Paul Gionfriddo, CEO of Mental Health America

Paul Gionfriddo - CEO of Mental Health America

Mark Masselli: This is Conversations on Healthcare , I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, Sec retary of Health and Human Services , Syl via Burwell
has issued an interesting challenge . A competition to see which developer can produce
a medical bill designed that actually is user - friendly .

Margaret Flinter: They are looking for a design that delivers a medical bill that ’s clearer,
less c omplex and eas ier to understand in a way that will improve the patient's financial
experience , that is a [Inaudible 00:00:29 ] as anyone who has ever tried to understand
an explanation of benefits or bill notes.

Mark Masselli: The problem is that so many practices switch to electronic medical
records in recent years and they were designed to accommodate far more coding
complexity . Unfortunately they have become too complex for many consumers to
understand .

Margaret Flinter: I am sure there are many people looking forward to the outcome of
this competition . Mark , I know I am.

Mark Masselli: There is another healthcare experience that's become increasingly
complex , the prescribing of pain medications . And it elicited a demand from some
Harvard medical students , a more effective curriculum to prepare them to confront this
deadly problem that’s become so prevalent in this country .

Margaret Flinter: I understand the student s actually organized their own tra ining
sessions on not only how to treat opioid addiction , how to recognize different kinds of
pain and the best way to manage it. I think it's very impressive that the students
themselves recognized what a crisis this is and have both demand ed and create d better
train ing.

Mark Masselli: Addiction and mental health issues are very much on the mind of our
guest today Margaret , Paul Gionfriddo, a long time friend and mental health activist and
CEO of Mental Health America an organization dedicated to making mental health
services a part of comprehensive primary care .

Margaret Flinter: And no matter what the topic , you can hear all of our shows by going
to chcradio.com.

Paul Gionfriddo - CEO of Mental Health America

Mark Masselli: And as always if you have comments , please email us at
[email protected] or find us on Facebook or Twitter ; we love hearing from you.

Margaret Flinter: We will get to our interview with Paul Gionfriddo of Mental Health
America in just a moment.

Mark Masselli: But first here is our producer Marianne O'Hare with this week's headline
news.

(Music)

Marianne O'Hare: I am Marianne O'Hare with these healthcare headlines. The CDC
and Nation al Institute of Allergy and Infectious Diseases and NIH are keeping their eyes
on close to 300 women in the US and American territories who are pregnant and had
been exposed to the zika virus . A 1 57 pregnant women in the continental US and 1 22
in its terr itor ies have test ed positive for the virus which causes severe birth defects and
also miscarriages . Of the 544 cases of zika reported in the US so far , most have been
acquired through mosquito bite but there are 10 cases of infection reported to have
happen ed through sexual transmission .

Meanwhile the President has also asked for $1 .1 billion to help combat the opioid crisis
which is grown dramatically in recent years . According to a recent study published in
Health Affairs it's behind a significant jump in hospital use and costs in 200 2 300 ,000
hospitalizations were directly related to opioid issues , in 2012 there were 520 ,000 opioid
related hospitalizations .

The FDA's new food nutrition label s are now on packages at a store near you [Inaudible
00:0 3:17 ] and in some cases more blocked label s have had a large things like the total
calories and serving size s and there is an added component that had the sugar lobby in
a latter [PH] a new line that shows the amount of added sugars to a food item . The
ad ministration fought back and won the battle that consumers need to understand how
much non - nutritional sugar is being added to a food so they can make choices based on
awareness of nutrient density of the product .

Americans are less enchanted with their marketplace insurance plans as time goes on .
According to a Kaiser Family Foundation study high deductibles and higher out - of -
pocket cost are leading to increased dissatisfaction with the plans . Study showed that
in 2014 27% of Americans poll were dissat isfied with the plans , in 2016 that number
jumped to 40% . However there is still overall satisfaction with the insurance coverage ,
68% still in favor of having it you can find the whole study at kff.org.

