a particular service will cost. When I inquired about the price of an office visit, most receptionists were confused but could eventually get an answer, and prices varied hugely, from as little as $40 to as much as $350. Why? I don’t know.

Oh, and the podiatrist billed my insurance for something like $12,000, beyond the $4,500 I paid, and she got $900 out of the insurance company. So her net benefit from the procedure was $4,500 in cash (from me) plus $900 from the insurance company. It is almost impossible to read this paragraph and not think, “Something is horribly wrong here.”

And I am not alone: almost anyone not covered by a very large employer plan, Medicaid, or Medicare has had similar experiences.

There is also an absurdly common misconception among normal people: that “insurance” is what matters for healthcare. Insurance is only part of the puzzle, but “insurance” is only as good as the healthcare we can access with it. Many doctors, for example, don’t accept Medicaid patients. So someone on Medicaid who counts as “having insurance” may not have access to care. Laszewski points out that many people “have insurance” (which is fine), but if the insurance never kicks in for the average person, then it is not functioning like true insurance, but not as the pay-all system that health insurance means to most Americans.

Federally Qualified Health Centers (FQHCs), which are federally funded nonprofits, have supersized in part because of the strange path of the US healthcare markets. Either by accident or design, FQHCs have become the default Medicaid providers in many parts of the country at the same time that the ACA significantly expanded Medicaid eligibility. Policy wonks in DC, along with some politicians, know that “insurance” is not the same as “health care” (as I myself said above). Even if politicians don’t know that, many of their constituents and voters who are on Medicaid know it. FQHCs are a partial solution, because they accept Medicaid patients and self-pays on sliding fee scales. FQHCs have also become front-line purveyors of Patient Navigation services (which link patients with Medicaid or ACA plans). Still, FQHCs usually do not have enough slots for everyone who seeks care, and waits can be long; FQHCs also often have trouble recruiting clinicians and in particular specialties like OB/GYN and psychiatrist.*

So the convoluted and intertwined health insurance and care access problems remain; the present situation likely cannot hold forever; and I do not know what will happen, politically speaking. But I would surmise that, if a family of four making $65,000 a year must pay $10,000 or more in true costs for healthcare before some manner of insurance kicks in, something has to give.

Single-payer is popular in some American political circles, though it’s not my preferred outcome and seems unfeasible financially; I’d rather see price transparency and mandatory health savings accounts coupled with true insurance for catastrophic care. Unfortunately, no one but me and a handful of healthcare wonks desire this outcome, or something adjacent. It’s hard to explain in a soundbite and normal voters have no idea what “price transparency and mandatory health savings accounts coupled with true insurance for catastrophic care” means. It doesn’t map well onto political ideologies. In healthcare, no one wants to talk about or admit to trade-offs. We write many grant proposals for FQHCs, but we never mention trade-offs. Seliger + Associates is a grant writing firm, so we’re firmly in the proposal world. All FQHCs should be in the proposal world when writing HRSA or SAMHSA or foundation applications. In the real world, however, just saying it’s so, doesn’t make it so. Trade-offs are real and pervasive. It may be socially undesirable to acknowledge them, but they are real.

The most likely political outcome will be more kludges on top of existing kludges. Fortunately, “price transparency” would fit this general paradigm. Unfortunately, there seems to be no political constituency for it. I cannot say what will happen next. I did not think Obamacare would happen, and I was wrong about that. I also did not realize that the feds would re-purpose FQHCs in the way that they have, as Medicaid providers, yet here we are. In healthcare, it seems, almost anything is, or has become, possible.


* This is largely due to barriers to entry imposed by existing doctors and especially the powerful American Medical Association. Many things could be done to increase the supply of doctors, including integrating med school into undergrad; shortening med school; allowing foreign doctors to practice without residency; or creating a special one-year residency for foreign doctors. None, however, are on the political horizon.

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SAMHSA’s Screening, Brief Intervention and Referral to Treatment (SBRIT) and FQHCs

The Substance Abuse and Mental Health Services Administration (SAMHSA) just issued the FY ’18 Screening, Brief Intervention and Referral to Treatment (SBIRT) Funding Opportunity Announcement (FOA): it has $35 million for five-year grants up to about $1 million per year for assessment/referral to substance abuse treatment—and, most interestingly for our discussion, FQHCs are listed among the laundry list of eligible applicants.

SAMHSA is pointing the way forward for many substance abuse providers: become an FQHC. This may seem odd, because FQHCs are supposed to be primary health care providers, while substance abuse treatment is not considered primary healthcare and is usually provided by narrowly focused agencies. But the depth of the opioid epidemic, in tandem with the overall growth of healthcare funding, means that many substance abuse providers are being pushed towards becoming FQHCs—even as many FQHCs are also being encouraged to expand into substance abuse treatment. And we know that, when it comes to the Feds, “encouraged” is often a euphemism for “get ‘er done.”

Many FQHCs, of course, don’t want to be substance abuse providers—but, as programs like SBRIT show, the amount of money available may be too tempting to refuse. Right now, it’s also tough for FQHCs to stretch their Section 330 grants to provide fully integrated behavioral heath services, including substance abuse treatment. HRSA occasionally issues Notices of Funding Opportunities (NOFOs) for FQHCs to enhance behavioral health services, but the operative word is “occasionally,” and there’s not enough HRSA funding for behavioral health services.

