Jon M. Peha’s description of our nation’s emergency response interoperability clearly highlights the challenges we faced in the multiple attacks of September 11, 2001, as well as many other incidents that haven’t made national headlines (“Improving Public Safety Communications,” Issues, Winter 2007).
We in the Department of Homeland Security S&T Directorate (DHS S&T) charged with addressing these issues are as excited as Peha by the release of public safety spectrum in the 700-megaherz (MHz) range. As Peha correctly notes, the physical properties involved make this valuable “real estate.” Devices that use 700 MHz have reasonable range (though typically less than the lower-frequency bands) and good building penetration (though not as good as 400 MHz). These two attributes may help us address the communications problems commonly found in responding to terrorist attacks or natural disasters.
I also believe that this frequency allocation will spur broadband applications such as data and video, as well as promote uses not yet conceived. But most important, it will relieve pressure on public safety channels that are currently overloaded, even during routine operations.
I further agree that “fundamental changes in technology and public policy are needed” and many in government and the private sector are working to that end. However, I do not agree that only a nationwide broadband network can meet these needs. The sheer scale and complexity of the current national infrastructure require that we use what the DHS SAFECOM program describes as a system-of-systems approach.
This approach reflects the emergency response community’s vision for interoperable communications and its regard for the actual operational requirements articulated by the responders who use the systems and equipment. Where Peha argues that today’s flexibility has come “at the expense of standardization,” SAFECOM has shown that standards can increase competition, compatibility, and innovation—without federal mandates. SAFECOM emphasizes a bottom-up approach that puts a focus on user needs and capitalizes on the inherent robustness of a system of systems. Because local organizations own and operate more than 90% of the emergency response wireless infrastructure, any successful effort to improve emergency response interoperability must be driven by the local emergency responders themselves and take into account the fiscal realities they daily face.
DHS realizes that local governments alone cannot unite a patchwork of systems without a consistent overarching vision. That is why SAFECOM has developed tools such as the Statement of Requirements (SoR), a living document based on communications standards, written by and for practitioners. The SoR, along with coordinated Grant Guidance and other resources, is encouraging the design, manufacture, and procurement of equipment that will interoperate. Interoperability means greater consistency and leads to increased flexibility. The result is the implementation, where appropriate, of various information processing and other digital solutions to produce compatible systems now and without tying agencies to specific manufacturers.
But technology and standards alone are not the only answers. SAFECOM’s Interoperability Continuum identifies five factors critical for interoperability success: governance, standard operating procedures (SOPs), training, exercises, and usage. With practitioner guidance and input, SAFECOM is working with emergency responders to address each category. For example, our recently published template for the development of SOPs helps local governments address the critical human elements of the interoperability problem.
I agree there is no single silver-bullet solution, but I applaud Peha’s proposal of a 700-MHz solution as well as his analysis of the barriers to such a solution. His notion is a welcome addition to the debate on the interoperability issue. A successful approach to interoperability progress puts emergency responders in the lead, serves rural as well as urban areas, recognizes the existing investments across the nation and meets the reliability requirements of our emergency responders. In service of this critical national mission, we can do no less.
I agree with much of what Ambassador Richard E. Benedick has to say in his thoughtful piece on “Avoiding Gridlock on Climate Change” (Issues, Winter 2007). Although I am not yet convinced of an “impending” global catastrophe, nonetheless I believe that the principal measures called for in his paper can be justified from a risk management perspective. Rather than waste time quibbling over likelihoods, I feel that the probability of untoward events is sufficiently large to justify a variety of risk reduction measures.
I also agree that the challenge is to transform the United Nations (UN) Convention on Climate Change “into a forum for dissemination of new ideas and practical results, rather than an instrument for illusory consensus, rhetoric, and delay.” And I agree that to do this requires breaking from the UN’s traditional approach of consensus-seeking among nearly 190 nations. With the majority of emissions produced by a much smaller number of countries, Benedick asks somewhat rhetorically “Is it necessary to have everybody at the table?” The answer is a resounding no! His suggestion for a parallel structure of smaller, focused negotiation to achieve partial solutions to specific pieces of the problem seems eminently sensible.
