Rethinking Mental Health

Too many Americans struggle with untreated mental illness and substance abuse concerns—but it’s not too late for policymakers to implement key reforms to improve the country’s behavioral health care system.

That was the conclusion reached by former U.S. Representative Patrick J. Kennedy, former U.S. Surgeon General Dr. David Satcher, and EDC’s Jerry Reed during an EDC-sponsored forum about the current state of behavioral health care in the United States.

During a lively conversation in front of 150 invited guests, Satcher, Kennedy, and Reed detailed the importance of aligning mental health care, addiction, and suicide prevention services—and then integrating them into primary care.

In his introductory remarks, Reed brought up an idea that would be repeated throughout the evening.

“Thirty percent of suicide deaths have a relationship to substance abuse,” he said. “I think it’s high time that we talk about substance use, suicide, and mental health in the same conversation, because they are clearly related.”

Over 40,000 Americans die by suicide each year, making suicide the 10th leading cause of death in the United States. Deaths due to drug overdoses—which reached 47,000 in 2014—now represent the leading cause of injury-related deaths in the country.

Satcher noted that the fight for more comprehensive behavioral health care would require a widespread effort.

“When we get to the point where we all see this as a common struggle, we’re going to start to make some real change,” he said. “But I don’t think we have seen it as a common struggle yet.”

As Surgeon General and Assistant Secretary for Health between 1998 and 2001, Satcher is credited with making great strides in promoting behavioral health issues in a public health context. His landmark 1999 report Mental Health: A Report of the Surgeon General addressed issues including stigma and lack of treatment and called for insurance companies to treat behavioral health concerns on par with physical health concerns—a recommendation that became law in the Mental Health Parity and Addiction Equity Act of 2008, coauthored by then-Representative Kennedy.

Kennedy, in emphasizing the need for better treatment of mental illness and brain disorders, looked to the nation’s success in addressing another recent public health crisis.

“Wouldn’t it be great if we were able to have the same arc of progress in the reduction of the mortality and morbidity we see with mental illnesses and addiction that we saw with HIV/AIDS?” he asked. “It absolutely can be the same success story.”

Reforms needed

The necessity of improving access to behavioral health services was a key theme of the conversation, which occurred on the eve of the Kennedy Forum’s Second Annual State of the Union in Mental Health & Addiction. The three experts all offered specific action items—some of which were included in a joint op-ed urging the 2016 presidential candidates to action on behalf of behavioral health care reform.

“While I’m pleased to see major increases proposed in the president’s 2017 budget in the areas of mental health, addiction services, and suicide prevention, so much more is necessary,” said Reed. “My hope is that Congress will pay particular attention to these proposed new initiatives and make the down payment necessary to provide care for those who struggle.”

Kennedy called for more even and transparent implementation of parity laws, lobbing criticism at both insurance companies and the government for failing to enforce provisions of the Mental Health Parity and Addiction Equity Act.

He also urged politicians to think boldly about the future of mental health care in the United States.

“We’ve got a great advancement in candidates talking about theses issues, but nobody has put together the big plan,” he said. “We are at a critical time when there is consensus in both parties that this has to be a public health issue, and this has to be on the national agenda.”

Satcher stressed the importance of continued investment in both research and prevention.

“We don’t talk about prevention enough when it comes to mental health,” he said. “And a great part of that effort for prevention is going to involve research. You need to know more about the brain; you have to find ways to diagnose people who are at risk for mental disorders earlier.”

He also offered a hopeful vision for the future.

“When we get to the point when we can diagnose mental disorders as early as possible, and even identify people at risk and intervene, it’s going to be a great day,” Satcher said. “And I think that day is coming.”