By Dr. David Shern, President & CEO

This is my last column for The Bell. Last December, I announced my intention to retire and spend more time with my family. A new President and CEO will soon be named. My decision to leave my position was difficult because of my commitment to our mission and the recognition that this is critical time in advancing our cause.

Nearly six years ago, I decided to leave academia and join Mental Health America based on a failure to get a family member the services he needed for a severe behavioral health problem and my sense that the advocacy community was entering a new era of comity and shared purpose.

And we have achieved enormous progress. Decades of advocacy, public education and research on the prevention and treatment of mental and addictive disorders, the Surgeon General's and multiple reports from the Institute of Medicine had a cumulative impact on policy. We were reaching a tipping point regarding the impact of these conditions on a broad range of public health outcomes. Disagreements between mental health and addiction interests have faded and the common ground we have found aided efforts, particularly in advocacy for insurance parity and later its inclusion in the Affordable Care Act.

The Supreme Court's decision to uphold the Affordable Care Act caps an era of progress in our work to expand and integrate mental health care. The 2008 parity bill, improvements in Medicare benefits, parity in SCHIP, parity and inclusion of behavioral health in all aspects of health reform are milestones in progress that demonstrate our impact. Mental Health America has a proud legacy of achievements.

These successes also present challenges. We face ongoing struggles to fully implement parity. The court's health reform decision requires continued advocacy to assure that all states expand their Medicaid programs. We must also continue efforts to integrate general and behavioral health, as well as efforts to integrate prevention and promotion initiatives in human service settings. The behavioral health community has a key role in the strategic leadership of these efforts.

To realize these possibilities, our community needs to maintain its unity. And we must summon the political will to demand access and quality at the state, community and national levels.

When Clifford Beers founded our organization more than a century ago, his ideas presaged many of our contemporary advances: the need for humane treatment that is respectful of individual rights; prevention based on science; the power of first-hand experience in reform and education; and the need for bold action—to move from "reform to cure, from cure to prevention. "

It has been a great honor to lead the organization that he founded and to partner with all of our valued colleagues. Although I am retiring, I don't intend to go away. I look forward to our continued work together to fully implement Beers' vision.

The full agenda for the 2012 National Zarrow Mental Health Symposium and Mental Health America Annual Conference has been released. The agenda, along with session descriptions and speaker biographies for 50 workshops, is available online at www.fromhousingtorecovery.org/agenda.

The three-day conference will provide participants with information and practical tools they can use in their professional practice, agencies and communities to assist with facilitating homeless prevention/intervention, housing development, clinical practice, recovery services and wraparound supports for individuals who live with mental illness and/or substance use-related disorders, and other vulnerable at-risk special populations.

On Thursday, Sept. 20th, The Clifford Beers Awards Dinner will feature a keynote address from Jessie Close, who lives with bipolar disorder and, with her sister Glenn Close, aims to erase the stigma and discrimination of mental illness through the non-profit organization Bring Change 2 Mind.

Dr. Mark Vonnegut, who is the son of author Kurt Vonnegut, will give a lunch keynote on Sept 20th. Vonnegut’s second memoir, “Just Like Someone Without Mental Illness, Only More So,” has been praised as “an honest, witty and vivid depiction of ‘normal’ life in between interruptions of mental illness.”

The conference agenda features a wide array of breakout sessions ranging from housing development and retention, to recovery-focused sessions including current research, special populations and social inclusion. Presentations will fall into the following 10 tracks:

• Housing Access and Retention
• Housing Development and Sustainability
• Collaborative Service Integration
• Special Populations
• Social Inclusion and Natural Supports
• Employment
• Public Policy
• Current Research/Emerging Knowledge
• Clinical Practice
• Community Supports and Recovery Services (track sponsored by SAMHSA)

Conference participants can receive 18 continuing education credit hours, including 3 credit hours of ETHICS! The Friday ethics workshop will offer ethical principles and best practices associated with boundary issues in mental health services and in supervision of those services. Boundary issues and role confusions that housing staff and recovery support specialists may experience with consumers will also be addressed. To learn more about the ethics workshop, go to http://www.fromhousingtorecovery.org/ethics/

Join us in Tulsa!

