Deborah Peel MD
Speech for the National Coalition of Mental Health Professionals and Consumers
June 22, 2001, NYU Medical Center:

Thank you very much.  Before I say anything else, I want to thank the Board of the National Coalition of Mental Health Professionals and Consumers for arranging this terrific conference.  The panelists were excellent.  I also want to thank Dr. Harold Koplewicz for providing us this wonderful place to hold our conference.   

As I start, I have to first address the obvious question on your minds.  Why is a Texan coming to New York to talk about mental health?  I know you must be wondering about that.

Earlier this week, the Governor of Texas, Rick Perry, made the front page of the New York Times, by vetoing a bill that had passed the Texas Legislature, banning executions of the mentally retarded.  What can I say?  That’s my state.  You may already know this, but Texas is at the bottom of the 50 states in providing mental health care and social services to its residents.

I see a couple of people shaking their heads in disagreement; they must be from Tennessee or Alabama.  Sure, there may be one or two states that might have slightly lower national rankings, but let me remind you, Texas is the largest state among those at the bottom.  So Texas can practice cruelty on a larger scale, we can do more cruel things to more people in Texas than they can in Alabama, because we have a larger population.  So, what choice do I have living there?

Some of the previous speakers talked about what each of us can do in the face of the ethical and moral disaster wrought by managed care.  We can identify with the aggressors, we can deny what is going on, or we can try to do everything we can do to help, as individuals and through our advocacy organizations. That’s what I try to do.  I try to do whatever I can do to work for access to real mental health care. That’s why I was so drawn to the National Coalition and to Karen Shore. I wanted to learn from this amazing person, how she and the Coalition have been able to do so much and be so effective in building and leading an effective coalition of professionals and consumers fighting managed care.

Even though Karen Shore listed a number of organizations that I’m a part of and that I work actively with, each of you are members of larger professional organizations and consumer organizations too. The problem with the larger professional and consumer organizations is that they are not addressing the central problem of our field.  They may be unable to do this because of their size, or their inability to prioritize or focus. They also do not work effectively in collaboration. I’m referring to the American Psychiatric Association, the American Medical Association, and most of the other large professional groups.  They seem to have too many agendas and they don’t stick to the core issue most crucial to mental health care, the need for access to real mental health care in our nation.

That leads us to my task at this conference, to introduce the “Inform America About Real Mental Health Care” campaign, on page 11 in your program.  The problem is, Americans do not understand what quality mental healthcare is.  Americans have no idea what they should be getting.  We’ve never explained it to them.  None of our professional or consumer organizations have explained to the nation what it will take to have real mental health care.

I’m not going to read the campaign to you now, but the basics are very simple: real benefits, real parity, and real funding.

Real benefits – that means direct and immediate access to mental health professionals and to all effective treatments, and it means no more phantom networks.

It also means real parity, not fake parity like we have now.  We will have true parity when mental illness is treated the same as physical illness. We must eliminate all mental health carve-outs and the utilization review process must be identical for mental and physical illnesses.

The last thing that is required for real mental health care is real funding. When health plans spend only 1-2% of the health care dollar on mental health, real treatment cannot exist.  

Without these three elements, there is no real mental health care.  Without all three, there can be no effective treatment for mental illnesses, for addictive disorders, or for serious emotional illnesses.

I’ve been in practice now for 25 years, as a physician, a psychiatrist, and a psychoanalyst. I never would have believed that mental health care would deteriorate over the 25 years I’ve practiced, but it has.

Knowing what I know now, I’m not sure I would become a physician again, or a psychiatrist or a psychoanalyst.  I would instead try to do what Robert O’Harrow has done.  I don’t know how aware you are of his work, but his reporting on privacy, his work, and Robert Pear’s, have helped this nation understand what is needed to have a quality mental health and health care system.  They have been extremely influential in changing national health policy. I think I’d be a reporter, if I had to start over today, because investigative reporters are the most able to inform the public and Congress about the need to rebuild our devastated mental health system.  They can get the message out about the changes that we need.

We consumers and professionals need to learn how to get our messages out.  That’s why the Coalition planned this campaign to inform America about real mental health care.

What about our message of real benefits, real parity, and real funding?  It’s simple.  It’s clear.  Why is it so simple?  Why is it so clear?  It has to be simple and clear so that everyone can learn it. Every citizen and every lawmaker needs to know it by heart.

A recent survey from the National Mental Health Association found that 93% of undiagnosed persons don’t recognize that the symptoms they have are the symptoms of a mental health disorder.  People don’t even realize that they have a problem that can be helped or treated. Another 44% of people believe that their symptoms can be self-treated.  Then, of course, 42% believe that a diagnosis of mental illness is stigmatized.

