National Council for Community and Behavioral Health Care’s 43rd Mental Health and Substance Abuse Conference
Las Vegas, Nevada
April 9, 2013
Thank you, Linda, for that introduction and for your leadership of this great organization. I want to recognize two great advocates who you’ll be honoring: former First Lady Rosalyn Carter and Congressman Patrick Kennedy. I join you in commending their outstanding service and advocacy. I’d also like to acknowledge our Substance Abuse and Mental Health Services Administrator Pam Hyde who is such a great leader on these issues and who is here today.
And finally I want to acknowledge all you – from service providers to advocates. Every day, millions of Americans look to you for support and a sense of hope. So I want to start by thanking you for all that you do back home in your communities.
It’s fitting that we’re gathered here today on the 50th anniversary of President Kennedy’s historic message to Congress on mental illness. It’s an opportunity both to look back to how far we’ve come, and to look forward to the work that remains.
On the one hand, we’ve made great progress since President Kennedy first called for a bold, new approach to mental health that emphasized prevention, treatment, education and recovery.
That message led to the Community Mental Health Act and federal investment in community mental health centers as an alternative to institutionalization.
Coverage of mental health care and substance abuse services was later expanded in programs like Medicare and Medicaid and in the private insurance market. Groundbreaking research translated into life-saving treatment. Laws like the Americans with Disabilities Act helped break down institutional barriers in our hospitals, homes, schools, and workplaces.
And most recently – and with the help of many people in this room – we launched the Surgeon General’s National Strategy on Suicide Prevention to integrate suicide prevention into public education and broader health care and workplace policies.
As a result, slowly but surely, attitudes toward mental illness and addiction have begun to change.
Yet, for all that we’ve accomplished over those fifty years – for all the progress we’ve made – we know that 60 percent of people with mental health conditions and nearly 90 percent of people with substance use disorders today still don’t receive the care they need.
So it’s clear that we have work to do. And today I’d like to talk about two ways we can move forward: reforming our health care system, and spurring a national dialogue about mental health.
For too long, our health care system has left too many Americans with behavioral health problems uninsured and underinsured.
In the past, nearly one in five individuals purchasing insurance didn’t have access to mental health services, and nearly one third had no coverage for substance use disorder services. And before federal parity laws, it was permissible for insurance plans to treat these disorders differently, offering less treatment or more oversight for these conditions compared to medical and surgical benefits.
An egregious double standard allowed many insurance plans to cover a sprained ankle while ignoring a serious illness like schizophrenia or not covering it at the same level.
But thanks to two historic laws, we’re closing these gaps in coverage. The Mental Health Parity and Addiction Equity Act ensures that mental health is covered on par with physical health – and President Obama has committed to issuing a final rule on the law this year. And the Affordable Care Act ensures that Americans have access to affordable coverage, and that their plans cover behavioral health benefits. Together, these laws will expand behavioral health benefits and federal parity protections to 62 million Americans.
We’re already seeing tremendous progress. Because of the Affordable Care Act, 17 million children can no longer be denied insurance because of a preexisting condition, like asthma or bi-polar disorder. More than 6.6 million young people from ages 19 to 26 can stay on their parents’ insurance plan at that critical age when we know behavioral health issues are likely to emerge or be exacerbated. More than 71 million Americans can now get free preventive services including screenings for alcohol abuse and depression.
The law is also promoting better care coordination that will benefit Americans with behavioral health conditions who also suffer from other chronic conditions, like heart disease or obesity. New delivery reforms are promoting prevention and early detection. And new medical home models mean patients can spend more time with primary care doctors who can help catch signs and symptoms of mental health and substance abuse problems. As Congressman Kennedy says, we need to assure “check-ups from the neck up” to make sure we are providing the most complete health care we can for the whole person.
Finally, the law will also make a difference for all of you who provide treatment and recovery support services, including bringing funding for services many of you have been providing without payment.
But perhaps the biggest impact this law will make is by expanding coverage, through new Health Insurance Marketplaces and expanded Medicaid programs, to people currently struggling with mental illness or substance abuse.
This is the biggest expansion in access to health coverage since Medicare and Medicaid – and it will have huge benefits for Americans who live with behavioral health issues. But here’s a key point. Just because people have access to new coverage doesn’t mean they know about it or that they’ll sign up. That’s especially true for young adults.
If you have children in their twenties like I do, you know that getting health insurance is not always the first priority for this group. I don’t know what their first priority is, but it certainly isn’t insurance.
But we also know that they are often the ones with the greatest behavioral health needs. Seventy-five percent of adult mental health conditions appear by the age of 24. If we don’t reach these young people, they’re not going to get covered and receive the care they need.
That’s why I’m asking for your help to reach out to young people, and to all the other Americans with and without mental illness or addiction who have been locked out of the system so long they’ve given up hope.
We need your help to find them, to let them know affordable coverage is within reach, and to sign them up. Open Enrollment in the Marketplaces starts on October 1 of this year, so the countdown is on. Talk to your colleagues and counsel the people and families who come to you for care. Visit healthcare.gov to sign up for updates and to get information you can share with your family, friends, and co-workers. And tell others about the site.
