"Mental Health Policy in the 21st Century"

Remarks of Congressman Patrick J. Kennedy

University of Texas Southwestern, Department of Psychiatry

January 28, 2002

Thank you, Deborah, for that wonderful introduction. Is she not amazing? You know, there's a lot of talk in Washington about energy independence and freeing the U.S. from relying on foreign oil. But I'll tell you what - if we really want to solve that problem, we just need to find a way to tap into Deb Peel’s energy level. Better than cold fusion!

Seriously, I want to take a minute and just comment on how lucky we all are to have Deb as an advocate for mental health. Her enthusiasm is infectious and she really is making a difference.

I also want to thank the University of Texas Southwestern Medical Center for hosting me here today. It's an honor to be here. Thank goodness there is at least one psychiatry department in the country undergoing a major expansion.

I've spent a lot of time talking with the folks at the National Institute of Mental Health, and we're making all kinds of advances in our understanding of these brain diseases. What we need is to do a better job of getting the research base out into the field. A first rate medical center like this combines research and training, which is exactly what we need more of. So I applaud your expansion.

And what is the profession into which these new psychiatrists will enter? I don’t need to tell you, friends, it is not pretty.

I shouldn't be hearing from seniors in my district that they can't get counseling anymore because they can't afford the 50 percent copay in Medicare.

I shouldn't be hearing from a child psychiatrist that he is the only provider left in town and he loses money with every patient he sees.

I shouldn't be hearing from parents who can't get services for their emotionally disturbed kids until they are in the juvenile justice system.

Our mental health system is in shambles.

You all know the scope of this problem. Mental illness touches one in five Americans. It is safe to say that virtually every family in this country has first-hand experience with mental illness. Yet somehow mental illness remains in the shadows, a public health crisis that many don't know exists.

What other disease could strike with such prevalence yet receive so little attention? When people think about the impact of disease, mortality gets the attention. Heart attacks kill. Cancer kills. AIDS kills. But look at the overall burden of disease. Lives can be consumed by disease without being shortened. Diseases disable as well as kill.

When a disease strikes young people right as they enter the prime of life - when it's a chronic disease that saps one's motivation and self-esteem -- when it sabotages a person's ability to hold a job or maintain relationships - don't tell me that's not a real burden. Don't tell me that disease isn’t costing lives.

When you think about burden in these terms, disability as well as mortality, mental illnesses account for 10.9% of the worldwide burden of all disease according to the World Health Organization and World Bank. In other words, more than one in every ten lost days of healthy life is due to mental illness. That's second only to heart disease, and is predicted to surpass heart disease by 2020. When you add in addictive disorders to mental illness, it's already the most burdensome family of diseases worldwide.

The human cost is staggering. I hardly need to tell you the price is paid not only by those with mental illnesses, but by their families and loved ones. We see the costs in our children, parents, grandparents, siblings, and friends. And, of course, for many of us, in the mirror.

We see the costs in suicide statistics that should horrify people. For every two homicides in this nation, there are three suicides. I don't think most people know that. Suicide is the eighth leading cause of death nationwide, and among kids is second or third, depending on the age group. It's a huge problem among the elderly as well.

And even if you're a cold, mean, heartless person, you should care. Untreated mental illness costs the U.S. $300 billion dollars - that's billion with a 'B' - each year, according to the National Institute of Mental Health. The Wall Street Journal has estimated that depression alone costs American companies $70 billion annually in lost productivity and direct costs. We’re not talking about Pravda here - this is the Wall Street Journal.

We feel the costs of mental illness throughout society. We have a prison system bursting at the seams, two million people in American prisons. Reports show that 20 percent of inmates nationwide suffer from severe mental illnesses. It's estimated that four in five prisoners are alcohol or drug abusers. Instead of treating the minds, we imprison the bodies.

Every night, approximately 200 thousand people with serious mental illnesses sleep on the streets. Mental illness contributes to dropout rates, special education placements, and grade retention in our schools. It is associated with teenage pregnancy, drug and alcohol abuse, and unemployment. As a society, we pay and we pay and we pay for mental illness in so many ways.

The only way we don't pay is in actually paying for treatment. Despite this laundry list of costs and suffering, between 1987 and 1997, mental health spending actually dropped as a percentage of overall health spending. Mental illnesses are the second-leading cause of disability in the U.S., yet we spend only 7% of our health care dollars to treat them. Given the tremendous costs in human and economic terms, given that these diseases touch a fifth of all Americans, you would think we would be mobilizing resources to address the mental health needs of this country. Instead we seem to have a system that blames mental illness on the mentally ill and ignores the impact on society.

We could have a system that recognizes a prevalent and costly disease and takes steps to ensure that people have access to treatment. That's what some - not nearly enough, but some - forward-looking companies aiming to save money have done.

But instead insurance companies put up roadblocks to treatment. There's less coverage, higher costs to consumers, more second-guessing of medical decisions, and laughably low reimbursement rates for providers.