The piece that Benedick chooses to focus on is technology development. He notes that “it is ironic that governments were negotiating emission reduction targets while simultaneously reducing their budgets for energy technology R&D.” He rightly notes that “technology development is the missing guest at the Kyoto feast.” The disconnect between targets and timetables and the costs required to achieve them has been a recurring theme in the climate debate. Nowhere is this more evident than in the assumption that inexpensive low-emitting technologies will somehow just materialize.
This is where Benedick’s call for focused negotiation among a smaller subset of players could be especially valuable. What is needed is an international consortium of developed-country investors (both public- and private-sector) to provide the technological wherewithal for the transition to a less carbon-intensive economy. These technologies are not only needed by developed countries to fulfill their emission reduction obligations but even more urgently by developing countries to fuel economic expansion in an environmentally compatible manner.
But despite the critical role of technology, certain market failures must first be addressed. There is need for a sustained commitment of resources on the part of the of developed-country governments to provide the basic research needed to lay the foundations for technology development, and the private sector of these countries must be given incentives to bring these technologies to the marketplace. Benedick and I may disagree over the role of market mechanisms versus command and control, but we are in complete agreement about the pivotal role of technology in meeting our climate goals.
Finally, I would like to thank Benedick for taking the time to reflect on an institution for which he has been a keen and thoughtful observer since its inception—the UN Framework Convention on Climate Change—but even more important, rather than being content to sit back and criticize, for offering practical suggestions for “putting the world back on the right path.” I commend his lucid and provocative article to those who missed it.
The aging psyche
“Growing Old or Living Long: Take Your Pick” (Issues, Winter 2007) by Laura L. Carstensen is a succinct summary of a growing body of work of great importance to our understanding of the psychological and emotional processes of aging; in particular, motivation. The work focuses on the real-life conditions of older people. What was once the privilege of the few has become the common destiny of the many, and the work Carstensen and her colleagues pursue directly benefits those who are living longer. She continues to explore what she calls socioemotional selectivity theory, a life-span theory of motivation.
According to Carstensen, when conditions create a sense of the fragility of life, both younger and older people prefer to pursue emotionally meaningful experiences and goals. The prospect of death contracts the sense of time and may be particularly relevant to the role of motivation in autobiographical memory.
It is reminiscent of an early paper by Eduardo Krapf, who wrote of the atrophy of a sense of the future, or “Torschsluspanik”: “panic at the closing door of the gate” [“On Ageing,” Proceedings of the Royal Society of Medicine 41 (1953): 957–963].
A critical question is “how could it be that aging, given inherent losses in critical capabilities, is associated with an improved sense of well-being?” One of her studies with an order of Catholic nuns supports “the idea that people remember their personal past positively over time,” in contrast to the experience itself. One possible interpretation of this finding is that older people find it difficult and even unacceptable to consider themselves to have lived unhappy lives.
The Carstensen studies were conducted on healthy older people. It would be interesting to undertake comparable studies of older people who report depression or are diagnosed as depressed.
R. William Johnstone’s “Not Safe Enough: Fixing Transportation Security” (Issues, Winter 2007) hits the nail precisely on the head. His refreshingly honest and realistic assessment of the current state of affairs not only avoids the D.C. bureaucratic two-step but shows his unmitigated nerve by daring to offer appropriate and effective changes to the transportation security system and its unfortunate failing policies. Few people have the credibility, critical thinking, and integrity to write such an article.
I am the former Transportation Security Agency Acting Director for Industry Training responsible for the initial design of the Federal Flight Deck Program (FFDO) (voluntary arming of pilots) and the Aviation Crew Member Self-Defense (CMSD) training program, which was made mandatory by the Homeland Security Act of 2002. Unfortunately, the CMSD program was later declared voluntary under pressure on both Congress and the administration from members of the industry. I also had a hand in rewriting the sensitive security document known as the Common Strategy. Hence, I can tell you that Johnstone’s concerns regarding the effectiveness of all elements of the new system are well founded.
