Rep. Patrick Kennedy: Integrating Behavioral Healthcare into Healthcare Reform

Rep. Patrick Kennedy: Integrating Behavioral Healthcare into Healthcare Reform

09.10.2009 04:59 PM

By Robin Jay, BHC Editorial Director

Just hours before President Obama addressed the nation in a highly anticipated speech about healthcare reform, and just one day after returning to office following the passing of his father, Senator Edward M. Kennedy, Representative Patrick Kennedy spoke on Capitol Hill Wednesday morning about the dire need to include mental healthcare and substance dependence treatment in healthcare reform.

“The opportunity that I had to work with him [my father, Edward Kennedy] on that level, with the parity bill, is one finest opportunities that I’ve ever had in all of my professional career and personal life. I remember once when we were in the House gallery, we were giving our final summations on the House bill, and my father came over and sat down to say to me, ‘Keep going, because it’s going to help us move the ball forward in our negotiations to have you push the edge of the envelope,’” said Rep. Kennedy. “The most logical first step in expanding the opportunity is for us to get early intervention through screening and brief treatment for those in the white-coat community who, frankly, are the first line of defense of those treating those who have mental illnesses and substance abuse problems.”

“And of course, the next challenge is to make sure that those white-coat docs get the adequate training, because if we’re going to require them to do the screening and brief intervention and treatment, we’re now going to have to make sure that they get the adequate training. So we’re going to make the next big move: professional education development. In this [House] bill, we have a number of sections that call for greater professional development for those who are in the mental health field. That’s where I think our Whole Health Campaign needs to really focus on right now — both insuring that that remains the focus of the bill and that we continue to make that a high need category for professions in the health field. We also make sure, amongst the state licensing boards for medical licensure, that we really work now to begin to put the pressure on those state boards for medical licensure to really adopt more questions related to drug and alcohol abuse and mental illness so that the medical education really starts teaching to the test.”

Representative Kennedy went on to say that advocates for the bill need to explain to the American people that the bill ‘is about living the healthiest life possible’ through preventive medicine and maintenance, education and treatment, so that people don’t have to worry about getting sick and being incapacitated with a chronic illness (which includes mental illness and substance dependence.)

Representative Kennedy addressed advocates from the Whole Health Campaign — a collaboration among more than 107 mental illness and substance use prevention, treatment, research and recovery organizations, which has created a series of new policy papers outlining the urgent message that substance use and mental illness issues be considered a health care policy priority during the reform process. The papers focus on access, quality, choice and cost of care for people with these disorders and their family members.

“We want to ensure that substance use and mental illness are going to be included during the health care reform process,” said Eric Goplerud, Ph.D, Director of the Center for Integrated Behavioral Health Policy at George Washington University, who was also on the panel and spoke just just prior to Rep. Kennedy. “It’s critical that legislators and consumers alike insist these issues are addressed — especially when a third of uninsured individuals and their families are struggling with these issues.”

Another speaker on the panel was Mady Chalk, Ph.D., Director, Center for Policy Research and Analysis at the Treatment Research Institute in Philadelphia. “Substance use disorders are most often a chronic disease and affect about 9.5 percent of the general population — about 24 million Americans over age 12,” said Dr. Chalk. “Only about 10 percent of them are identified and treated, and 40 percent who try to get help are denied treatment because of the cost or insurance barriers. Yet research shows that integrated care through early intervention and economical screening and brief intervention (SBI) in healthcare settings has reduced substance use and saved healthcare dollars. For example, studies have shown Medicaid costs are reduced by 5 percent ($4,500 less) over five years. Inpatient and emergency department costs decline by about 39 percent and 35 percent respectively, and total medical costs per patient per month decline from $431 to $200 following treatment. National health reform is essential.”

Ron Manderscheid, Ph.D., the panel moderator and chair of the Whole Health Campaign, Director of Mental Health and Substance Use Programs at Global Health
Sector, SRA International Inc., and Present-Elect of ACMHA, The College for Behavioral Leadership, concluded with, “We greatly appreciate the legislators’ efforts to address substance use and mental illness in their reform bills. It is critical that two particular aspects of healthcare reform — workforce development among health professionals and the transition to a medical home model — are adequately addressed to serve the needs of individuals with substance use and mental health disorders.”

To listen to Rep. Patrick Kennedy’s remarks during the panel discussion, please click on the media player above or read the interview transcript that follows…

Ron Manderscheid, Ph.D. SRA International and Chair of the Whole Health Campaign: We’re honored to have Representative Patrick Kennedy join us today. Representative Kennedy is one of the heroes of the mental health and substance use care field. We’re thrilled that he’s able to join us. I would be remiss if I did not extend to him the sympathy of our communities on the death of his father, Senator Edward M. Kennedy, who also was also a hero for our community.

Rep. Patrick Kennedy: Thank you all very much. Many of you have written me. I lost my dad and I appreciate it very much. It was a wonderful celebration of his life to see so many people come out and talk about the difference he made, especially on this issue of opening up the doors of opportunity for millions of Americans with physical challenges, including those with mental health challenges.