Not only do these discriminatory policies make treatment too costly for many, they send the signal that mental health is not real health. Now we know that notion is preposterous. The Surgeon General has stated as strongly as he possibly can that mental health is integral to overall health. But insurance companies deny the science and treat mental health like some sort of luxury option, like cosmetic surgery.

The outrage over this lack of parity should extend far beyond this room. The insurance companies don't fully cover mental health because it's expensive? Well many cancer treatments ain't cheap, but you don't see them cutting that out. What's next, no insulin for diabetic children? Not only is it stupid economics, it's morally reprehensible.

With insurance practices like these, it's no wonder that two-thirds of mentally ill Americans never receive treatment.

We came closer than we ever have in the last session of Congress to passing mental health parity. We didn't get it, but the heat is on the Republican leadership and they know it. There will be hearings this spring in the House, and I'm going to keep pushing this issue until parity becomes a reality.

We need parity not only at the consumer level but at the provider level. Funding for behavioral healthcare under managed care has dropped 50% in the last 11 years, compared with about 10% for other specialties. Back at home in Rhode Island, providers haven't seen a rate increase in literally ten years.

And it's not because there's no money. Last year in Rhode Island, Blue Cross/Blue Shield paid bonuses to two of its executives of 96 thousand and 100 thousand dollars and sat on enormous profits. United Healthcare's stock split two-for-one in February.

So there's money there for executives and investors, it's just consumers and providers who feel the pinch. We have to do something about these anemic reimbursement rates or we'll simply run out of providers.

This provider shortage is particularly acute among children's mental health professionals. While the long-run solution must involve adjustments to reimbursement rates, I'd like to also attack the problem by giving people at the outset of their careers incentives to enter this field.

That's why I'm working on legislation to address the children's mental health care crisis. We need loan forgiveness and other options to make children’s mental health a little more financially attractive, and that's the kind of thing my bill will do.

Of course, what all of this comes down to, and we all know it, is stigma. Why do insurers give mental health short shrift? Why do policy makers ignore the obvious collateral benefits of investments in mental health? Why do employers fail to recognize the positive impact that mental health benefits have on the bottom line? For that matter, why do many suffering from mental illness fail to seek treatment?

Because outdated stereotypes and assumptions drive decision-making. We don’t cast moral judgment on asthmatics or diabetics or others suffering from chronic diseases. Only mental illness is the fault of its victim.

The good news is that we are starting to chip away at the wall that has, since time immemorial, separated those with mental disorders from the rest of society.

I wish you all could have been in the room last month when the House Republican members of the conference committee voted to drop the parity provisions from the health spending bill. The House Republicans there, who were under strict orders from their leadership to vote no, were positively squirming in their seats.

Nobody wants to be the person to stand up and say mental health is not deserving of coverage. We now have a majority of both houses of Congress that have said mental illnesses are real illnesses deserving of the same medical treatment as any other disease.

While parity remains held up by the House leadership, I was able to work with my colleagues on the Appropriations Committee to pass a significant increase in funding for the block grant that funds community mental health services. We funded a jail diversion program for mentally ill defendants. We added a new program to better integrate mental health services into the lives of seniors

There is a growing recognition that these disorders are not the figment of someone’s imagination. As horrible as the events of September 11 were, they have, I think, heightened the awareness of mental health issues.

In the wake of the terrorist attacks, every member of the NYPD is required to undergo counseling. The Special Forces, which have performed so admirably in Afghanistan, debrief with mental health professionals after combat as a matter of course. When people realize that even our national heroes, the people we rely on in a crisis, must attend to their mental health needs, it breaks down some of the myths. I think the wind is blowing our way. I think that wall of division is crumbling. Over the long term, arbitrary inequality is not a sustainable condition in America. Scientifically, economically, and, most of all, morally, the stigma that shapes our mental health system eventually must give way.

And the good news is that if we can hasten this transition, we can remake your field. We can create a system of mental health instead of mental illness.

Without that stigma, we could better integrate mental health into schools. Prisons wouldn't need to be psychiatric hospitals of last resort. Your colleagues in internal medicine, pediatrics, and geriatrics would be better trained to recognize symptoms of mental illnesses.

We could actually build a comprehensive, prevention-based system, one that brings prevention and early-intervention strategies into other settings. We could break down that arbitrary distinction between physical and mental health once and for all.

This is the mental health of the future. Needless to say, it's a long walk from here to there. So my question to you is, how is each of you going to help us take a step forward?

Each of us has to follow Deborah's lead and take it upon ourselves to make change happen.

The reason we have changed the landscape on parity is because the grassroots rose up and made their voice heard. There was a tremendous outpouring of support from consumers and providers.

Your advocacy and education is vital. The status quo is bad for patients, it’s bad for providers, and it's bad for the country. We can create a better system, and I look forward to doing it with you.

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