I particularly share his concerns regarding the deficiencies in each of the onboard security measures. It is my sincere professional and personal opinion that the pilots and flight attendants have not received the appropriate security training needed to counter ongoing concerns regarding possible future terrorist attacks on commercial aviation. Additionally, knowing the level of Johnstone’s knowledge and documented research, I am equally confident that a lack of funding and comprehensive realistic training development and delivery plague all of the transportation industry.
Johnstone’s recommendations are well founded and supported. Congress must officially declare transportation security a matter of national security so that the administration will be free to treat it as such. This will go a long way toward alleviating the impact of dual mandates that cause transportation industry representatives to fight against sound security measures because of funding and control concerns. From here, maybe we can get back to working together to fight our common enemy and implement the other well-defined suggestions presented in Johnstone’s article.
The semiconductor industry epitomizes many of the points made by Robert D. Atkinson in “Deep Competitiveness” (Issues, Winter 2007). Atkinson’s call for a sense of urgency is underscored by recent trends in where semiconductors are made and sold. In 2002, 30% of semiconductor manufacturing equipment was sold in the United States, but this had fallen to only 19% by 2006. In 2000, more semiconductors were consumed in the United States than in any other region, but by 2004 there were twice as many semiconductors sold in the Asia/Pacific region than in the United States, and the gap has grown since.
The semiconductor industry’s successful comeback against Japanese competition in the 1980s also supports Atkinson’s rebuttal of those pundits who dismiss the seriousness of the current competitive challenge on the grounds that we met past challenges. As Atkinson notes, we overcame past challenges precisely because we took them seriously. The United States had fallen behind Japan in worldwide semiconductor market share in 1986, and many executives were determined that the chip industry not share the fate of the U.S. television industry, a sector that had suffered an irreversible decline that is readily apparent when one browses the flat-panel TV aisles in a store today. The United States responded with economic sanctions to enforce a trade agreement to open the Japan market and end Japanese dumping and with the formation of the SEMATECH industry/government research partnership. These actions were unprecedented at the time and were critical to the United States retaking semiconductor market share leadership in 1993.
Atkinson’s focus on an enhanced R&D credit and new industry/government/university research partnerships is echoed in the semiconductor industry’s current activities and policy recommendations. The value of the U.S. R&D credit is far below those of our trading partners, and other nations are quick to point out their tax advantages when companies are deciding where to expand their R&D activities.
The Semiconductor Industry Association has launched a Nanoelectronics Research Initiative (NRI) that pulls together the semiconductor companies, 23 universities in 12 states, state governments, and the National Science Foundation. The purpose of the NRI is to identify the next new logic switch, perhaps based on a particle’s spin or a molecule’s shape, to replace today’s transistor. The country whose companies are first to market will probably lead the coming nanoelectronics era in the way that the United States has led for half a century in microelectronics.
Robert D. Atkinson writes about competitiveness but has a more fundamental purpose in mind. He intends to influence the way we think about the economic past, present, and future.
Atkinson begins his argument by effectively debunking the myth that the 1980s semiconductor challenge from Japan was simply a mirage. He illustrates the way in which the federal government and the states responded with policies to support innovation, speed the movement of ideas from the laboratory to the living room, and forge pragmatic partnerships with a business world that was adapting Toyota’s high-performance workplace to U.S. conditions.
Atkinson is equally persuasive in taking on the idea that nations never compete.
He favors positive-sum efforts to compete through investment, innovation, and education but warns about national strategies based on what he calls “market mercantilism,” where countries seek an economic edge through currency manipulation and intellectual property theft.
Finally, he argues for a growth economics defined by our ability to innovate and to translate those innovations into investment and jobs in the United States.
I differ with Atkinson only in calling for even bolder action. His call for a world based on markets, not mercantilism, is sound but not equal to the current challenge. Record trade and account deficits weigh heavily on the U.S. manufacturing base and threaten the country’s long-term capacity for innovation. We should be moving now to multilateral negotiations with the world’s leading economies to restore trade balance. When the war on terror puts geopolitics ahead of economic priorities, we need to prevent the loss of key industries by compensating them in a way that will strengthen their innovative capacity. After all, the U.S. edge in national security has often depended on the strength of our economy and our capacity for innovation.
