Our Health Policy Matters

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...

For the past several months, I've been traveling around the country for Mental Health America. I have been delivering two messages.  The first is that it was a mistake to use a "danger to self or others" standard as a trigger to treatment for people with serious mental illnesses.  Because this has made mental illnesses the only chronic diseases we wait until Stage 4 to treat, and then often only through incarceration. The second is that if we are to treat people with mental illnesses the same way we treat people with other chronic conditions, we have to act before Stage 4.  We have to start with prevention and then invest in early identification and intervention.  We have to integrate health, behavioral health, and other services.  And we have to give people an opportunity to recover at all stages in the disease process. May is  Mental Health Month . Since 1949, it has been a signature program of Mental Health America, formerly known as the Nat...

For the past several months, I've been traveling around the country for Mental Health America. I have been delivering two messages.  The first is that it was a mistake to use a "danger to self or others" standard as a trigger to treatment for people with serious mental illnesses.  Because this has made mental illnesses the only chronic diseases we wait until Stage 4 to treat, and then often only through incarceration. The second is that if we are to treat people with mental illnesses the same way we treat people with other chronic conditions, we have to act before Stage 4.  We have to start with prevention and then invest in early identification and intervention.  We have to integrate health, behavioral health, and other services.  And we have to give people an opportunity to recover at all stages in the disease process. May is  Mental Health Month . Since 1949, it has been a signature program of Mental Health America, formerly known as the Nat...

It sometimes seems like policymakers go out of their way these days to pick on people with mental illness. According to a report released last week by the American Mental Health Counselors Association , 3.7 million people with mental illness will remain uninsured because of the decisions of states not to expand Medicaid.  And if you believe some earlier data from the Kaiser Family Foundation  about the total number of people who will be left uninsured because of states' failures to expand Medicaid, then you can only conclude people with mental illnesses account for nearly 80 percent of all those who are being denied insurance coverage in non-expanding states. This includes 652,000 in Texas and 535,000 in Florida, and around 200,000 each in Pennsylvania, Indiana, Georgia, North Carolina, South Carolina, Tennessee, and Louisiana. The association characterizes this as “dashed hopes” and “broken promises.” You might also call it a national disgrace. For...

It sometimes seems like policymakers go out of their way these days to pick on people with mental illness. According to a report released last week by the American Mental Health Counselors Association , 3.7 million people with mental illness will remain uninsured because of the decisions of states not to expand Medicaid.  And if you believe some earlier data from the Kaiser Family Foundation  about the total number of people who will be left uninsured because of states' failures to expand Medicaid, then you can only conclude people with mental illnesses account for nearly 80 percent of all those who are being denied insurance coverage in non-expanding states. This includes 652,000 in Texas and 535,000 in Florida, and around 200,000 each in Pennsylvania, Indiana, Georgia, North Carolina, South Carolina, Tennessee, and Louisiana. The association characterizes this as “dashed hopes” and “broken promises.” You might also call it a national disgrace. For...

This is Mental Illness Awareness Week . But the sad tragedy of Miriam Carey is another reminder of how deeply unaware we are about mental illness in general and its relationship to violent behavior in particular. And how much we rely on myths to fill in the gaps in our knowledge. We all heard the news about Ms. Carey last week.  But we were not exactly informed by it.  Ms. Carey drove her car onto a White House driveway, hit some temporary fencing, backed up, and then pulled away . She was pursued toward the Capitol by law enforcement officers in what became a high-speed chase.  Ms. Carey was eventually cornered near Garfield Circle.  Six officers, with guns pulled, approached her car there.  She apparently panicked, scattering the officers as she drove away.  At least nine shots were fired at her as the chase began again.  She eventually got stuck on a median near a Capitol guard station, where she was shot to death by an officer. ...

This is Mental Illness Awareness Week . But the sad tragedy of Miriam Carey is another reminder of how deeply unaware we are about mental illness in general and its relationship to violent behavior in particular. And how much we rely on myths to fill in the gaps in our knowledge. We all heard the news about Ms. Carey last week.  But we were not exactly informed by it.  Ms. Carey drove her car onto a White House driveway, hit some temporary fencing, backed up, and then pulled away . She was pursued toward the Capitol by law enforcement officers in what became a high-speed chase.  Ms. Carey was eventually cornered near Garfield Circle.  Six officers, with guns pulled, approached her car there.  She apparently panicked, scattering the officers as she drove away.  At least nine shots were fired at her as the chase began again.  She eventually got stuck on a median near a Capitol guard station, where she was shot to death by an officer. ...