Few, if any, of our FQHC clients, have had SAMSHA grants and most are reluctant to apply. This may be a case of grant “tunnel vision” in which FQHCs focus on HRSA in the same way that public housing authorities (PHAs) often tether themselves to HUD grants. The wider grant universe, however, provides opportunities for diversity that can help organizations weather shifts in funder priorities. And to paraphrase a salesman’s advice given to William Holden’s Joe Gillis in Billy Wilder’s Sunset Boulevard, “As long as the lady is paying for it, why not take the Vicuna?”

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NIH opioid research grants are here; expect opioid treatment RFPs to come soon

In his review of Dreamland: The True Tale of America’s Opiate Epidemic” and in his post on the “New grant wave for Medication Assisted Treatment (MAT),” Isaac noted that the heroin and prescription drug addiction epidemic crisis is likely to generate new grant programs. Since then, the crisis has in some ways been getting worse, not better, especially in politically sensitive parts of the country. The federal response has so far been slower than we expected, but the NIH just released a trio of research grant RFPs focusing on “Marijuana, Prescription Opioid, or Prescription Benzodiazepine Drug Use Among Older Adults.” Those grants are under the NIH R01, R03, and R21 categories.

The only surprising thing about these RFPs is how long they’ve taken to hit the street. Every time you see a news article or watch a TV exposé about the opioid epidemic, the likelihood of federal action rises. And every time you see such an article or video, you should be thinking about how it will affect your own proposals.

For example, SAMHSA just released a new RFP for a very old program: “Targeted Capacity Expansion-HIV Program: Substance Use Disorder Treatment for Racial/Ethnic Minority Populations at High Risk for HIV/AIDS (Short Title: TCE-HIV: High Risk Populations).” Someone ought to tell SAMHSA that brevity is a virtue in program titles, but apart from that I’ll note that, if I were writing a TCE-HIV proposal, the needs assessment would be filled with data about opioid use. We have collectively known about the dangers of sharing needles for decades, but the present opioid issue gives new urgency to old problems.

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New grant wave forming for Medication Assisted Treatment (MAT)

A new grant wave is forming. An unexpected and shocking epidemic of heroin and prescription opioid addiction has erupted across America and the federal response is going to be a huge increase in funding for treatment and related services.

We’ve already seen signs of the grant wave in HRSA’s Substance Abuse Service Expansion program, which was designed to focus on “Medication-assisted Treatment in opioid use disorders.” Last week, the Obama Administration proposed a new $1 billion heroin treatment initiative involving pass-through grants to the states, which will in turn issue RFPs to local treatment providers, most of which will be nonprofits.

The new Obama initiative is to fund more medication-assisted treatment (MAT). Unlike the old methadone approach, MAT combines behavioral therapy with more modern medications to treat substance abuse disorders. While the Obama initiative is clearly aimed at treatment providers, peripheral grants are sure to become available for ancillary services like outreach, engagement, education and case management, most of which can be implemented by virtually any human services nonprofit.

Unlike many of President Obama’s proposals, the MAT grant initiative is likely to gain strong and quick bipartisan support in Congress, because vast stretches of rural America, as well as many suburbs and cities, are being overwhelmed by heroin, prescription opioid addiction, and concomitant ODs, often in the seemingly most unlikely of places. This includes over 400 ODs in New Hampshire in 2015. This bucolic state is not usually associated with a 22-year old woman overdosing in a squalid Nashua alley.

Listen to this heart-wrenching NRP story about how a middle aged and middle class New Hampshire makeup artist’s step daughter died. The makeup artist specializes in “painting” the presidential candidates that inundate NH every four years; she’s made-up everyone from Bernie Sanders to Mario Rubio this year. Each candidate has gotten an earful of the the addiction/OD crisis while captive in her chair.

In addition, almost every Democratic and Republican presidential candidate, with the possible exception of Hillary Clinton, seems to have been personally touched by the addiction and/or OD of a child, another relative, or a friend. It’s like Traffic writ large. Carly Fiorina and Chris Cristie regularly tell OD anecdotes as part of the their stump speeches, while Bernie and the now-out-of-the-race Rand Paul take a libertarian stand that prefers treatment over legal sanctions regarding substance abuse disorders.

When Bernie and Rand somehow agree on a major domestic policy issue, you know that the problem transcends politics. The US long-ago lost its 40-year “War on Drugs.” After over four decades of draconian law enforcement and incarceration that disproportionately affects communities of color, the net result is that heroin is actually cheaper than ever—the Washington Post reports that a bag of heroin costs less than a pack of cigarettes in much of America! High cigarette taxes are part of the reason, but heroin is not taxed. Taken together, these trends point to the need for nonprofits to be nimble enough to catch this cresting grant tsunami.

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Links: Grant writing training, Los Angeles, hospitals, skyscrapers, land use, bikes, SAMHSA disfunction, illnesses and more!