In addition to a comprehensive 21stcentury competitiveness strategy, we need a periodic presidential report on the state of the innovation system that will drive policy to build on strengths and correct weaknesses. A national commitment to seek new sources of energy can, like the space race of an earlier era, attract young Americans to careers in science and engineering, drive innovation, improve the environment, and add flexibility to foreign policy.
Atkinson makes a very important contribution by pointing to new ways of thinking about the economy and making several imaginative proposals in the policy arena. I can only second his call for a sense of urgency that will lead to action now.
Robert D. Atkinson’s article on competitiveness talks of various incentives and subsidies to industry to encourage progress. But any pyschologist will tell you that two motives are better than one, and the lure of profits needs to be supplemented by the fear of competitors.
It took foreign competition to force our automakers to improve. This is not a matter of private enterprise versus government. The reason tractor manufacture in Russia was so bad was that there was only one factory making tractors. Why not look at the massive U.S. mergers and acquisitions that promise to reduce competition and the various other ways in which we protect profits from any erosion? The very fact that economists assume there must be unemployment to prevent inflation implies some lack of real competition. And do we really do the rest of the world a favor by exporting subsidized farm products?
Robert D. Atkinson begins his article with a call for action to meet the challenges facing the United States in a global economy, and he has a point. The factual analysis presented in the recent Council on Competitiveness report Competitive Index: Where America Stands recognizes that despite America’s considerable economic achievements over the past two decades, there are serious warning signs that need to be heeded.
Identifying fundamental research and a skilled workforce as critical to competitiveness also puts him in good company. The National Science Board, the President’s Council of Advisors on Science and Technology, and the National Academy of Engineering are among those who make the same case. The need for a genuinely level international economic playing field has been articulated by the Council on Competitiveness.
Atkinson’s approach complements what the Council on Competitiveness has called the “innovation ecosystem.” Innovation requires the interaction of a number of factors in geographic proximity. It calls for research universities to interact with industry and provide networking for the start-up companies they spin off. It requires the presence of a skilled workforce and of venture capital. It requires tangible infrastructure such as broadband access as well as the intangible infrastructure of innovation-friendly policies. These ingredients must balance and complement each other.
I welcome Atkinson’s appreciation for the importance of university/industry interaction, which can have a profound effect on economic development. Twenty-five percent of Georgia Tech’s research is conducted with industry, compared to a national average of 8%, and we have operated a successful technology incubator for over 25 years. In the past decade, we have spun off 75 companies. Such activities benefit universities and their students by teaching about the issues facing industry and their customers.
I also commend Atkinson’s support for expanding the federal R&D portfolio, which would enable a better balance of the physical sciences and engineering with health and medicine. For too long, patterns of funding have left physical sciences and engineering behind, which makes no sense given that the interdisciplinary nature of innovation requires all disciplines to move forward together. Congress and the president have signaled an intention to address this imbalance, but progress has been slow.
My concern about Atkinson’s proposals is his advocacy of a $2 billion fund to support industry/university research alliances. These days funds of this magnitude are scarce, and $2 billion would go a long way toward doubling the budget of the National Science Foundation (NSF), directly addressing the rebalancing of the federal R&D portfolio. Second, past attempts at funding programs for industry/university alliances have caused controversy relative to who gets the funding, why a major industry that already supports research should receive federal funding, and how to balance shares between industry and universities.
Agency-based industry/university/government programs that are carefully structured can and do work. For example, NSF’s Science and Technology Centers require industry involvement and support of the research. However, creating a large federal entity to drive industry/university/government collaboration is likely to be unworkable and create more problems than it solves.
