Our Health Policy Matters

 After 7+ years as President and CEO of Mental Health America, I retired on June 30, 2021. During that time, MHA accomplished a lot. It changed the ways we think about mental health and mental illness. We introduced our MHA screening program . It became the most successful early identification program ever, especially for children. Today, 10 million people have completed a free, anonymous screening with MHA and received targeted follow-up resources for their mental health. This number will grow by millions each year. We created our B4Stage4 messaging frame. Arguing that mental health conditions were the only chronic diseases that as a matter of public policy we waited until Stage 4 to treat, and then often inappropriately only through incarceration, we said we needed to act before Stage 4. Local, national, and international partners helped us advance this frame and change the way we approach and treat serious mental health conditions – because all mental health condition...

 After 7+ years as President and CEO of Mental Health America, I retired on June 30, 2021. During that time, MHA accomplished a lot. It changed the ways we think about mental health and mental illness. We introduced our MHA screening program . It became the most successful early identification program ever, especially for children. Today, 10 million people have completed a free, anonymous screening with MHA and received targeted follow-up resources for their mental health. This number will grow by millions each year. We created our B4Stage4 messaging frame. Arguing that mental health conditions were the only chronic diseases that as a matter of public policy we waited until Stage 4 to treat, and then often inappropriately only through incarceration, we said we needed to act before Stage 4. Local, national, and international partners helped us advance this frame and change the way we approach and treat serious mental health conditions – because all mental health condition...

From time to time, I take a look at this blog - a collection of nearly 200 essays now aging in place - because I want to remind myself about how I thought about health policy broadly and the health and mental health policy issues that were hotly debated around the time the Affordable Care Act was being crafted and implemented. I think about how my own narrative and the narratives of my family members were affected by policy decisions made by others. There are plenty of commentators and scholars who know a whole lot more about this stuff than I ever did. So, most of my blogs have no historical significance at all - although one may someday.  It includes my first written expression of the "Before Stage 4" concept that became a hashtag (#B4Stage4) and the messaging frame for the work of Mental Health America beginning in 2014, a frame that was widely embraced by the mental health advocacy world. I posted only a handful of new blogs here while I was the position as President and ...

From time to time, I take a look at this blog - a collection of nearly 200 essays now aging in place - because I want to remind myself about how I thought about health policy broadly and the health and mental health policy issues that were hotly debated around the time the Affordable Care Act was being crafted and implemented. I think about how my own narrative and the narratives of my family members were affected by policy decisions made by others. There are plenty of commentators and scholars who know a whole lot more about this stuff than I ever did. So, most of my blogs have no historical significance at all - although one may someday.  It includes my first written expression of the "Before Stage 4" concept that became a hashtag (#B4Stage4) and the messaging frame for the work of Mental Health America beginning in 2014, a frame that was widely embraced by the mental health advocacy world. I posted only a handful of new blogs here while I was the position as President and ...

This is the view outside my hotel deck this afternoon in Half Moon Bay, CA. It's really beautiful. But it's not the view I was expecting. I was expecting a grittier view as I visited for a few hours with my son Tim somewhere in downtown San Francisco's Mission Street area. I travel a lot for my job as President and CEO of Mental Health America. When those trips bring me to northern California, I always try to build in some extra time so I can visit with Tim. Today was no exception. I got up at 3:15 am to catch a 5:30 am flight out of Washington that got me to San Francisco by 11. I have something for work at 6, so I expected to have several hours with Tim. But visiting with Tim takes planning in advance. Tim has schizophrenia. He has lived in San Francisco for the last decade. He has often been homeless, or in jail, or in treatment. Even when he has housing, he doesn't stay in one place very long, and he doesn't have a phone. So I make my plans through t...

This is the view outside my hotel deck this afternoon in Half Moon Bay, CA. It's really beautiful. But it's not the view I was expecting. I was expecting a grittier view as I visited for a few hours with my son Tim somewhere in downtown San Francisco's Mission Street area. I travel a lot for my job as President and CEO of Mental Health America. When those trips bring me to northern California, I always try to build in some extra time so I can visit with Tim. Today was no exception. I got up at 3:15 am to catch a 5:30 am flight out of Washington that got me to San Francisco by 11. I have something for work at 6, so I expected to have several hours with Tim. But visiting with Tim takes planning in advance. Tim has schizophrenia. He has lived in San Francisco for the last decade. He has often been homeless, or in jail, or in treatment. Even when he has housing, he doesn't stay in one place very long, and he doesn't have a phone. So I make my plans through t...