Mental Health America has been working on two critical fronts related to the funding of behavioral health supports, services and research—the traditional appropriations cycle for spending bills for the next fiscal year (FY2013) and the looming battle over the budget sequester.

With respect to appropriations, the Senate and House have taken two markedly different approaches. The Senate Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee provided a funding increase of $20 million each for both the Mental Health Block Grant and the Substance Abuse Block Grant, as well as a $100 million increase for the National Institutes of Health.  Equally important, it rejected the administration's proposed cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA) and partisan efforts to prohibit implementation of the Affordable Care Act (ACA).

In sharp contrast, the House Labor and Health and Human Services Appropriations Subcommittee approved a bill that cuts funding for SAMHSA by 10 percent. It also eliminates the Agency for Healthcare Research and Quality and other agencies, eliminates funding for the Prevention and Public Health Fund, strips funding for the Patient-Centered Outcomes Research Institute, makes double-digit percentage reductions in funding for public health agencies (including the Centers for Disease Control) and prohibits the implementation of the ACA. These proposed cuts go well beyond the spending caps established in last year’s bipartisan Budget Control Act (BCA)—a reckless assault on the health of individuals and their families. Mental Health America has urged the House to oppose this dangerous funding package and to follow the Senate’s approach.

Although both bills advanced on largely partisan votes, it is unlikely that either bill will come to the floor of their respective chambers. Republican and Democatic leaders have tentatively agreed to a $1.047 trillion, six-month stop-gap spending bill to keep the federal government running  after the Oct. 1 start of the new fiscal year and into the new Congress.

A separate but related issue involves the sequester that is scheduled to take effect on January 2 unless Congress acts to rescind or delay the 8.5-12 percent cuts to discretionary funding required under the BCA. Although there is growing bipartisan agreement that sequestration would be devastating for the nation, there is no agreement on how to avoid it.  However, in an overwhelming 414-2 vote the House requested the administration to provide data on the impact of the sequester on all discretionary funding, which reflects a growing recognition that defense discretionary (DD) cannot be treated differently than non-defense discretionary (NDD) spending.

Mental Health America signed a letter with nearly 3,000 other organizations that calls for a balanced approach to deficit reduction that does not include greater cuts to discretionary spending. The letter spurred Congressional leaders to release a report (linked here) on the impact of the budget sequester on NDD.

It’s unclear what action may be taken before the November election. There is a long list of fiscal policy issues—including the expiring Bush tax cuts—that could be addressed in a lame duck session.

What is clear is that advocates must continue to educate legislators about the impact of a sequester on mental health and addiction services and supports.

The Supreme Court ruling to largely uphold the Affordable Care Act (ACA) gives states the freedom to move forward with implementation. Despite the court's decision, Congressional Republicans and presidential nominee Mitt Romney continue to threaten to repeal the law. Therefore, the final referendum on whether or not the ACA will stand will occur after the November election.

The most anticipated part of the decision was whether or not the individual mandate, the provision requiring all Americans to have health insurance or pay a penalty, would be upheld. By a 5-4 majority, the court upheld the mandate based on the administration’s argument that the federal government may impose a tax, not the primary argument that the Commerce Clause gives the government the power to impose the requirement.  Chief Justice John Roberts surprised many by joining with the more liberal justices—Ginsburg, Sotomayor, Kagan, Breyer—in upholding the mandate.

In finding the mandate constitutional, the justices also upheld the other provisions of the ACA that hinge on it—the guarantee issue of benefits despite pre-existing conditions and the establishment of the insurance Exchanges, marketplaces where individuals and small employers can purchase insurance.