The article by Joan Johnson-Freese in the Winter 2007 Issues (“The New U.S. Space Policy: A Turn Toward Militancy?”) is a welcome respite from the spin forthcoming from official State and Defense Department quarters. In light of the recent Chinese test of a destructive antisatellite (ASAT) weapon, Johnson-Freese’s article is also eerily prescient, noting “If the United States proceeds with development of these technologies, at staggering cost, others can and will do the same, only in a cheaper, easier, defensive mode.” From news leaking about long-term planning for the test, it seems Beijing had already made up its mind about the U.S. pathway in space and decided to do something to counter it.
Granted, the motivation behind the Chinese test is highly unclear, in part because of the long-term U.S. policy against engagement with China regarding the future of military space. There are several possible interpretations: (1) The Chinese had long ago decided that they needed an offensive and asymmetric strategy of holding U.S. space assets at risk in any conflict over Taiwan, and Beijing’s diplomatic offensive against the space weaponization was a cover to buy time to achieve that capability. (2) The Chinese ASAT test was conceived largely as a deterrent to U.S. space-based missile defenses, which China views as a threat to its nuclear deterrent, rather than an offensive program. (3) The test is an effort to bring the United States to the negotiating table over space-based missile defense and space weapons; a classic Cold War “two-track” tactic using a display of hard power to jolt the other side into discussions and to ensure possession of a bargaining chip.
Whatever the motivation, the test was reckless and irresponsible in that it resulted in large quantities of space debris that will remain in orbit for decades and pose a threat to all satellites in nearby regions. It therefore highlights in a very dramatic way the need for responsible nations to come together to establish rules of the road for behavior in space, both in peacetime and in wartime (those cases may be different, but that needs to be discussed) and methods to enforce those rules.
It also lays bare the fallacy of the long-held U.S. position against engaging with others regarding the future military uses of space, as well as the emptiness of the Bush administration’s harsh rhetoric. This approach has failed to “dissuade or deter” a potential adversary from “developing capabilities” to impede U.S. freedom of action in space. It has also undercut established norms against testing ASAT weapons by insisting on keeping U.S. options to do so. Further, it has provided political cover for a potential adversary to argue that it is only reacting to “threats” from the United States. It is time to rethink this head-in-the-sand approach and for the U.S. government to take the lead in discussions aimed at establishing clear guidelines regarding what is acceptable and unacceptable behavior in space for all players. As the Chinese have demonstrated, the United States may still hold primacy in space, but it doesn’t own it. Insisting on complete freedom of action regarding military space will not reduce future threats to U.S. space assets but create a Wild West environment where everyone is less secure.
While Joan Johnson-Freese had her ear to the ground listening for “the words ‘space weapons’ “ from the new U.S. space policy that she analyzes (or for “the echo of such sentiments” as she later writes), a soundless bolt from the blue (perhaps in space it should be called a bolt from the black) was preparing to strike: the Chinese antisatellite (ASAT) missile test of January 12, 2007. The “incoherence and disingenuousness—and militancy” of U.S. policy that she diagnosed (with some justification) have now been dwarfed by even greater incoherence and disingenuousness from China.
She argues that the new U.S. space policy “perpetuat[es] the false belief that space assets can be defended; in reality, it is impractical if not impossible from a technical perspective to defend space assets.” This is an important conclusion, but it is not well supported in this article; it is only assumed to be true. It leads to a policy recommendation: “The only way to protect assets is to outlaw attacks and the technologies that enable attacks” and to “try” (she might more accurately have written “hope”) to develop a legal regime to verify any such attacks once they occur.
Two problems with this approach are not adequately addressed in the article. First, the concept of outlawing anything requires a detection and enforcement mechanism that is strikingly absent (and perhaps congenitally impossible) in this arena. Second, the technologies that enable such attacks are inherently impossible to exhaustively define, as she indicates in her own words: “Given the dual-use nature of space technology, almost anything shot out of the atmosphere might qualify.”
The Chinese ASAT missile was clearly a space weapon, for example, but what about the small free-flier spacecraft just announced that will be deployed from Shenzhou-8 next year to televise the planned spacewalk? That same piece of hardware, delivered on a small automated rendezvous vehicle (of the type being developed by a dozen different programs around the world), would be a very effective weapon against a spacecraft considered a military target. Resolving this definitional dilemma remains a critical challenge for developing treaties, laws, and codes of conduct that will have any reliable utility.