This might just be the year for mental health reform in Congress. A few months ago, practically no one would have said that. But on Wednesday of this week, the House Energy and Commerce Committee voted 53-0 to send H.R. 2646 - a significant mental health reform bill - on its way, most likely to the House floor for a July vote.  And in recent weeks, a Senate bill has gathered steam, too, and that chamber could also now take up this legislation this summer. So what happened to make mental health reform a real possibility? First, members of Congress sincerely wanted to do something.  The House proposal, sponsored by Rep. Tim Murphy of Pennsylvania and Rep. Eddie Bernice Johnson of Texas, has 199 co-sponsors as of today.  Our mental health system has been in disarray since - well, since as long as anyone can remember. Second, members have finally decoupled mental health reform from gun control.  Mental illnesses and violence have never been stron...

This might just be the year for mental health reform in Congress. A few months ago, practically no one would have said that. But on Wednesday of this week, the House Energy and Commerce Committee voted 53-0 to send H.R. 2646 - a significant mental health reform bill - on its way, most likely to the House floor for a July vote.  And in recent weeks, a Senate bill has gathered steam, too, and that chamber could also now take up this legislation this summer. So what happened to make mental health reform a real possibility? First, members of Congress sincerely wanted to do something.  The House proposal, sponsored by Rep. Tim Murphy of Pennsylvania and Rep. Eddie Bernice Johnson of Texas, has 199 co-sponsors as of today.  Our mental health system has been in disarray since - well, since as long as anyone can remember. Second, members have finally decoupled mental health reform from gun control.  Mental illnesses and violence have never been stron...

Where our nation's mental health is concerned, disparity, not parity, rules. Mental Health America released a new report today.  It's entitled Parity or Disparity: The State of Mental Health in America, 2015 .  The report offers the first cumulative ranking of mental health status and access to services for all fifty states and the District of Columbia. Source:  Data from www.mhascreening.org The report includes measures of mental health status and access for adults and children, drawn from national databases that are regularly updated.  Altogether, they paint a very interesting picture of how states measure up to one another in protecting the mental health of their people. The best states for your mental health?  Massachusetts leads the list, followed by Vermont, Maine, North Dakota, and Delaware.  Rounding out the top ten are Minnesota, Maryland, New Jersey, South Dakota, and Nebraska. There are traditionally liberal and traditionally conserva...

Where our nation's mental health is concerned, disparity, not parity, rules. Mental Health America released a new report today.  It's entitled Parity or Disparity: The State of Mental Health in America, 2015 .  The report offers the first cumulative ranking of mental health status and access to services for all fifty states and the District of Columbia. Source:  Data from www.mhascreening.org The report includes measures of mental health status and access for adults and children, drawn from national databases that are regularly updated.  Altogether, they paint a very interesting picture of how states measure up to one another in protecting the mental health of their people. The best states for your mental health?  Massachusetts leads the list, followed by Vermont, Maine, North Dakota, and Delaware.  Rounding out the top ten are Minnesota, Maryland, New Jersey, South Dakota, and Nebraska. There are traditionally liberal and traditionally conserva...

By now, everyone has heard the news from Ferguson, Missouri.  An unarmed 18 year old named Michael Brown was shot and killed by a police officer.  Michael Brown was black. Some of the events surrounding the shooting are in dispute.  But what isn’t in dispute is that for the past two weeks, a community has been torn apart by race – a community that until recently was best known for its proximity to St. Louis and its designation as a Playful City, USA . Picture credit: Health Affairs Media reports since the August 9 th shooting have focused almost entirely on one angle – race relations.  We’ve heard about unrest in the city, the National Guard, police in riot gear, and danger in the streets.  We’ve heard about the District Attorney’s ties to law enforcement, and concerns that a too-white Grand Jury may be racially motivated not to indict the police officer involved in the deadly shooting. But the media have been strangely silent about a dif...

