Mental Health America Presents Recommendations for Action at "Mental Health in America" Briefing
Contact: Steve Vetzner, (703) 797-2588 or svetzner@mentalhealthamerica.net
ALEXANDRIA, Va. (January 22, 2013)—Wayne W. Lindstrom, Ph.D., president and CEO of Mental Health America, was one of a panel of experts to present recommendations on Tuesday at a briefing and panel discussion entitled “Mental Health in America,” hosted by members of the House Democratic Gun violence Prevention Task Force. His prepared remarks are below:
“We applaud President Obama for making mental health a priority, including expanding mental health services and placing an emphasis on prevention, early identification and treatment of mental health conditions, in the plan he issued last week. The President embraced many of the steps and initiatives that Mental Health America recommended to Vice President Biden’s Task Force and in meetings with administration officials.
“In particular, MHA is encouraged by the plan’s commitment to issuing a final rule for the Mental Health Parity and Addiction Equity Act, assuring the mental health community that the final rule on the essential health benefits will ensure small group and individual plans in the Exchanges include mental health benefits at parity, and requiring that current state Medicaid programs and the Medicaid expansion cover all required mental health services and comply with parity are all vital to expanding access to services. These steps are all vital to expanding access to services (which ought to include a call for reinforcing the Early Periodic Screening Diagnosis and Treatment in every state Medicaid program to improve the health of low-income children), meeting the workforce challenges across the disciplines, and ending the freeze on gun violence research.
“The president’s plan represents the beginning of a sea change in the way we look at and talk about mental health in this country. It acknowledges that this tragedy is a public health issue. It also recognizes that there is no health without mental health. This is true of individuals, communities and our nation. It is well understood that people recover from even the most serious mental health and addiction challenges and that mental health promotion initiatives foster healthier individuals and communities.
“It is important to note that just as there is no health without mental health, there are no services and supports without appropriate investments. Mental health and substance use systems have been chronically underfunded, despite the fact that recovery is real, and there are effective evidenced-based and promising practices for prevention, intervention and treatments. Since 2009, state budgets have been cut by $4.6 billion for recovery focused, community-based mental health and addiction services. Given these huge cuts in the states, I urge Congress to avoid further cuts in any fiscal or budget negotiation and instead provide funding increases for mental health and addiction services.
“With meaningful investments, the next step is to change the national conversation. We must decouple the immediate thought that mental illness equals violence; it does not. In fact, people with mental illnesses are much more likely to be victims of a crime than perpetrators. But violence does impact mental health. Witnessing violence in our communities and homes is traumatic, and experiencing trauma can lead to a myriad of mental health, substance use, and emotional and relational issues.
“Our priority must be to facilitate the pathways for people to access appropriate treatment and supports without fear of shame, marginalization and discrimination. We have the knowledge of what works, including the policy tools to implement those practices, and how to fight the self-stigma that keeps people from seeking treatment, the real fear of discrimination if they do, and the barriers to accessing treatment and supports without full insurance parity. We must invest in mental health and addiction services that promote hope, recovery and community inclusion.
“I want to focus on two areas highlighted in the president’s plan—the need for a greater investment in the prevention, early identification and treatment of mental health conditions and the call for a national dialogue led by Secretaries Sebelius and Duncan on mental health.
“The President recognized the importance of prevention, early identification and treatment of mental health conditions and expanding services to young people. Mental health conditions are the chronic conditions of our youth. Half of all individuals with a mental illness experience the onset—the initial manifestations—of the disorder by the age of 14, but do not seek treatment, on average, until the age of 24. A challenge in addressing this set of chronic conditions is this 8-10 year treatment gap, which compels us to reach out to children and adolescents more “upstream.” Given the early onset of emotional and behavioral disorders and their subsequent direct and indirect costs—estimated at $247 billion annually—investments in early intervention programs, especially those that better connect health and education systems, should be prioritized.
“There is strong evidence that these interventions work. Mental Health America, the National Association of State Mental Health Program Directors and Vanguard Communications completed a project that summarized the literature and allowed various audiences to understand the importance of prevention and promotion. With further investments, we can produce a strategy for translating these materials into a toolkit that can be used by community based organizations to implement mental health promotion and mental illness and addiction prevention initiatives, as well as to advocate for their implementation in every community.
“MHA commends the federal Substance Abuse and Mental Health Services Administration (SAMHSA) for designating prevention as their first strategic priority. Consistent with this priority, SAMHSA and the Department of Health and Human Services are attempting to increase the ability of states, communities and families to prevent mental health and substance use conditions and promote mental health. Arguably, the national context for initiating Mental, Emotional and Behavioral (MEB) prevention and promotion initiatives has never been more favorable.
“Congress, in responding in part to the voluminous data regarding the underperformance and expense of the U.S. health care system, included the Prevention and Public Health Fund (PPHF) and the National Prevention Strategy (NPS) in the Affordable Care Act (ACA) – shifting the focus from treating illness to preventing them and promoting health. MHA urges decision-makers to utilize the NPS, which prioritized mental health and addiction prevention, and the PPHF to implement a wide range of prevention and wellness promotion activities, including individual and community-based interventions, primary and secondary prevention interventions, and early intervention programs.