Johnson-Freese perceptively draws attention to widespread suspicions about U.S. military intentions in space, which she lays at the door of the writers of that policy but which perhaps have been sparked by other agencies that she also describes. She cites an October 19 article in the Times of London that denounces what it sees as the “comically proprietary tone about the U.S.’s right to control access to the rest of the solar system,” and she correctly observes that the wording of the actual policy makes it “difficult to characterize its purpose so bluntly.”
But then she adds that “this negative perception certainly exists,” as if it were the fault of the policy itself rather than the fault of journalists who inaccurately reported that the policy said that the U.S. would deny access to space to anyone it chose, and of other journalists who copied the error without taking the trouble to read the policy. Perhaps they, like Johnson-Freese in her own admission, were “hearing” things in the policy that weren’t really there and unfairly disregarded subsequent U.S. clarifications. Her now-ironic rationalization of such misplaced but inflammatory suspicions against the United States is expressed in the words “actions sometimes speak louder.”
On January 12, 2007, they did indeed speak louder and may have drowned out the heart of Johnson-Freese’s argument.
In his thoughtful comments (in Forum, Issues, Winter 2007) on Thomas C. Schelling’s article on nuclear deterrence (“Nuclear Deterrence for the Future,” Issues, Fall 2006), Richard Garwin says that “Deterrence of terrorist use of nuclear weapons by threat of retaliation against the terrorist group has little weight, when we are doing everything possible to detect and kill the terrorists even when they don’t have nuclear weapons.” Schelling, in his article, stresses the difficulty that terrorists might have in constructing a weapon and suggests that if they do acquire one, they may use it strategically rather than in the punitive way of the 9/11 attacks. He notes that a main problem facing them if they want to construct a bomb would be the acquisition of nuclear materials. Garwin outlines steps to make it difficult or impossible for the terrorists to acquire such materials or to acquire a complete nuclear weapon.
Although I agree wholeheartedly with the need for and advisability of carrying out the steps Garwin recommends, I am dubious about our ability to ensure that they can be 100% successful. Moises Naim, in his book Illicit (New York: Doubleday, 2005), describes a vast global smuggling network that has demonstrated the ability to bypass all means put in place to stop such activity. There is no reason to believe that the security of nuclear weapons or materials, however tight, will be totally leak-proof under the assault of such a network. There must therefore be a way to make deterrence work in this context, along with the preventive measures Garwin recommends.
It is true that transnational terrorists by definition don’t present the kind of target that permits the threat of retaliation against a country that has characterized nuclear deterrence in the past. The essence of deterrence, however, is not necessarily contained within national boundaries. Deterrence works when the deterree perceives that a retaliatory attack in response to an aggressive act will cost the deterree so much that any potential gains from the initial attack are vastly outweighed by the losses that would result from the inevitable counterstrike. There are a number of potential targets that today’s terrorists who are most threatening to the United States must hold so dear that if they were destroyed in a counterstrike the terrorists would be deprived of their raison d’etre. Those targets may be distributed in countries other than those from which the terrorists may be operating; a retaliatory attack against them would not be designed to kill terrorists per se, as Garwin suggests, but rather to remove from them the very thing they are fighting for. In the process, the roots of their civilization could be threatened or even eliminated.
Thus, a warning to the effect that a terrorist nuclear attack on the United States would put at risk all that the terrorists hold most dear could have the desired deterrent effect. Indeed, if made with the correct wording, it should stimulate the countries within which terrorists may be hiding and plotting to exert greater efforts than they appear to have been doing to put the terrorists out of business—in their own defense if not out of sympathy for the United States. The precise targets need not be specified; the terrorists and the countries harboring them will know what they are.
