Re: To preserve, strengthen and expand America's mental health and addictions treatment capacity

It's just two weeks after our 38th Annual Conference in Boston, where it was wonderful to see and talk with so many of you about our industry, our challenges, and our opportunities. As I continue to hear about how much you enjoyed the conference, I decided that for my letter this month I would share my opening plenary address from the conference. For those that were there, it is a reminder of how we can and must shape the future. And for those that were not able to join us, I hope it conveys the spirit of Boston--a time to entertain each other, to rejoice together, and to labor together.  

I look forward to seeing all of you for the National Council's Capitol Hill Day in Washington, DC, June 17-18.

And as always, I'd love to hear from you at LindaR@thenationalcouncil.org or at 301.984.6200, ext. 227.

Best Regards,
Linda Rosenberg, MSW

President and CEO National Council for Community Behavioral Healthcare


May 2008 National Council Annual Conference Opening Plenary, Linda Rosenberg

Boston is a city that holds a unique place in America--and in the world. Since the American Revolution, Boston's citizens have helped shape and enrich our American experience. Mark Twain once observed that "In New York, they ask what a man is worth?  In Boston, they ask, "What does he know?"

America's first public school and university were started here in the 1630's. The first newspaper and public library soon followed. In the nearly 400 years since, Boston has served as a magnet for scholars, thinkers and leaders... who have profoundly influenced the course of events in this great nation--John Hancock, John Adams, John F. Kennedy, Robert Kennedy and--Senator Edward M. Kennedy, who in his 46th year in the United States Senate is leading the fight for parity and moving us closer to ending discrimination against people with mental illnesses and addictions.

Social movements and even revolutions have started here in Boston! And I hope that this same spirit energizes each of you during our time together in this very special place.

In 1630, John Winthrop, leading ten ships from England into Boston Harbor, gave this charge to his fellow colonists: "We must be knit together, in this work. We must entertain each other in brotherly affection.... delight in each other; rejoice together; and labor and suffer together.... For we must consider that we shall be as a City upon a Hill. The eyes of all people are upon us."

And it is in this spirit that I welcome you to the National Council's 38th Annual Conference.

2008 is a barrier breaking election year--with an African American and a woman running for the White House--and healthcare reform is front and center. Over the next few days, you'll have the opportunity to think and talk about healthcare, to hear from James Carville, Michael Dukakis, Mark McClellan and a stellar array of thought leaders--researchers, economists and policymakers--who'll share with you their views on the American healthcare system and the likelihood of meaningful reform.

But no matter the reality or the pace of reform, we need to advance our agenda. We have been subject to chronic neglect, chronic underfunding and harmful restructuring for too long. In what is a very difficult economic climate, state after state in economic trouble, member after member facing funding cuts--Florida, Rhode Island, Michigan, California, and on and on and on.

It is more important than ever that we come together, work together, and take action together. We must preserve, strengthen and expand the mental health and addictions treatment capacity in this country. The eyes of all people are upon us.

Last year in Las Vegas, I asked for your leadership. I asked for your leadership in responding to the United States Senator that said, "If I haven't learned about your issues, it's because you have not taught me." And I promised that the National Council would lead the way. Today I'm here to report on our progress, and to begin a discussion about the work ahead.

And indeed, we have made progress. We're not content with evocative words like fragmentation, transformation, and integration. We're about members, their boards, and consumers taking action. We're communicating data supporting our policy positions with increasing sophistication. And, we're getting RESULTS on our issues in Washington as never before.

While we've worked on many issues during the past year, perhaps our crown jewel achievement is the introduction of the bipartisan Community Mental Health Services Improvement Act in the U.S. Senate and House of Representatives.

Importantly, this is the first major legislation dealing with community based services introduced in the Congress since the 1960's; it's legislation that puts critical mental health and addictions issues in front of Washington's policymakers.

The Community Mental Health Services Improvement Act

• Integrates primary care into behavioral settings to address the tragic premature deaths of people with serious mental illnesses 
• Calls for a new funding stream for integrated mental health and addictions treatment, because new treatments need new dollars
• Begins to address our workforce crisis and our crushing administrative burdens; and helps to make the promise of an electronic health record a reality. 

Introduction of this legislation underscores that the National Council is no longer a passive observer of events, or simply reactive, but that we are taking the initiative to shape the debate on our key issues. This is our bill. We wrote it. We found leaders in the Congress to introduce it. And we're lining up cosponsors.

We're also improving our fire-fighting skills, as evidenced by our leadership role in convincing Congress to stop the CMS from slashing funds for rehabilitation, case management, and school-based services. On a daily basis, we are on the case pursuing a broad-based legislative agenda intended to help you do your jobs. And you are doing your job, helping to make recovery a reality for millions of Americans.

In Missoula, Montana, you're helping a veteran who served two tours of duty in Iraq recover from a depression that's left him unable to work or to leave his house. In Detroit you're giving a young mom who's been addicted and homeless another chance--to live in a decent apartment and to raise her three kids with the help she needs to become the mother she never had. In Miami you're helping a young man diagnosed with schizophrenia stay out of the state hospital, stay out of jail and stay in school.

And tomorrow night at the Kennedy Presidential Library we celebrate our Awards of Excellence honorees, people and programs that do extraordinary work everyday.

But it's not enough. We need to do more. Serving all in need is an achievable goal. And the National Council will lead the way.