So, where are we as a country in dealing with mental illnesses, addictive disorders, and emotional problems?  According to the US Surgeon General’s report in 1999, we are a nation where one-fifth of the people have a mental illness or an addictive disorder and 93% of them are in denial!  I would suggest to you that the other four-fifths are in denial too. So our message has to be very clear and very simple.

If you have a lump in your breast, you need to get a mammogram. Everyone knows that. If you realize you have a clinical depression, do you know what kind of evaluation you should have?  Do you know what quality treatment should be?  No.  That’s why we have to educate everyone.

I’m going to digress a minute.  My 8 year-old daughter wanted to play with me the other night, at a time when I was worrying about how I was going to give this speech, what I was going to say to all of you, and how I was going to make the case for why we all have to inform America about the need for real mental health care.  Kathryn said, “I’ll write your speech for you.”  I was grateful and curious, so she wrote one. Let me read you her speech.

It’s titled “Deborah’s Speech”:

“Hello, my fellow listeners.”  I asked Kathryn, “How did you learn to write speeches?”   She replied, “I just knew”.  Then she started, “I think mental health is one of the importantest things there is.  Someday, you might see a pharmacist begging for treatment and what would you say?  I would say, ‘yes’, even if they had told someone’s boss about their medicine and got them fired.”  She understands there is no prescription privacy and how dangerous it is to get care when there is no medical privacy.  Then she said, “even if a therapy person needs therapy, they should be able to talk.  Y’all better listen”.  Sorry, that grates on my ears, too.  “Because this is important.  Even a robber might need help because he or she did wrong (I love her being gender neutral).  We should fight against the police officers to let the people in jail talk to us.  Do not forget that person in jail could be your patient.  And people that get drunk can be your patient, too”.  Then she closed on a note of sibling rivalry, “if your patient has a brother or sister that died of being shot, they need extra help.”  Not a bad speech at all.

Of course, the point is that my eight-year-old daughter has been informed about real mental health care.  She understands what our message is.  She gets it.  If an eight-year-old can get our message, then we ought to be able to help this nation get the message about real mental health care.

Kathryn understands real benefits; she knows that people need medication and therapy.  She thinks that people need access to the right mental health professional, and get the treatment that is right for them.

She believes in parity.  She clearly believes that mental illnesses, addictive disorders and serious emotional problems are real, as real as physical illnesses.  She wrote about people suffering.  She knows mental illnesses cause suffering and she also knows that there is real help.

In terms of the third part of our message, real funding, she even gets that.  She realizes people need help wherever they are, even in jail.  That can’t happen without funding.  Again, if my eight-year-old can get the message, surely Texas can get the message, and this nation can get the message.

Texas and the Texas Legislature is very much on my mind, since our once every two years legislative session just ended.  The bill to block executions of the mentally retarded was not the only bill that Governor Perry vetoed. He vetoed a record 78 bills in all, including one for prompt payment for health practitioners in the State of Texas.  That tells you there’s a high “bubba factor” down in Texas, we have to pitch issues at about the eight-year-old level so our Governor and legislature can understand them. Kathryn’s speech tells me we’ve got the right message pitched at the right level.

Many of us become so inured to how bad the situation is for those with mental illnesses or we’ve been so worn down by the hassle of fighting for care, that we have given up and try not to even think about how truly awful things are anymore. But imagine a visitor from another planet coming to look at our health care system, what would he or she see?

If someone gets a heart attack, they go to the emergency room, they go straight into the hospital, they have interventional radiologists, cardiologists, cardiac surgeons, they see specialists and they get immediate effective treatment. It’s smooth, the health care system still works for them.

But if a person attempts suicide, what happens to them? That person also goes to the emergency room, but someone has to call an 800 number and try to justify why that person is seriously ill and needs to be hospitalized or evaluated.  Their family or staff has to call a 1-800 number to find out if there’s even a mental health professional that will see that person in the hospital.  This blatant discrimination must be stopped.

We must make sure that any new health system which develops from the ashes of the destructive managed care system includes real mental health care.  Any new health system must include real benefits, real parity, and real funding.

We have to take this clear message and now we have to deliver it.  We need each of you to help us deliver this message.  In fact, steal this plan.  Call it “Inform Buffalo”, or call it “Inform Schenectady. I’m going to take it to Texas and call it “Inform Texas About Real Mental Health Care”.  Take this plan and use it to educate everyone about what is needed.