“In releasing the plan, Secretary Sebelius called on the Centers for Disease Control to stand with SAMHSA and NIMH. This collaboration is monumental in enlisting the CDC to operationalize our prevention strategies. To that end, I would urge the CDC to utilize the Community Transformation Grants (CTG’s), new streams of funding for communities to finance the implementation of the NPS and other prevention strategies, as a means to weave behavioral health interventions more strongly into general public health strategies than has traditionally been the case. For example, if nearly half the population that smokes has a behavioral health condition or if those with mental disorders have high rates of obesity, it makes no sense not to include this vulnerable population in these efforts.
“In addition, there is polling data that supports prioritizing a prevention portfolio. The public overwhelmingly supports allocating resources towards community prevention initiatives, described as efforts to make it easier for people to maintain their health and make healthier choices (73% support with 43% strong support vs. 20% oppose). Support and intensity are lower when taxes are mentioned, but a solid majority is still in favor with this tougher language (61% support with 32% strong support vs. 34% oppose).
“I would recommend that CDC partner with SAMHSA and NIH to have a mix of the three types of primary prevention – universal, selective and indicated interventions. These strategies will minimize adverse childhood experiences, which can occur at multiple levels, including biological, psychological, family, community, and cultural levels, and foster protective factors, which are defined as characteristics at the individual, family, or community that are associated with a lower likelihood of problem outcomes.
“Based on the implementation literature as well as on the experience of existing community based programs (e.g. Communities that Care and Promoting school-university-community Partnerships to Enhance Resilience (PROSPER), there are many evidence-based interventions that can have long-term impacts on our communities—namely, the Good Behavior Game, Positive Behavioral Interventions and Supports, Incredible Years. There are also a number of programs at the Health Resources and Services Administration (HRSA), including home visitation program, and SAMHSA, including suicide prevention, systems of care, Healthy Students/Safe Schools, Project LAUNCH, which can be brought to scale in a state or the nation.
“These interventions are at the heart of a piece of legislation that MHA has supported for a number of years now. I urge Congress to enact the Mental Health in Schools Act (HR 751 in 112th Congress), which would provide funding for public schools across the country to partner with local mental health professionals to establish on-site mental health care services for students. Research has demonstrated that prevention and early intervention strategies strengthen children’s and families’ mental health and resiliency, prevent or lessen the burden of chronic illness, and help with the recovery from trauma. MHA pledges our commitment to continue to work with House and Senate members to reintroduce this bill and get it enacted.
“Finally, MHA embraces the President’s call for a national dialogue on mental health that is critical to changing the conversation surrounding mental health, improving understanding and eliminating stigma. MHA, along with our affiliate network, welcomes the opportunity to have an active role in this dialogue.
“We may be able to capitalize on these ‘learning moments’ to engage the public in a broader conversation about the role of behavioral health in community well-being and productivity. The goals of the initiative should be to:
· Elicit community opinion regarding the most important problems that they are confronting and the factors that they believe underlie these challenges.
· Provide trusted and helpful information regarding the role of behavioral health in community health, safety and productivity that responds to community opinion regarding the causes of their greatest challenges,
· Inform individuals regarding the effective and often inexpensive policies and programs that can be used to build community strength through promotion, prevention and effective treatment,
· Build public consensus and support for strong community behavioral health infrastructure in order to bolster educational and occupational achievement, social well-being, and productivity goals for the community and help ensure their sustainability in the community, and broaden community acceptance and inclusion of persons with mental health and substance use conditions.
“As we come to understand the fundamental link between behavioral health, overall health, community productivity and well-being, the importance of community wide support for behavioral health prevention and treatment becomes increasingly apparent. A very strong case can be made at the community or national level that measures of our health and wellbeing as a society should be of grave concern including the fact that the United States has the highest rate of mental illness in the world, second highest rates of substance use disorder exceeded only to the Ukraine, the most expensive heath care system in the world with heath status outcomes near the bottom of the Industrialized world and great disparity in health, educational and social status among differing socioeconomic and racial/ethnic communities, high levels of community violence, highest incarceration rate in the world, poor levels of academic achievement.
“Other than the first two indicators that directly address the rates of diagnosable mental and addictive disorders, most individuals may not believe that these social wellbeing concerns are related to behavioral health. However, each of these indicators reflects the effects of weak behavioral health infrastructure in the community.
“I began my remarks by acknowledging that there is a sea change in the way we look at and talk about mental health in this country. The diversity and breadth of individuals and families touched by mental health and addiction is consistent with the many different agencies and arenas in which these issues reside. As a result, I urge you to develop an Interagency Council on Mental Health and Addiction to bring together the disparate stakeholders that can be part of the strategy for improving the mental health of the nation. I have never been more hopeful that there is a moment right now to do what is right and help the millions of Americans with a behavioral health condition. The question is not about what to do, the better question is when and how to do it. MHA is ready to engage.”
Mental Health America (www.mentalhealthamerica.net), founded in 1909, is the nation’s leading community-based network dedicated to helping all Americans achieve wellness by living mentally healthier lives. With our 240 affiliates across the country, we touch the lives of millions—Advocating for changes in mental health and wellness policy; Educating the public & providing critical information; and delivering urgently needed mental health and wellness Programs and Services.
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