Paul Gionfriddo - CEO of Mental Health America

And the world is living longer , World Health Organization released a report showing the
average life expectancy has grown by five years around the world led by a jumping life
expectancy in sub - Saharan Africa of some 10 years due to largely a better malaria
control and expanded HIV treat ments . The Japanese women have a highest life
expectancy 87 years whereas Swiss man having the highest male life expectancy at
around 81 years all that mountain air and Swiss cheese. I am Marianne O'Hare with
these healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Paul Gionfriddo President and CEO of
Mental Health America , the nation ’ s oldest community - based nonprofit organization
committed to improving mental health in this country . Mr. Gionfriddo was appointed in
2013 to the National Advisory Council at the Substance Abuse and Mental Health
Service Administration . He has also served as president of Quantum Foundation as
Executive Director of Indigent Care in Austin , Texas at the Connecticut State
Legislature , and as mayo r of Middletown , Connecticut . He has written extensively on
behavioral health issues including his critically acclaimed book Losing Tim: How Our
Health and Education Systems Failed My Son with Schizophrenia . He is a graduate of
Wesleyan University and a good friend of ours . Paul, welcome to Conversations on
Healthcare .

Paul Gionfriddo: Thank you for inviting me to be on.

Mark Masselli: You know we are in the middle of National Mental Health Awareness
Month and when you look at the stats you realize n o one is immune . It's estimated that
1 in 5 Americans will have some diagnosable mental health issue in any given year and
yet many simply don't get help they need . I wonder if you could tell our listeners about
the impact of unmet behavioral health need s in this country and why diagnosis and
treatment pose such a challenge ?

Paul Gionfriddo: Well for the longest time we have treated m ental health concerns and
conditions as public safety problems and not as public health problems . As a result I
when we de institutionalized population in 198 0s we re - institutionalized that population
and when we closed our state mental health beds and facilities we reopen ed them with
county jail s , that puts a real damper on people's willingness to seek help and to take out
into the open the kind s symptoms they have got . W hat Mental Health Month has been
about is taking a month where people can talk about mental health openly , people can
talk about what it feels like to have a mental illness openly . And we can begin to move

Paul Gionfriddo - CEO of Mental Health America

from this public safety model to a public health model and get services that are
integrated into the regular healthcare delivery system .

Margaret Flinter: Well Paul, you have focus ed so much effort on improving mental
health and now you are at the helm of the nation's oldest organization dedicated to
promoting earlier diagnos i s and improving access to mental health services . So talk
with us about the key goals of Mental Health America and how efforts like your
B4Stage4 progra m are really position ed to help achieve these goals ?

Paul Gionfriddo: Yeah. What Mental Health America stands for is four things:
prevention for all , early identification and intervention for those at risk, integrated health ,
behavioral health and other services such as education services , housing support s and
employment supports for those who need them . So we made mental health concerns
and conditions the only chronic diseases we wait until State 4 to treat so a year and a
half ago we launched our B4Stage4 initiative which is designed to move people's
attention up stream in the process to help people think about intervening at Stage 1 or
Stage 2 not waiting till the crisis has occurred . And we have put a lot of our resources
by launching an online s creening program to make ubiquitous screening the goal of
everyone in America because we believe kids should be screened for mental health
concerns as frequently as they are screen ed for vision or hearing . We think adults
should be screened as frequently as they are screened for blood pressure and the US
Preventive Services Task Force agree s with us t hey think everybody over the age of 11
got to be screened annually for mental health .

Mark Masselli: Well Paul you just announce d this ambitious initiative with the Walgreen
change and the goal is to provide behavioral health screening for at least 3 million
people through Walgreens ’ national network of stores in the coming years . How will
folks who receive diagnosis get interventions they need in a timely fashion ?