In 2009, there were 36,891 suicides in the United States, according to the CDC .  This translates to a rate of 11.9 for every 100,000 people. And rates among certain groups were even higher.  For example, the suicide rate among veterans, according to the Veterans Administration, was three times higher – or 35.9 per 100,000 veterans. Suicide is a problem that ought to command our attention. And it does.  For many years we have used suicide data as surrogates for documenting the consequences of serious mental illness.  We all know that the “danger to self” standard we use for determining when people with mental illness qualify for emergency care is, in effect, a “suicide may be imminent” standard. As a result, for many years community mental health organizations have also been asked to track suicides as a measure of the effectiveness of their programming.  But there are reasons why focusing on suicide rates too closely leads to inadequa...

In 2009, there were 36,891 suicides in the United States, according to the CDC .  This translates to a rate of 11.9 for every 100,000 people. And rates among certain groups were even higher.  For example, the suicide rate among veterans, according to the Veterans Administration, was three times higher – or 35.9 per 100,000 veterans. Suicide is a problem that ought to command our attention. And it does.  For many years we have used suicide data as surrogates for documenting the consequences of serious mental illness.  We all know that the “danger to self” standard we use for determining when people with mental illness qualify for emergency care is, in effect, a “suicide may be imminent” standard. As a result, for many years community mental health organizations have also been asked to track suicides as a measure of the effectiveness of their programming.  But there are reasons why focusing on suicide rates too closely leads to inadequa...

In November, 2012, a fourteen-year-old Utah boy named David Q. Phan committed suicide by shooting himself on a pedestrian bridge near his junior high school.  It was reported that he had been the victim of bullying. In June, 2013, the New York Times published a story about three students who committed suicide at East Hampton High School during the past three years.  All three students were Hispanic. Sam Harris, who is half-Native American and half-African American, has written a first-person account of his own experience with mental illness that has been published on SAMHSA’s “Promote Acceptance” web site.   In his account, he reports that he lived for years with symptoms of mental illness without seeking help in part because he believed that he would be stigmatized by “going to the white man” for help. And in a case which has attracted recent national attention in the aftermath of the Zimmerman verdict, 32-year-old Marissa Alexander – an African Ameri...

In November, 2012, a fourteen-year-old Utah boy named David Q. Phan committed suicide by shooting himself on a pedestrian bridge near his junior high school.  It was reported that he had been the victim of bullying. In June, 2013, the New York Times published a story about three students who committed suicide at East Hampton High School during the past three years.  All three students were Hispanic. Sam Harris, who is half-Native American and half-African American, has written a first-person account of his own experience with mental illness that has been published on SAMHSA’s “Promote Acceptance” web site.   In his account, he reports that he lived for years with symptoms of mental illness without seeking help in part because he believed that he would be stigmatized by “going to the white man” for help. And in a case which has attracted recent national attention in the aftermath of the Zimmerman verdict, 32-year-old Marissa Alexander – an African Ameri...

Fifty-four percent of Iraq and Afghanistan war veterans who have sought treatment in the VA system since 2001 have been treated for mental disorders. This is the second most-frequent diagnosis among these veterans.  It is an indicator of the profound effect recent war service is having on the mental health and well-being of our veterans. The data come from a March, 2013, report entitled Analysis of VA Healthcare Utilization Among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) Veterans .   Here are some numbers that reflect how extensive the use of VA services has been during the last decade. As of the end of 2012, 2.5 million troops had served since the beginning of the Iraq and Afghanistan wars.  Just over 1.6 million had become eligible for VA healthcare.  Of that group, almost 900,000 had used VA healthcare services by the end of 2012. These 900,000 veterans most often sought treatment in VA cen...

Fifty-four percent of Iraq and Afghanistan war veterans who have sought treatment in the VA system since 2001 have been treated for mental disorders. This is the second most-frequent diagnosis among these veterans.  It is an indicator of the profound effect recent war service is having on the mental health and well-being of our veterans. The data come from a March, 2013, report entitled Analysis of VA Healthcare Utilization Among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) and Operation New Dawn (OND) Veterans .   Here are some numbers that reflect how extensive the use of VA services has been during the last decade. As of the end of 2012, 2.5 million troops had served since the beginning of the Iraq and Afghanistan wars.  Just over 1.6 million had become eligible for VA healthcare.  Of that group, almost 900,000 had used VA healthcare services by the end of 2012. These 900,000 veterans most often sought treatment in VA cen...

It is way too early to break out the champagne over the latest Medicaid expansion initiatives bubbling up around the nation.  States that have been reluctant to expand traditional Medicaid are ablaze with proposals to offer “premium support” to expansion populations.  Premium support programs may differ in their details, but they have one thing in common.  Instead of offering regular Medicaid to an expansion population, the state pays the cost of their private insurance premiums. Kaiser Health News reported last week that the Department of Health and Human Services is encouraging states to explore this approach.  MSN featured some “let’s make a deal” offers on expansion by a number of GOP legislators.  And Health News Florida reported a wave of bipartisan enthusiasm for a Florida premium support proposal that was unveiled after support for traditional Medicaid expansion collapsed. For policymakers who don’t like Medicaid but want the fe...