The way that managed care operates is to delay, deny, and substitute inferior mental health care. That approach is systematic and deliberate. What would the visitor from another planet think?  He or she would think that the destruction of effective mental health care our country is no less than a conspiracy to destroy the very fabric of our society.

This idea is just now dawning on the business community.  There was a series in the Wall Street Journal on June 13^th about depression and business by Elyse Tanouye. She wrote about the 70 billion dollar a year cost of depression.  The business community is the unindicted co-conspirator, in conjunction with managed care and the insurance industry, who has destroyed real mental health care in our country. It’s gratifying to see the business community finally begin to wake up and notice that the absence of real mental health care is costing them dearly in human resources and dollars, as well as causing needless suffering and death.

As I finish my remarks, I want to tell you why Karen and the Board wanted me to lead this organization. They know that I am convinced that the only way we will ever have a real mental care system in this country is if the public and Congress are educated and informed.  Without an informed public and Congress, there is no future for mental health. They know that I believe we must work with our national political leaders to achieve real mental health care.

Actually, we all have a lot in common with politicians, with Dick and Patrick.  Those of us that provide or receive care, and as Karen pointed out, there can be a lot of overlap between the two, are feared and loathed by the population. Politicians are too. So we should have a lot of mutual empathy. We should be able to work together.

But why should you personally get involved in politics?  This has been very difficult leap for mental health professionals and for consumers alike to make.  Politics is a whole new world to us; it’s not familiar to us. Very few of us have gotten very involved with politics, out of ignorance, fear, and loathing.

But we must get involved now because there’s no other choice.  Remember what Bill Gates said not long ago?  He said something like, “what in the world does Janet Reno have to do with my business?”  Well, what in the world do Dick Gephardt and Patrick Kennedy have to do with our business?  Everything!  They have everything to do with our business.

Patrick Kennedy is going to introduce Dick to you very shortly. But before he does, I’d like to say a few things about Dick Gephardt. I’ve been fortunate enough to know him for many years now; our families have gotten to know one another.

Those of you who have tried to talk to lawmakers or media people about mental illness, have seen their eyes glaze over when they just don’t get what you are talking about. I want to tell you that Dick Gephardt really gets it.  Dick Gephardt really gets mental illness.  It comes from his heart.

If you read any speech that he’s written, if you look through his all policies both domestic and international, you will see that what underlies his words is a value that he shares with all of us: he believes in the unique value and worth of each individual. He believes that each person is worthy of being helped and deserving of basic human rights.  That deeply held value underlies his entire career in public service and it underlies all his policy positions.

We are so fortunate to have a leader of his intelligence and character in Congress. I can never say enough good things about him.  He’s simply a wonderful person; he’s a truly fine man. We are so lucky to have him as our helper and our advocate in Congress.

I’ve been asked, “Why doesn’t Dick sign on to co-sponsor this bill or that bill?”  I’d like to briefly clarify his role as the House Minority Leader. There’s a fundamental difference between his job as leader of the Democrats in the House and that of other Congressmen and women.  His job is to work behind the scenes. His job is like that of the quarterback who figures out how and where others can get the ball through to make a touchdown.  What he does is help Patrick Kennedy, for example, in championing a funding or parity bill.  His job is to help Patrick pass his bills and not take the spotlight.  His job is to strategize with the other members and build consensus, in order to pass legislation.

Before I close by introducing Patrick Kennedy, I want to urge you to join the Coalition. If you understand our message about the need to inform America about real mental health care, as my daughter Kathryn does, you should join the Coalition in a New York minute!  And what is a New York minute? It’s that teeny-weeny, infinitesimal fraction of a second between when the streetlight turns green and the first cabby hits the horn.

It’s now my great pleasure to introduce to you the Honorable Representative Patrick Kennedy of Rhode Island.  He is on the House Appropriations, Labor, and Health and Human Services Committees, so he can fight for real funding for mental health care.

He’s been a co-sponsor of mental health parity, of bills to stop discrimination against the mentally ill in Medicare, and he is also the newest member of the Advisory Board of the National Coalition of Mental Health Professionals and Consumers.  Thank you so much for joining us today, Patrick.

What is most amazing about Patrick Kennedy is that he has chosen to make mental health care his personal mission.  He has courageously spoken about his own treatment for depression. We need him, we need a hero, and we need a real champion for mental health in the House. I think Patrick Kennedy is that champion.  He’s the one we want.  He’s got the energy, the intelligence, the ability, he’s got everything – and he’s a Kennedy, too.

Please welcome the Honorable Patrick Kennedy to the podium.

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