You can also make sure your intake workers are trained on how to help people access coverage options. And while SAMHSA is providing training and resources to help, we’ll also need the mental health and addiction communities to come together to get the job done.
If we can get people signed up for coverage this fall, we’ll be that much closer to our goal of every American having access to the behavioral health care they need. And we’ll be that much closer to helping all of you with the infrastructure you need to keep doing the good work you do in each and every community represented here today.
But let’s also be honest. Reducing barriers in the health care system alone isn’t enough. We can’t just change laws and policies. We also need to change hearts and minds.
While America has come a long way, we are still a country that too often confines conversations about mental health and addiction to the far edges of our discourse. We often fail to recognize the signs – and when we do, our first reaction is often not to reach out, but to turn away.
When we see someone having a heart attack, our instinct is to rush to help. Yet when we see someone in the middle of a psychotic or major depressive episode, our reaction is often to keep our head down and walk the other way. We often fail to recognize mental illness and substance abuse disorders as health conditions. We often see them as social problems – homelessness, juvenile justice issues, or social welfare concerns.
This is true not just for strangers, but also for our loved ones. Too often, we fail to offer support. We blame the person with illness. We tell people to toughen up or just stop an addiction.
If we can’t create a culture where people are able to talk openly about their mental illness or addiction, and can get help seeking care when they need it, then all the health reforms in the world will do no good.
In the aftermath of the tragedy at Newtown, there’s been an opening for these conversations to begin. While we know that the vast majority of Americans who struggle with a mental illness are not violent, as a nation, we’ve begun to ask what we can do to make sure our neighbors, friends, and family members can get the help they need.
That’s why President Obama and Vice President Biden put forth an ambitious agenda to make it easier for young people, adults, and families struggling with mental health problems to seek help and support.
And tomorrow, the President will unveil the part of his budget that makes a critical $160 million investment in the HHS programs that can make the difference – and builds on the promise of mental health parity – by expanding access to services, supporting research, and ensuring care for everyone ranging from students to our veterans.
The budget will invest in the mental health workforce to train more than 5,000 mental health professionals who can serve our young people, and advances new state-based strategies to prevent young people ages 16 to 24 with mental health problems from falling through the cracks when they leave home.
The President’s budget will also invest in Project AWARE, an effort to train teachers and other adults to detect and respond to signs of mental illness – and that could reach an additional 750,000 young people.
Project Aware also includes investments for “Mental Health First Aid”– something the National Council has been a real leader on – to train those teachers and school districts, law enforcement and local health agencies to identify early signs of mental health problems in young people and refer them to appropriate treatment.
In addition, the President’s budget will also support the CDC’s proposed research on the causes of gun violence and effective strategies to help prevent future tragedies – and to help students dealing with trauma and anxieties as a result of school violence.
But if we’re really going to turn a corner and keep moving forward, we need to expand the conversation that started after Newtown.
That’s why the President and Vice President have asked Secretary of Education Arne Duncan and me to start a National Dialogue on Mental Health. I know you are looking forward to the launch, and I can tell you it will occur soon and we’ll need help from all of you to help us move this agenda nationwide.
The National Dialogue will encourage community conversations, public and private partnerships, and online engagement across the country to increase national awareness about mental health, and reduce the fear, shame, and misperceptions that too often prevent people from getting the help they need.
It will seek to let people know it’s okay to talk about mental health if they are struggling and urge them to seek help. It will encourage people to reach out and to assist a struggling friend or loved one in finding help. And it will give people hope. It will let them know that prevention works, treatment is effective, and people do recover.
Today we have more effective support services than ever before. And the proof is in the tens of millions of Americans with behavioral health conditions living healthy lives and contributing to their communities. We need a dialogue across the country that tells those stories. And we need you, as behavioral health leaders, to help communities see behavioral health issues as public health issues, not as social problems.
We hope you will participate in the National Dialogue. And we’re eager for your input on how we can ensure it has the biggest possible reach.
What we ultimately want to do is take the conversations you’re having in this conference hall and bring them into school auditoriums, community centers, houses of worship, living rooms and kitchen tables across the country. And we can’t do it without you.
People will only benefit from the progress we’ve made if services are available – and if those who need help aren’t afraid to seek it out. All of us – community leaders, advocates, teachers, faith leaders, health providers, parents, neighbors, and friends – have a role to play to help make this happen.
Fifty years ago, speaking about a mental health system that led to indifference and isolation, President Kennedy said:
“This situation has been tolerated far too long. It has troubled our national conscience – but only as a problem unpleasant to mention, easy to postpone, and despairing of solution.”
Fifty years later, we’ve come a long way. But we still feel the urgency of those words.
Mental illness and addiction still trouble our national conscience. But because of the steps we’ve taken in the last few years – and because of your commitment – they are a challenge we can now confront openly, acting with haste, and secure in the knowledge that treatment works and that recovery is real.
So thank you again for what you do. And I look forward to working with all of you to ensure that before the next fifty years – or even the next five years – pass us by, we will bring behavioral health out of the shadows once and for all.