By now, everyone has heard the news from Ferguson, Missouri.  An unarmed 18 year old named Michael Brown was shot and killed by a police officer.  Michael Brown was black. Some of the events surrounding the shooting are in dispute.  But what isn’t in dispute is that for the past two weeks, a community has been torn apart by race – a community that until recently was best known for its proximity to St. Louis and its designation as a Playful City, USA . Picture credit: Health Affairs Media reports since the August 9 th shooting have focused almost entirely on one angle – race relations.  We’ve heard about unrest in the city, the National Guard, police in riot gear, and danger in the streets.  We’ve heard about the District Attorney’s ties to law enforcement, and concerns that a too-white Grand Jury may be racially motivated not to indict the police officer involved in the deadly shooting. But the media have been strangely silent about a dif...

I started writing Our Health Policy Matters three and a half years ago, right after the 2010 mid-term elections. Since then, I have written about two policy areas about which I am passionate – public health and mental health.  As I explain below, I am about to change my professional focus.  And while I will be speaking about one more than the other in the future, for me these two areas are related. Let me explain why. Mental health and public health are first and foremost about wellness.  They are about identifying risk factors for disease and eliminating or mitigating them. Many of the same environmental risk factors contribute to poor health, especially poor mental health.  These include poverty, violence, abuse, and neglect.  When we address or mitigate these risk factors, we improve our nation’s health and mental health together. We often place the burden of responsibility for maintaining one’s health squarely on the shoulders of individ...

I started writing Our Health Policy Matters three and a half years ago, right after the 2010 mid-term elections. Since then, I have written about two policy areas about which I am passionate – public health and mental health.  As I explain below, I am about to change my professional focus.  And while I will be speaking about one more than the other in the future, for me these two areas are related. Let me explain why. Mental health and public health are first and foremost about wellness.  They are about identifying risk factors for disease and eliminating or mitigating them. Many of the same environmental risk factors contribute to poor health, especially poor mental health.  These include poverty, violence, abuse, and neglect.  When we address or mitigate these risk factors, we improve our nation’s health and mental health together. We often place the burden of responsibility for maintaining one’s health squarely on the shoulders of individ...

A Kaiser Health News sampling of the latest headlines about Obamacare reflects our continuing anxiety over the law just months before it is fully implemented. The most interesting to me was this one.  According to a new CNN poll, only 43 percent of the public favors Obamacare .  But of those who oppose it, only 35 percent do so because it is too liberal.  Sixteen percent say that it is not liberal enough! No matter how you feel about Obamacare, one of the most significant changes it facilitates will be the integration of health and behavioral health care – meaning that care for both physical and mental illnesses will soon be delivered together. This only makes sense.  People with cancer, for example, often develop depression or anxiety that complicates their care.  And people with mental illness often develop physical conditions – sometimes as a side effect from the medications they take – that can cut twenty-five years from their lives. Inte...

A Kaiser Health News sampling of the latest headlines about Obamacare reflects our continuing anxiety over the law just months before it is fully implemented. The most interesting to me was this one.  According to a new CNN poll, only 43 percent of the public favors Obamacare .  But of those who oppose it, only 35 percent do so because it is too liberal.  Sixteen percent say that it is not liberal enough! No matter how you feel about Obamacare, one of the most significant changes it facilitates will be the integration of health and behavioral health care – meaning that care for both physical and mental illnesses will soon be delivered together. This only makes sense.  People with cancer, for example, often develop depression or anxiety that complicates their care.  And people with mental illness often develop physical conditions – sometimes as a side effect from the medications they take – that can cut twenty-five years from their lives. Inte...

Health policy has often been in the news headlines this month.   To cite three examples, CDC released a new report about causes of death.  CMS published data showing wide variations in hospital charges for common procedures.  And, in the context of a newly-reported Oregon Medicaid expansion study, states have been making decisions about Medicaid expansion. Let's look at the mental health policy stories behind the headlines. Suicide on the Rise The CDC reported this month that as of 2009, there were more deaths from suicide in the United States than there were from motor vehicle accidents. Suicide rates increased by over 28 percent among men and women aged 35-64 from 1999 to 2010.  While men were three times more likely to commit suicide, the rate increased more for women (32 percent) than for men (27 percent). Suicide rates are highest in the west, but they are increasing in 39 states. Men are most likely to commit suicide with fire...