29th Rosalynn Carter Symposium on Mental Health
November 8, 2013
As Prepared for Delivery
Thank you, Madam First Lady (Carter). For more than a generation, you’ve been one of our country’s leading voices on behalf of Americans living with mental health issues.
Your advocacy on behalf of the Mental Health Parity and Addiction Equity Act, in particular – more on this in a moment – has made a tremendous difference.
I’m delighted to have this opportunity to join all of you at the Carter Center, here in Atlanta. You know, Ray Charles famously sang about “Georgia on My Mind.” For nearly three decades this symposium has been Georgia for the Mind. And year after year, the road to progress leads back to you.
Madam First Lady, if I could – I wanted to share a few of the words you wrote back in 2003, because they still resonate a decade later:
“We know so much more today,” you wrote, “and yet the problems are still very much the same, with one exception: recovery. Twenty five years ago, we did not dream that people might someday be able actually to recover from mental illnesses. Today it is a very real possibility.”
This hasn’t happened on its own. We’ve gotten to where we are today because of so many of you who are here at this symposium today, who’ve worked and advocated and fought so hard for so many years.
I think we’d all agree that our work is not done.
I know that I’m not alone in this room when I say that this is personal for me. In the last six months, I’ve had two family members experience crises. Both of them eventually were able to receive help and support because they had resources and friends and family to turn to. But it was not easy, in either case. And the hand-off from crisis stabilization to community support was rocky, to say the least.
The “coordination” wasn’t really “coordinated.” And I run the Department of Health and Human Services. I know what assistance is out there. And I have an amazing array of caring experts to give advice.
Beyond the personal toll for families and individuals, we have much work to do as a country, to help people achieve the promise of recovery:
Nine in 10 Americans with substance use disorders do not receive the care they need.
And 60% of Americans living with a mental health conditions do not receive the care they need.
We need to expand access to treatment, services, and support. And in this vein, I have some very big news to share with you – news that I know many of you have been anxiously awaiting:
Later this morning, we will issue the final Parity Rule.
In tandem with the Affordable Care Act, the Parity Rule will expand and protect behavioral health benefits for more than 62 million Americans.
This is the largest expansion of behavioral health coverage in a generation – and it’s thanks to the efforts of so many of you who are with us today, including and especially, Rosalynn Carter.
This rule is reality, because of the leadership of President Obama, who committed to getting this done by the end of the year.
And it has been bolstered by Americans from throughout our country who submitted 5,400 public comments that helped guide us through writing the final rule.
I want to share with you a few details…
The Parity Rule, as many of you know, governs how large group health plans offer coverage for mental health and substance use conditions. Coverage for these conditions, when offered, must be comparable to coverage for medical and surgical care.
The regulation also includes important consumer protections that make clear that the insurance companies which offer these plans must provide information on how coverage is determined. This helps ensure that there is transparency and compliance with the law.
The final rule makes these protections stronger:
- Insurance companies are now required to use comparable clinical standards and cost considerations for both physical and mental health and addiction benefits.
- Insurance companies are now required to provide their customers with information about the standards they use to evaluate claims – especially when they reject a claim. As an example, they have to disclose how they decide what services are “medically necessary.”
- And parity protections for mental and substance use disorder services now apply to “intermediate levels of care” – services that fall somewhere in between hospital care and a visit to the doctor’s office.
Mental health parity and addiction equity is the law of the land, and it’s already making a difference for everyday Americans in every part of our country.
We will release a study later today which finds that large, employer-based health plans have been making important strides.
For example, nearly all large health plans have eliminated higher cost-sharing for inpatient behavioral health care services. And most have done the same for outpatient care as well.
Most have also stopped charging different deductibles for mental health and substance use services.
What’s more, there has been a significant decline in restrictive day limits on inpatient care, and outpatient visit limits have been largely eliminated.
Now, these reforms apply to large group plans. The Affordable Care Act provides similar parity provisions to individual and small group plans, as well.
And this is one of several ways the new law’s benefits enhance prevention and treatment of mental illness and addiction, and provides support for Americans in recovery.
For the 85% of Americans who have health coverage, the Affordable Care Act expands access to mental health and substance abuse preventive services, like screenings for alcohol abuse and depression, and behavioral assessments for children – all without copays or other out-of-pocket fees.
It prevents insurance companies from denying coverage or charging more based on pre-existing conditions like bipolar disorder and depression.
And it allows young people to stay on their parents’ plan until age 26. This can help young people who have their first episodes of psychosis. With three quarters of mental illness occurring by age 24, this is a critically important time in a young person’s life to have coverage.
