Volume 7, #3 | Summer 2012
President’s Corner: Reflecting Back - Looking Forward
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.
2012 National Zarrow Mental Health Symposium and Mental Health America Annual Conference - September 19-21: Agenda Announced
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.
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.
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.
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.”
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:
Access and Retention
Development and Sustainability
Inclusion and Natural Supports
Supports and Recovery Services (track sponsored by SAMHSA)
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!
Capitol Hill Update: Spending and Sequester
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.
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).
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
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.
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
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.
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.
is clear is that advocates must continue to educate legislators about the
impact of a sequester on mental health and addiction services and supports.
Health Reform Update: Supreme Court Upholds Mandate, Limits Medicaid Expansion
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.
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.
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.
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
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.
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.
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.
Advocacy Notes: Action in Washington and Around the Country
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
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
Chicago School of Professional Psychology at Los Angeles
West 7th Street, Los Angeles, CA
September 24, 2012 – New
York State Psychiatric Institute, Columbia University Medical Center’s
Department of Psychiatry
York, NY 10032
October 9, 2012 – Delray
Beach Library-Hagen Ranch Road Branch
Hagen Ranch Road
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 firstname.lastname@example.org
Vote for America's Mental Health in 2012: Voter Guide to Rights and Issues
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.
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.
this guide you will find:
- Voter registration information
- A “November Elections Action
- Questions for Town Halls &
- A “Letter to the Editor” &
Talking Points guide
- Relevant websites & additional
- A review of party platforms, and
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 email@example.com.
Issue Focus: Obesity and Mental Illness
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. ::
The e-Bell Newsletter is published by the Mental Health America, which works with its 240 affiliates nationwide to promote health, prevent mental disorders and achieve victory over illnesses through advocacy, education, research and service. To receive the e-Bell, visit Mental Health America’s Web site www.mentalhealthamerica.net or call 800-969-6642.
Cited reproductions, comments and suggestions are encouraged.