The biggest surprise—and one disappointment—of the decision was the ruling to narrowly limit the Medicaid expansion provision of the ACA.  Specifically, the Court ruled the federal government can offer funds to states to expand Medicaid to cover everyone below 133 percent of the Federal Poverty Level (FPL) and if states opt to expand and take those funds, they must comply with the requirements of the program.  The Court also ruled that states can opt out of the Medicaid expansion and, if they do, it won’t affect their reimbursement for traditional Medicaid.  In other words, current Medicaid programs for those who are categorically eligible would maintain the federal match even if states refuse to comply with the Medicaid expansion.

So far, six governors have indicated that they plan to forgo the Medicaid expansion, and several other states that joined in the Supreme Court case will wait until the November election before deciding whether to move forward.  Forgoing the Medicaid expansion would result in a gap in coverage for individuals below 100 percent FPL who aren’t currently getting Medicaid based on categorical eligibility.  Anyone earning over 100 percent of FPL will be eligible for subsidies to purchase insurance in the Exchanges. The question remains how those who earn too little for the subsidies will access insurance if they live in states that opt out of the Medicaid expansion.

This potential gap in coverage is especially concerning because individuals below 100 percent FPL are much more likely to have disabling and costly chronic illnesses, including mental health and substance use conditions, than the general population.  Not providing a mechanism for them to access health insurance would force individuals to continue to rely on community clinics, hospitals and emergency departments for expensive deep end services. 

However, the ACA includes a provision to reduce federal payments to hospitals intended to cover the costs of care to the uninsured. The law intended many of those who relied on those safety net providers to become insured through the Medicaid expansion.  Those payments will be reduced even in states that forgo the Medicaid expansion. This will put hospitals and state budgets at a huge financial risk and potentially pressure states to opt for the Medicaid expansion.

The November election and subsequent decisions by state and federal policy makers will determine the fate of the ACA and the Medicaid expansion.

Hill Day 2012—Advocates Press Congress for Action: More than 600 advocates from Mental Health America, the National Council for Community Behavioral Healthcare and the U.S. Psychiatric Rehabilitation Association pressed Congress to recognize and address the mental health needs of the nation last month during the annual Capitol Hill Day. Advocates from around the country also participated in a Virtual Lobby Day, calling their Senators and Representatives and reinforcing the important messages being carried in person by attendees.

Hearing on Seclusion and Restraints—One of Mental Health America’s legislative priorities is The Keeping All Students Safe Act (S. 2020/ H.R. 1381), which would establish national minimum standards for the use of seclusion and restraints in schools. The legislation will promote a cultural shift toward prevention and early intervention, including the use of evidence-based positive behavioral interventions and supports. This shift will help school personnel understand the needs of their students and safely address the source of challenging behaviors – a better result for everyone in the classroom. In many cases, the use of positive supports and interventions greatly diminishes and even eliminates the need to use restraint and seclusion. On July 12, the Senate Health, Education, Labor & Pensions Committee (HELP) held a full committee hearing entitled “Beyond Seclusion and Restraint: Creating Positive Learning Environments for All Students.”  Panelists called for a national policy addressing seclusion and restraints in our schools.  The hearing was in large part responding to the data released by the Department of Education in March that showed that nearly 40,000 students were physically restrained during the 2009-10 school year; 70% of whom were students with disabilities. The data also revealed that these practices are disproportionately used upon minority students. In 2009, a Government Accountability Office study found children have been injured, traumatized, and even killed through restraint and seclusion in schools. The hearing was a clarion call for an approach that emphasizes prevention and early intervention. Mental Health America signed a letter with 175 other organizations (linked here) in support of the legislation.

Parity Hearings—Modeled after the field hearings in 2007, which were successful in helping to enact the Mental Health Parity and Addiction Equity Act (MHPAEA) into law, the 2012 field hearings are intended to shine a light on problems patients are still facing as they try to access mental health and addiction treatment and areas where parity is increasing access to care.  At the hearings, consumers, providers, representatives from the business and insurer communities and state and local representatives will testify on parity implementation and enforcement. Summaries of recent hearings can be found at http://parityispersonal.org/Parity_Field_Hearings. Below are hearings in the coming weeks.