For the 15% of Americans who do not have insurance, and those who purchase coverage on their own, the new Health Insurance Marketplace is an opportunity to obtain coverage which, by law, must include mental health and substance abuse treatment services (and have those services covered at parity with medical and surgical benefits).
For all the inexcusable problems we’ve had with HealthCare.gov – and we are making progress toward fixing them every day – the new law is much more than a website.
It’s an opportunity for millions of Americans to obtain preventive services, treatment, and care for both behavioral health and physical health. And no one will ever again be denied coverage based on a pre-existing health condition – mental or physical.
I should also note that Americans continue to sign up every day online, on the phone, on paper, and in person.
In fact later today, I’ll be visiting the Southside Medical Center here in Atlanta, one of many Community Health Centers all across our country which is offering in person assistance.
Those of you I saw in Boston a couple weeks ago at the Kennedy Forum heard me run through a few of the other significant initiatives we have underway. As a great son of Atlanta (Martin Luther King Jr.) said, it’s important to preach to the choir, because otherwise they might stop singing.
So I just want to run through a few of these things, briefly.
Each year, we lose more than twice as many Americans to suicide as we do to homicide. To reverse this trend, we’re a part of the National Suicide Prevention Strategy that was launched by the National Action Alliance.
We’re also taking steps to meet the demand for mental health and substance abuse treatment services for veterans, service members and their families. These efforts are led by an amazing team of First Lady Michelle Obama, and her great partner, Dr. Jill Biden.
At HHS, we’ve joined with foundations, health providers, faith leaders, school leaders and advocates to work on an unprecedented national effort on bullying prevention: encouraging Americans to “stop bullying on the spot” and to give all our kids a safe space to grow up healthy.
And in Boston we announced $57 million in new Safe Schools/Healthy Students grants, to further our efforts to give our kids a healthy start.
President Obama has also proposed a new $130 million initiative to create job opportunities, support “Mental Health First Aid,” and get help for students who show signs of mental illness.
Changing Hearts & Minds
I wanted to return for a moment, to Rosalynn Carter’s words: “We know so much more today.”
If, 29 years from now, we want to look back and be able to say the same, then as a country – and perhaps as a world – we need to expand our understanding: our understanding of one another and our understanding of the science of the human brain.
We need to move beyond the idea that when we talk about mental health, we’re talking about somebody else. It’s not somebody else. It’s all of us.
I would argue, therefore, that our biggest challenge in terms of these issues is not a challenge of the head, but of the heart.
Just think for a second of how different things would be if everyone felt like they could access treatment without the fear of being judged. Imagine what it would mean if people felt as comfortable saying they were going for counseling as they are for a flu shot or physical therapy.
All of us here today have a role to play to help make this happen.
And one of our best allies in this movement is the President of the United States.
President Obama has 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.
Under his direction, I’ve been working with Secretary of Education Arne Duncan to host community conversations across the country to increase awareness about mental health and recovery– and many of you have been a part of them.
As we work to move the culture, we are also pushing to advance the science.
At the National Institutes of Health, some of the world’s leading scientists are pushing the outer-bounds of discovery as they work to better understand the human brain.
Their work is allowing us to improve – in dramatic fashion - the accuracy of how we diagnose mental illness.
And it is fueling previously unimagined advances in the ways we treat mental illness – making treatment safer and more effective.
As we speak, NIH scientists are working on new, faster-acting anti-depression medications that could help patients who are not responding to the medicines on the market today.
Meanwhile, millions of patients are benefiting from new, cutting-edge advances in counseling and therapy, which are guided by new research, and designed for specific illnesses.
And just think what we could be accomplishing if the so-called sequester wasn’t dramatically reducing research budgets and slashing funding for critical services.
President Obama believes in this research. And he has proposed a $100 million investment to study and map the human brain.
As Vice President Biden has said, “It’s truly amazing what we don’t know, and it’s even more astounding what we might learn.”
We truly have come a long way in the 29 years since this symposium was first held. And we still have a long ways to go.
But what we do know is that we’re at a unique moment in our history. As Rosalynn Carter has spoken about so eloquently, the things we are on the verge of achieving today, are things we didn’t even dare dream about, just a generation ago.
We have a very real opportunity to improve – and in some cases save - the lives of millions of our friends, neighbors and family members.
We have to change hearts in order to treat minds. We need an “all-hands-on-deck” approach. We need the sort of hard work and dedication that so many of you have put into this movement for so many years.
The road to progress leads back to you.
Thank you all very much.