Paul Gionfriddo: Millions of people come to us via our website and through social
media and millions of people every day visit Walgreens ’ website . So initially we put this
together to operate in this virtual environment where people go to mha screening.org ,
they are able to scree ning anonymously using the very same clinical tool s that the
doctor might use . Walgreens ha s now put a link from their website on to our screening
page so that we can get more people t o screen . What we are providing for Walgreens
is a set of online tools and resources that people will be able to use post - screening to
learn more about the conditions they have got . And what Walgreens is going to be able
to provide are some more linkages to their chat with a pharmacist program for example
our local affiliates – we have 100 of them around country – will be in a position to take

Paul Gionfriddo - CEO of Mental Health America

referrals as well and get people connected to local providers and other support services
in their communities so we will have a fully fleshed out screening to support s program .

Margaret Flinter: I am interested in this breakthrough system that Walgreen s is using
and that may be part of what you are referring to that facilitates interaction with
clinicians online an d includes a medication adherence tool . Talk about how emerging
technologies like this are making a large - scale program possible in the way that would
have been very difficult to achieve in the past and what's unique about this one?

Paul Gionfriddo: Yea h. In the past we were pretty much tied to physical location s. If
they wanted to get adherence to ols, they would pretty much have to go to someone or
some place . In recent years t he online environment s have change d this dramatically
and there are a lot of services that are moving into digital space , the best one s is Fitbit
which give you instantaneous feedback about certain things that are going on in your
body like your heart rate, the number of steps you are taking and things like that . We
are try ing to take advantage of the fact that young people especially are interested in
using these kinds of tools . Three quarters of the people who use our screening tools
are under the age of 25 , two - thirds of those tell us they have never been diagnosed with
any thing , pretty hard to get somebody to adhere to treatment and they have never
received a diagnosis and they aren’t really in treatment . So what we are trying to get
them to do is take a next step with some of the se tools and actually be willing to talk
fu rther about it, be willing to take the ir results to a clinician at Stage 1 in the process
where recovery comes a lot easier .

Mark Masselli: We are speaking today with Paul Gionfriddo President and CEO of
Mental Health America , the nation ’ s oldest communi ty - based not - for - profit organization ,
committed to improving mental health in this country . Mr. Gionfriddo also served on the
National Advisory Council at the Substance Abuse and Mental Health Service
Administration at HHS . Paul you have written about your own personal experience
navigating the mental health system in your book Losing Tim: How Our Health and
Education Systems Failed My Son with Schizophrenia and you even noted as a young
lawmaker , you inadvertently supported laws that made screen treat ment options more
difficult for families to access . I wonder if you could pull those together and share with
us the story about Tim and the navigation that you had to go through with the
Connecticut system and also give us an update on how Tim is doing.

Paul Gionfriddo: Yeah. Tim right now is 31 years old and for the last 10 years he has
been mostly homeless on the streets of San Francisco . Recently he has come back
into services a little bit he has had some housing, we actually got a chance to visit h im
about six weeks ago and he was doing very well and hoping at this point to stay in

Paul Gionfriddo - CEO of Mental Health America

services but all too frequently when he has come back in housing first he is tended to be
evicted from that housing and then we lose track of him for weeks and months at a time
again . Part of the reason he is evicted is because he just doesn't follow the rules
because he has got Schizophrenia and can't . What I think we made as our biggest
mistake in the 1980s was not understanding that while the people who were coming out
of our state hospital were adult s there people who were going into them were kids. Half
of all mental illnesses emerged by the age of 14 and these are childhood diseases ,
childhood problems and we never build a system of support s around our chi ldren . What
happened to Tim is what happens to a lot of kids like that they get into the school
system and the schools have no idea what to do with them , even though they are legally
required to provide individualized services and programs for those kids . S o I think that
that's the mistake we made as a matter of public policy in the course of the last 30 years
so we are continuing to see policies in America that are going to continue to put more
people like Tim out on the street and we at Mental Health Am erica really try to put in
place policies that will recogniz e early, it will get services to kids in the schools , in the ir
communities early on and that will change the trajectories of the se kids ’ lives.

