Something remarkable happened at the recent US Senate Committee on Health, Education, Labor & Pensions Committee Hearing on Improving the Federal Response to Challenges in Mental Health Care in America. Civility, respect and a desire to be comprehensive were ever present at this hearing. The Senators allowed breathing space for the expert witnesses to expand on their answers to questions put forth to them, illustrating their understanding that mental health reform is complicated and needs to be addressed from a variety of perspectives. The witnesses in this hearing consistently spoke of the need for broad-ranging prevention efforts across the age spectrum to help address mental illness in America.
The tone of this congressional hearing on mental health reform was what I have longed to see, especially when contrasted with the vitriol and pettiness that has dominated similar hearings in the House of Representatives, where the simplistic and misleading pairing of mass shootings and mental illness has dominated the conversation.
Witness Testimony
Brian M. Hepburn, MD, Executive Director, National Association of State Mental Health Program Directors (NASMHPD) provided thoughtful analysis of the issues his organization sees in states across America. Responding to Senator Alexander's opening remarks seeking guidance on how the federal government could support state efforts, Hepburn used the example of the funding that has been set aside for First Episode Psychosis programs. Dr. Hepburn encouraged the Committee to consider changing the allocation methodology so that states with smaller consumer populations, and thus smaller block grants, can receive an amount sufficient to implement an effective FEP program. Changing FEP allocation methods to more accurately reflect what is needed to create quality programming is a critical point that advocates need to champion.
Penny Blake, RN, an Emergency Room Nurse, and a member of the Emergency Nurses Association, brought instant credibility to the dilemma Emergency Rooms across America face when dealing with mentally ill individuals. She spoke of the lack of community mental health services in many parts of the country that put emergency rooms in a bind if the services needed are not available. She stressed that communities must have the health care infrastructure and funding to provide the resources to keep this population healthy. She pointed out that a high-quality, community‐based mental health system would include acute and longer‐term care, access to community mental health clinics, inpatient and outpatient treatment, the availability of 24-hour crisis psychiatric care and services that would allow for integrating the patient more fully into society.
William W. Eaton, PhD, Professor, Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, was the next expert witness to speak. According to Dr. Eaton, there is a plethora of prevention programs for mental and substance abuse disorders with proven positive outcomes. Most of these programs are social intervention programs that can be put in place before a disorder emerges. Dr. Eaton stressed that these resources were unused and often overlooked. (Readers may want to check out the recent Morning Zen post by Dr. Dennis Embry on the power of prevention.)
Dr. Eaton went on to discuss the exciting work being done in genetics, to help us better understand the root causes of mental illness. He stressed that genetic studies would increase their focus on the social, environmental interaction to help identify triggers for the onset of mental illness. Once again, all roads lead back to prevention. Dr. Eaton reminded the committee that a person with schizophrenia will die 20 years early - not because of disease, but because we are not paying attention to them.
- Amen, Dr. Eaton. If your testimony can help the Senate Committee increase emphasis on proven prevention efforts that not only head off the development of psychosis but will save untold amounts of money that would need to go to treating mental illness after the fact, then how can this Senate Committee not pay attention? Advocates take note - It is our job to keep this Committee's feet to the fire on the importance of prevention.
Hakeem Rahim, EdM, MA, CEO, Live Breathe LLC, Let's Talk Mental Illness, National Alliance on Mental Illness, was the final witness to speak. Mr. Rahim spoke eloquently of the importance of both medication and support groups in his recovery. He stressed to the committee that the power of being able to confide in and relate to others going through similar experiences could not be stressed enough.
An enlightening discussion promoting the benefits of prevention
After the opening statements, there was a wide-ranging discussion of proven practices and strategies that could directly reduce incidences of mental illness. Dr. Eaton stressed the importance of stigma reduction classes in high school and reiterated that it was "more important to move upstream to more prevention." Ms. Blake called for a comprehensive approach, from high-intensity services to the types of services that integrate individuals more fully into society. Dr. Hepburn reminded the Committee that 30 years ago we waited until someone developed a serious mental illness. Now, the emphasis needs to be on moving "upstream toward prevention and early intervention", citing as examples both the promising work being done in first episode psychosis programs and the need for a more robust approach to children's mental health. Dr. Hepburn also gave the Committee a sobering reminder of the state of the mental health service delivery system in America when he pointed out that the average age of a mental health provider is 58. Never was training and education more important than it is now.
One of my favorite quotes from the question and answer portion of the hearing was from Senator Collins, who said: "The practices of the past are dictating the services of today." Truer words were never spoken, Senator Collins!
I encourage you to watch the Senate HELP Committee hearing on mental health. Their commitment to honor the effectiveness of treatment strategies across the continuum represents a welcome approach to addressing the challenging issue of mental health reform.
We have work to do!
Make no mistake, there is much work to be done with the plethora of mental health bills in the legislative pipeline, but watching the Senate HELP Committee hearing provided a glimmer of hope that our nations politicians are heading in the right direction on mental health reform.
Stay positive fellow advocates. Spring is coming, and the opportunity for meaningful mental health reform is at hand.