September 17, 2012 – Los Angeles, CA
6:30 pm
The Chicago School of Professional Psychology at Los Angeles
617 West 7th Street, Los Angeles, CA

September 24, 2012 – New York City
9:30 am
New York State Psychiatric Institute, Columbia University Medical Center’s Department of Psychiatry
1051 Riverside Drive
New York, NY  10032

October 9, 2012 – Delray Beach, FL
5:30 pm
Delray Beach Library-Hagen Ranch Road Branch
14350 Hagen Ranch Road
Delray Beach, FL

If you would like to be involved in hosting or providing outreach for a hearing or have a story related to parity noncompliance you would like to tell, please contact Sarah Steverman at ssteverman@mentalhealthamerica.net

With all of the changes in health care and voting laws happening at the state and federal level, it is more important than ever for the mental health community to be involved in this year’s election.  On November 6th, we hope you will Vote for America’s Mental Health and choose candidates who plan to make decisions to improve the health care system, support consumer choice in treatment, prevent mental health and substance use conditions, and promote the overall well-being of our communities.

We have prepared this voter guide to help mental health advocates ensure that people with mental health conditions feel empowered and able to vote, that candidates at the federal, state, and local levels are considering the concerns of the mental health community, and to encourage all voters to ultimately Vote for America’s Mental Health in 2012. The guide can be viewed here.

Inside this guide you will find:

• Voter registration information
• A “November Elections Action Checklist”
• Questions for Town Halls & Candidate Forums
• A “Letter to the Editor” & Talking Points guide
• Relevant websites & additional resources
• A review of party platforms, and more…

We hope you will use this guide in the months leading up to the November election to Vote for America’s Mental Health in 2012. Let us know how you are becoming involved in your state and community by emailing us at info@mentalhealthamerica.net.

Obesity is a major public health threat, which has justifiably generated considerable debate and discussion over causes and solutions. Greater attention is also being given to the connection between serious mental illness and obesity. Among adults with serious mental illness, the obesity rate is higher than the rate of the general population (42 percent versus 36 percent). Given the epidemic of obesity experienced in the U.S., there is a need for policies and practices that reduce its prevalence. This is particularly important for persons with severe mental illnesses given their heightened risk for weight related illnesses and excess mortality from these health conditions.

Mental Health America staff recently conducted a review of the literature related to obesity and mental illness, synthesizing the existing research. The review focused primarily on issues related to adults but also included a brief description of childhood obesity issues. Special concerns related to individuals with serious mental illnesses were a primary focus of the review. The review concludes with a discussion of the policy implications of the issue, describing policies that support the prevention, early identification, and treatment of obesity for individuals with serious mental illnesses, including several provisions of the Affordable Care Act. You can read the review here.

The odds are that someone you know—a family member, one of your friends, or one of your colleagues—is affected by a mental health or substance use condition. And that's why Mental Health America was formed over 100 years ago.

For over a century, Mental Health America has been instrumental in reducing barriers to treatment and services and educating millions about mental illness and recovery. As a result of our efforts, many Americans with mental disorders have sought care and are now enjoy fulfilling, productive lives in their communities.

Whether you or someone you know has a mental health condition, or simply care about the issue of mental health and living a mentally healthier life, We Can Help, But Only With Your Support!

As a member of our nationwide movement, you will help us build on our century of service and strengthen our voice as we continue our ground-breaking steps to achieve victory over mental illness:

• Our advocacy work helped pass landmark mental health parity legislation that ends decades of insurance discrimination and expands access to care.
• Our first—of—its—kind Live Your Life Well program is providing the public with tested tools so they can preserve and strengthen their mental health and wellness.
• And through the programs and services of our 240 affiliates, we are delivering critical support to the over 60 million individuals and families living with mental health and substance use conditions.

Become a member of Mental Health America for just $5 a month (or a $50 annual payment)! Your contribution will support Mental Health America and our 240 affiliates across the country as together we work to improve the lives of millions of Americans. Remember—There is No Health Without Mental Health. ::