Mental illness and substance use touches most of us. It's touched my family and perhaps yours. It's the reason many of is do what we do, it's why we advocate so long and so hard.

And as demand for treatment grows, insurance coverage must be preserved and expanded. It's critical that we preserve the guarantee of Medicaid coverage for low income, disabled Americans. Commercial parity must be passed; Medicare parity must follow; and if we accept what research is teaching us--that addictions are chronic, relapsing conditions that require ongoing monitoring and management, just like diabetes, asthma, and yes like mental illnesses--then we must act. We must lead the fight to restore eligibility for social security disability for people with addiction disorders.

Data from our member organizations documents increased demand and increased numbers of uninsured. States reallocated their general fund mental health dollars to the Medicaid match. And now state plans to cover the uninsured are floundering. This leaves large numbers of individuals with treatable mental illnesses in our overburdened emergency rooms and without access to the services that can engage them, treat them, and return them to work.

We're denying our economy productive taxpayers. We're wasting human lives. We must introduce and champion a federal funding stream to cover the mental health and addictions treatment costs of the uninsured.

The Community Mental Health Service Improvement Act begins to address our workforce crisis, but it's just a beginning.  

We cannot standby and watch our best and brightest become plastic surgeons and investment bankers. Skilled staff demands adequate compensation. We must be attractive to leaders that reflect the diversity of our communities. And we can't allow people with serious mental illnesses or addictions to wait for weeks and months for an appointment with a psychiatrist. We must be clear and forceful advocates for cost based reimbursement that supports salaries that can attract and retain skilled staff.

If we truly want to narrow the gap between science and service, we must stop investing in manuals and planning grants, and start investing in retooling the organizations that deliver services.

We must preserve, strengthen and expand the mental health and addictions treatment capacity in this country. But it has not been and it will not be easy.

We are part of a healthcare system that reflects the American belief in the marketplace. A healthcare system that suits many of the people that will vote in November's presidential election. A healthcare system that talks universal coverage but hates taxes. A healthcare system that resists cost containment, counting on disease management and prevention for savings, although so far they show little evidence of delivering savings. A healthcare system that's promoting "medical homes" as the newest cost saving strategy, confusing a strategy to improve the quality of care with one that saves money.

But we do know something about saving money. Pioneering studies are telling us that there are enormous disparities in healthcare expenditures from one region of our country to another, with no difference in healthcare outcomes. If the entire nation could bring its costs down to match the lower spending regions, we would cut 20 to 30 percent off America's healthcare bill. Most of the difference in spending is for hospital care. Hospitalization, including inpatient psychiatric care, is a vital intervention that must be available but in many communities we can do better.

If we're serious about improving consumer outcomes, point of service is where improvement will occur. And again the National Council is leading the way.

Members have come together in an Access and Retention Initiative--brainstorming, designing and implementing new ways of operating and engaging consumers. They're increasing the numbers of people they can serve and cutting down on missed appointments, emergency room visits, and hospitalizations. Mental health organizations and community health centers are working together in our Healthcare Collaborative Project and in our Learning Community, working to create seamless access between primary care and specialty mental health services.

The National Council Middle Management Academy is onsite preparing our next generation of leaders.

And fifteen psychiatrists--emerging leaders--representing a range of member organizations--are here to kick-off a year long National Council Psychiatric Leadership Project.  At noon, our International Leadership Exchange Program is being introduced, members can visit and learn from colleagues in Great Britain, the Netherlands and Australia. It's a world of possibilities.

Members across the country are lining up to be part of our first public education campaign to roll out Mental Health First Aid in their towns and cities.

We invite you to have tea with the Dukakis' or wine and cheese with Lorraine Bracco--and at the same time support Project Helping Hands--the National Council charity that helps member organizations--their staff and consumers in times of crisis.

We understand communities and we know how to solve problems. We know that effective community services

• Promote continuity and avoid unnecessary, traumatic hospitalizations and criminal justice involvement.
• Are easily accessible and flexible.
• Promote treatment adherence partnerships with consumers; and view housing and jobs as fundamental to recovery.
• Extend beyond the child or adult to their families - understanding that mental illnesses and addictions are family and community problems.
  

And, we know that effective community services must measure, measure, measure progress.

National Council members are clear about their accountability to purchasers, end users, and tax payers, and are ready to lead the way.

We must leave Boston pledged to preserve, strengthen and expand the community mental health and addictions treatment capacity in this country.

And yet, it is understandable if we sometimes become discouraged. But we must remember that there is a world of possibilities. The science of mental health and addictions is making tremendous progress. New and more effective approaches to care are being developed. Recovery has become the cornerstone of mental health and addictions treatment. Importantly, the American public and our national leaders are learning more and more about the economic and social costs of mental illness and addictions. And while we know that many compelling needs remain unmet, we have done a lot with very little.

Acting together--talking with and educating elected officials and their staff, inviting them to visit our programs, supporting the campaigns of those sympathetic to our issues--we can make a difference.

And if you haven't yet gotten involved, if you haven't gotten your Senator or Representative to sign onto the Community Mental Health Services Improvement Act, if you haven't yet taken your future into your own hands, you can start by joining us on June 17-18 in Washington D.C. for the National Council's 4th Annual Capitol Hill Day.

In the words of President John F. Kennedy:

"All of this will not be finished in the first one hundred days. Nor will it be finished in the first one thousand days, nor in the life of this administration, nor even perhaps in our life on this planet. But let us begin."