Margaret Flinter: Well Paul, families often encou nter the toughest challenges once kids
age out of the system and aren’t eligible for some of th ose supportive programs they
may have had and certainly as the state budgets are floundering we see famil ies finding
it tougher and tougher to find safe homes an d dependable programs for their adult
children who grapple with complex mental health issues . And in fact The Atlantic just
had a very powerful article describing the nation ’ s jails and prisons as the largest mental
health hospitals in the country . I won der if we could talk a little more about solutions ,
where are the solutions for these young adults and older adults ? Now , you know Tim is
a example and Tim’s got the most supportive family in the world trying to help him but
lots of folks don’t so what ar e the solutions to really help these people ?

Paul Gionfriddo: Well I think the simplest solution is – in a way the most obvious one –
we have ask ed the members of Congress to include a provision in federal reform
legislation which remain s in the house bill at this point that would [ Inaudible 00:14:13 ]
incarceration of nonviolent offenders with serious mental illness within 10 years . States
could do that as well because there i s plenty of money and plenty of resources out there
b ut we have got to stop putting people in jail and we have got to stop using the jail s as
treatment programs for adults . If we did that , we would free up literally millions and
millions of dollars that we would be able to put into the building of the community - based
mental health systems that we promised to people back in the 1980s . And it's as simple
as that I think , let's get them out of the jail and let's move the money from the jail to
follow people back on the communities put clinical support folks, peers, clini cians into
the mix as opposed to just judges and lawyers and police officer s.

Paul Gionfriddo - CEO of Mental Health America

Mark Masselli: You know Paul you have talked about getting behavioral health services
to children early on we have also been very committed to sort of redefining the primary
care space and have made available to the schools throughout our state the opportunity
to have a behaviorist full - time in their school but also in the primary care space you
know the embedded behaviorist in primary care . We really n eed to take advantage of
the care delivery system and try to have people re - imagin e the way delivery might
happen . And we note that the Affordable Care Act is out there trying to promote models
aimed at of better outcomes , w hat do you see as interesting i nitiatives in the primary
care space that people in the country should be keeping an eye on ?

Paul Gionfriddo: What I think that people need to be doing is first and foremost making
certain that primary care clinicians are educated to an d informed about t he need for
integration in health and behavioral services . These are responsibilities fall on them
anyway whether they are pediatricians or adult service providers . Similarly , the
behavioral health providers need to understand better about how to integrate their work
into primary care and into educational settings in others . I really do think we have to
break down a lot of the barriers between the schools and the educators who understand
that the ir primary purpose is to educate kids but don't always understand that some kids
aren’t available to learn unless you deal with their health issues as well .

And I think that involves providing support s into the education al system but if we then
turn around have a special ed system that says if you are going to provide those
support s you ha ve got to pay for them , m ost schools are going to continue to be
reluctant to do that . So I think we also need to reform some of or special education
laws and may be take a look at allowing mandatory parts of individualized education
programs be covered not by the Education Department but by their kid ’ s private health
insurance s if it's otherwise available to provide some of those services and support s .

I think we just have to re - imagine the system and say this is about health not about
safety . And we have to throw out what we have done which is in school suspension
and expulsion with adult s putting them into jails and prisons and we have to say , okay
purpose is to keep kids in their families , keep kids in their schools , the purpose is to
keep adult s with their families , to keep them in their jobs . And whether that’s the
service that’s provided on site or if it's case of kids may be provided by a mento r there
are a lot of tools . So I say in the book , it's a chain of neglect where we don't do
anything , there are a lot of ways to break the chain , we only have to do it one place
though and that’s what will change things . And we just have to get everybody in the
country who haven't even envisioned the idea of integrating services yet in any
meaningful way to just start thinking about it.

Paul Gionfriddo - CEO of Mental Health America

Margaret Flinter: Well Paul you have served on the Advisory Council with the
Substance Abuse and Mental H ealth Services Administration along with so many other
things that you are doing. We had the Administrator Kana Enomoto on the show
recently and certainly we were talking about just enormous problem of addiction right
now in particular the opioid a ddictio n . I wonder how your organization is grappling with
this mi x of both the mental illness issues and also the addiction issues that have just so
powerfully swept across the country .