The opportunity that I had to work with him on that level, the parity bill, is one finest opportunities that I’ve ever had in all of my professional career and personal life, and I know that many of you who join me in that effort had a wonderful experience seeing the Senate bill come over to mirror our bill on the House side. But also to know that in spite of all the language about how the Senate bill wasn’t going to go any further, to see my father come over and sit in the House gallery when we were giving our final summations on the House bill and say to me, at least at that time, “Keep going, because it’s going to help us move the ball forward in our negotiations to have you push the edge of the envelope.”

And like the true legislator that he was, he knew there was always an opportunity to go even further, that there was never — never say never — to a final negotiation. If there was an opportunity politically to move the ball even further, he was always going to take advantage of it. And because of the work that we did, holding firm on the House side, we were able to move the ball even further, and I wanted to come here today to thank all of you for helping to move the ball even further in this health bill that we’re now considering in the Congress, both on the amendment, which was really, really crucial — and I want to thank Representative Tauscher’s office, as well, for helping to sponsor the committee — but to all of you for helping to write letters in support of making sure that was adopted as one of the key preventive items, because of all the preventive items that were listed in the health bill, none of them included behavioral health.

So for no other purpose but to make sure that we had a parity of approaches in health care, we needed to include some behavioral health in the list of colonoscopies, mammograms, or everything else that was listed. It had to, just for the spirit of parity, include some behavioral health. But even better, this was something that obviously had been long advocated by ONDCP and others to be the most logical first step in expanding the opportunities for us to get early intervention through screening and brief treatment for those in the white-coat community who, frankly, are the first line of defense of those treating those who have mental illnesses and substance abuse problems, so that they don’t lose those people who they’re first seeing who may come up with a challenge when they refer them. But they actually are the ones who first grab them and then keep them and first introduce them to this notion of treatment and intervention and the challenges that they may face so that they can get continual help, but not just drop them off the cliff and hope that they pick it up with their referral, which of course, usually is not always the case when they do refer someone to a specialist.

And of course, the next challenge is to make sure that those white-coat docs get the adequate training, because if we’re going to require them to do the screening and brief intervention and treatment, we’re now going to have to make sure that they get the adequate training. So that comes to the point where we’re going to make the next big move and that’s a professional education development.

In this bill, we have a number of sections that call for greater professional development for those who are in the mental health field. That’s where I think our Whole Health Campaign needs to really focus on right now is both ensuring that that remains the focus of the bill and that we continue to make that a high need category for professions in the health field, and that we also make sure that amongst the state licensed boards for medical licensure and the like that we really work now to begin to put the pressure on those state boards for medical licensure to really adopt more questions related to drug and alcohol abuse and mental illness, so that medical education really starts teaching to the test. If the questions are there, then they’re going to start teaching to the test, and I think all of us all along talked about the need for this, but it’s a matter of now getting the professional boards of addiction specialists, who are now forming their own societies who are coming up with these evidence-based questions and measurements to now implement those evidence-based standards in these questionnaires that will go out on these medical boards. So that’s going to be the next big effort.

And finally, we just need to get this bill moving forward because it’s one of the things that we’ve talked about, Medical Home and Whole Health. I like idea of Whole Health. It gets to the notion of changing the nomenclature of health. But really, we’ve got to go even further and talk about freedom and independence. The reason why they’re rejecting this health bill now is they have this notion that it’s going to curtail their ability to get what they want, when they want, and that’s why they got all these people going to all these wicked town hall meetings. That’s what’s going on here, because they just fear that they’re not going to be able to get what they get now, and so we’ve got to reassure them that what we’re after here is the freedom to live your life to the fullest without any impairment and to make the most of your God-given abilities.

And then we’re going to define health in the broadest sense so that it means the maximum capacity and environment for you to meet all of your expectations of living a full, quality life. And if that means housing, if that means assistance for families so that you can be more independent in your job opportunities, if that means a safer environment, if it means a whole host of things, in addition to the most direct ones that we think of healthcare in terms of health, but counseling and other things, social services, which may not directly be identifiable as healthcare, which we know are real leverages to really advancing someone’s mental health, those are things that we need to keep in mind. In this country, we’ve made healthcare be sick-care, not healthcare, and the notion of healthcare is something that is really lost on people because what it should be about is, “How do you get people to live long lives with fullness of their ability to live health that’s unimpeded in any way?”

And I think that’s where we missed the mark in explaining to people that this bill is about living the healthiest life possible through preventive maintenance and education and treatment, so that they don’t have to worry about getting sick and being incapacitated and having chronic illnesses. That should be our messages that we’re wanting to get out. We’re free, we’re of independence. That should be the buzzword for us, as opposed to, “We’re just taking care of people who are sick.” Rather, we’re for keeping them from getting sick. That’s prevention and the best way of solving mental health is to keep people from getting sick, and that should be our buzzword as well.

So I hope that we can keep this concept of Whole Health really going and I really thank David Lewis for all of the work we’ve talked about earlier about getting parties to just sign off on this on a bipartisan basis, and we really got them to move forward on that. But I want to thank all of you because I know you all have been working on this for a long, long time.

Behavioral Healthcare Central
9-10-09