It may be argued that the United States would not strike back in such a way, precisely because the strike could hit countries and peoples that are far removed from the terrorists who made the attack on the United States and that may not even be harboring such terrorists at the time of the attack. However, the world should learn from history not to underestimate the potential of the United States to react in violent and unexpected ways when it finds itself or its vital interests to be under extreme stress. The examples of Pearl Harbor, Korea, and Kuwait are the most outstanding of many such examples from 20th-century history. If a nuclear weapon of terrorist origin explodes in a major U.S. city such as New York or Washington, leaving several hundred thousand people dead and a large part of the city devastated, the terrorists don’t know what might motivate the United States as it strikes back in anger. Respect for country boundaries and innocent peoples could look very different after such an event, especially if it is a decapitating strike and lower levels of the U.S. government and U.S. military are the ones who are making the decisions about retaliation.
In the mid-1990s, the Naval Studies Board of the National Academy of Sciences carried out a study, under U.S. Navy sponsorship, of post–Cold War conflict deterrence. The study was chaired by the late Gen. Andrew Goodpaster, formerly Supreme Allied Commander of NATO forces. Garwin, Schelling, and myself, among many others, were participants. The study report [Post–Cold War Conflict Deterrence (Washington, DC: National Academy Press, 1997)] did not reach any firm conclusions about the use of nuclear weapons for deterrence, but it noted the body of opinion that in the emerging post–Cold War environment of international relationships, our nuclear weapons would be useful only to deter the use of nuclear weapons by others. The report emphasized that the conditions of deterrence remained to be worked out. It also emphasized the importance of communicating the resulting policies, with appropriate allocations of both clarity and ambiguity, to potential adversaries.
The recommended work to devise new deterrence policies to fit modern conditions has yet to be undertaken seriously. We should not leave one of the most dangerous and unpredictable threats to U.S. and world security out of such consideration.
The article, A Healthy Mind for a Healthy Population (Issues, Summer 2006), asserts that health care for mental problems and substance use conditions “requires fundamental redesign.” I could not agree more. As the newly confirmed Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), within the Department of Health and Human Services, I share the author’s concerns regarding quality, access, and outcomes of behavioral health services in the United States (U.S.).
I am pleased to report that SAMHSA has already taken steps to “transform” mental health care in America and implemented a new, innovative financing approach for substance abuse treatment and recovery support services. The President’s New Freedom Initiative and Access to Recovery program have cemented recovery as the new framework for public policy development in mental health and substance abuse services in this country. However, in lieu of providing a litany of SAMHSA’s many important activities already under way to achieve improved access and higher quality services, we must remain focused on how much is yet to be accomplished.
New data point to the alarming and unacceptable rates of early mortality and morbidity for people with serious mental illnesses, a loss of 25 years. Sadly, these years lost to early death and disability are primarily attributable to a lack of attention to consumers’ physical healthcare needs. And after years of debate, we have established that individuals with co-occurring mental and substance use disorders should be the expectation, not the exception in our treatment systems. While we have made notable strides in this area over the past decade, there is yet much to be achieved when it comes to ensuring that access to services exist, evidence-based practices are applied, and financing structures promote, not hinder, integrated care. Our own 2005 data tells us that among the 5.2 million adults with both serious mental and substance use problems fewer than half (47%) received mental health treatment or substance use treatment at a specialty facility. Only 8.5% received treatment for both mental health problems and substance use treatment.
To continue our quest for quality improvement, we must continue efforts to reduce the significant lag time between the generation of new scientific knowledge and its application at the community level by prevention and treatment programs and providers. These issues demand our attention and our action. Through SAMHSA’s partnership with the states to adopt a few carefully chosen national and state-level outcome measures, we are building accountability and effectiveness measures into every grant dollar and agency program, rewarding performance with proven results at the levels of the individual, family, community, and service system as well as measuring our own effectiveness as an agency
SAMHSA welcomes the support provided in the article for the work we are doing. We hope this will help open further doors when collaborating with consumers, family members, clinicians, academicians, policymakers, and administrators in behavioral health. Together, through concerted efforts, we can effectively make recovery the outcome for those persons with mental and substance abuse disorders.