* A new study says it doesn’t matter how much time you spend with your kids. Anxious and neurotic upper-middle-class parents, consider yourself relieved. I don’t (particularly) recall wanting to wanting extensively to interact with my parents when I was a kid, though maybe my memory is flawed. (Lancy’s The Anthropology of Childhood is also relevant here.)

* We’ve updated the Seliger.com FAQ pages. Check it out! There’s even a new question, answered. We’ve also changed our stance, but not our emphasis, on grant writing training.

* “Finding the Dense City Hidden in Los Angeles,” which surprises me too.

* “Radical Vaccine Design Effective Against Herpes Viruses,” which is hugely important in many ways, and the development of this vaccine should retard AIDS transmission.

* As demand for welders resurges community colleges offer classes. Call this a counter-cyclical story!

* “An Interview With the NYU Professor Banned From the United Arab Emirates,” which tells you a lot about NYU.

* On government, voting, and costs.

* “Hospitals Are Robbing Us Blind: Forget Obamacare. The real villains in the American health care system are greedy hospitals and the politicians who protect them.”

* “Skyscrapers are all too evidently phallic symbols, monuments to capitalism and icons of hubris. Yet Will Self can’t help but love them. He explores their significance – from JG Ballard to Mad Men, and from London to Dubai.” I love skyscrapers too.

* “Poor land use in the world’s greatest cities carries a huge cost“—in financial, equality, and other terms.

* “Slumber Party! Casper leads a new crowd of startups in the $14 billion mattress industry, trying to turn the most utilitarian of purchases into a quirky, shareable adventure. Wake up to the new world of selling the fundane.”

* “Why I keep fixing my bike,” which is shockingly beautiful and about more than just the bike.

* “Bungling the Job on Substance Abuse and Mental Health: Employees at this federal agency rank it 298th out of 315 in a list of best places to work in the government.” Based on our interactions with SAMHSA we can’t say we’re surprised. Perhaps they should have more mental health counseling and coaching for SAMHSA staff? If so, we can definitely suggest some curriculums.

* “Thinking too highly of higher ed,” by Peter Thiel, who also wrote Zero to One (which you, like everyone, should read).

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The Existence of Drug Courts Implicitly Acknowledgement Failed Public Policy: An Example From the “Grants to Expand Substance Abuse Treatment Capacity” Program

Occasionally, an RFP will inadvertently show how one part of the government recognizes and tries to mitigate the unfortunate effects that come from another part of the government.

We—naturally—have an example of this principle in action: readers of last week’s e-mail grant newsletter probably saw “Grants to Expand Substance Abuse Treatment Capacity In Adult, Juvenile, and Family Drug Courts,” which offers funding “to expand and/or enhance substance abuse treatment services in existing adult, juvenile, and family “problem solving” courts which use the treatment drug court model in order to provide alcohol and drug treatment.”

Creating “‘problem solving’ courts” is another way of saying that conventional drug prohibition has failed, and conventional courts are a poor means of dealing with drugs. According to SAMHSA, they don’t solve problems; they are at best neutral, or they actually create problems. If they solved problems, we wouldn’t need new courts to solve problems.

Conventional courts, in other words, exacerbate the negative societal outcomes that drug laws impose or encourage. Right now, we’ve got a self-reinforcing legal system, because becoming involved in that system will ruin your life because the system itself will ruin your life for you.

SAMHSA realizes this to some extent. By funding “Grants to Expand Substance Abuse Treatment Capacity In Adult, Juvenile, and Family Drug Courts,” a combination of SAMHSA staffers and Congress are implicitly admitting that drug prohibition doesn’t work, and the enforcement effort behind prohibition doesn’t work. This is fairly obvious to anyone involved in the system, or anyone who has seen the movie Traffic and read Daniel Okrent’s brilliant book Last Call: The Rise and Fall of Prohibition. Or anyone who has read articles like “The global war on drugs has cost billions and taken countless lives — but achieved little. The scant results finally have politicians and experts joining calls for legalization.”

We, as a society, had the good sense to give up on Vietnam and now Afghanistan. Vietnam is now trying to join the global economy. The crazy system built around the “War on Drugs” helps no one except people employed as prison guards* and in other enforcement capacities. The money that we currently direct to prisons and police could be directed to treatment and prevention, while the black-market transactions that currently take place on street corners could take place in Rite-Aids and be taxed.

While I wouldn’t recommend that friends starting snorting coke every weekend, there are plenty of functional alcoholics and addicts out there. Alcoholism or drug abuse aren’t attractive lifestyles to me, but some people live them, and the second- and third-order effects of trying to stop those people are worse than the problems those people might cause by indulging in drugs or booze.

(Another note: there was $2,500,000 for this program in 2010 and almost $13,000,000 available now. This could be an example of random program funding drift, or it could say something about current federal priorities.)


* California’s guards are particularly pernicious, as “Fading are the peacemakers: One of California’s most powerful political forces may have peaked” and “Big Labor’s Lock ‘Em Up Mentality: How otherwise progressive unions stand in the way of a more humane correctional system” demonstrate. These problems are well-known to California policy wonks but too little known among everyone else.