Paul Gionfriddo: I think we have something of a different take on it as w ell . We have
seen certain drugs become gateways and thinking particularly of drugs like marijuana
which for a lot of our population ha ve been – for the lack of a better way to describe it –
effective self - management of symptoms that have landed people as the gateway to jail .
We need to rethink a lot of the way we fought our war on drugs here a nd to make
available to people kinds of pharmaceuticals that they need that will actually mitigate
symptoms . And not really force them into employing strategies to get pharmaceuticals
that may not be quite the ones they need that are creating a lot of the crisis that frankly
has been around in our country for generations now but has been confined largely to
low - income communities and minority communities . And it's o nly in recent years that
people have begun to notice that actually this is every where I remember when high
school principal telling me when Tim was growing up that marijuana was in our high
school and I want to tell him you know when I was in high school, you know marijuana
was in your high school but we ignored some of these for an awful long time and I think
we are paying the price .

Mark Masselli: We have been speaking with Paul Gionfriddo President and CEO of
Mental Health America the nation ’ s oldest o rganization dedicated to improving
behavioral health services for all people in this country . You can learn more about their
work by going to mentalhealth a merica.net or following them on twitter
@M ental H ealth A m . Paul, thank you so much for joining us today .

Paul Gionfriddo: Thank you for inviting me to be on.

(Music)

Mark Masselli: At Conversations on Healthcare , we want our audience to be truly in the
know when it comes to the facts about healthcare reform and pol icy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org , a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got for us this week?

Paul Gionfriddo - CEO of Mental Health America

Lori Robert son: Donald Trump said, hairsprays not like it used to be because chemicals
in it that affect the ozone layer have been banned. Many countries began phasing out
the ozone - depleting substances in hairspray in the late 1980s but these regulations
wouldn’t affect the quality of hairspray. Trump also said using hairspray in his
apartment which he said was all sealed would prevent any ozone - depleting substances
from escaping into the environment , b ut these chemicals would still make their way out,
experts told us.

Trump has been making false claims about hairspray and the ozone layer for at least
five years and m ost recently made these statements at a rally in West Virginia .
Hairspray is made up of chemicals that make hair stiff and a propellant. Before the
signing of the Montreal Protocol in 1987 , h airspray and other aerosols used
chlorofluorocarbons as propellants CFCs are potent ozone - depleting substances.

A weakened ozon e layer leads to an increase in ultraviolet radiation which then brings
about higher rates of skin cancer, cataracts and immune system problems in human
populations. The gravity of the issue promoted countries to phase out CFC’s , hairspray
now uses HFC’s or hydrofluorocarbons and the ozone layer is recovering . But these
regulations have nothing to do with the stiffening agent in the spray , only the propellant
that propels the stiffening agent out of the can.

As for Trump’s sealed apartment we interviewed both a chemist and a physicist with the
National Oceanic Atmospheric Administration . They told us it makes no difference if
you spray chemicals inside or outside , they will eventually make it outside moving
through the lower atmosphere over month before being transported up to the
stratosphere. And that’s my fact check for this week, I am Lori Robertson Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email us at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Healthcare.

(Music)

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. For all the people in the world
without limbs acquiring prosthetics can be costly and out of reach. It's especially
challenging to make prosthetics for children since they are in constant state of growth.

Paul Gionfriddo - CEO of Mental Health America

Rochester I nstitute of Technology scientist Dr. Jon Schull stumbled upon a clever and
affordable solution, provided online open source templates to anyone anywhere in the
world who has access to 3D printer and provide prosthetic hands for next to nothing.

Dr. Jon Schull: I have made this Google maps mashup if you have a 3D printer and you
would like the help , put yourself on this map a nd if you know someone who needs a
hand put yourself on this map.

Mark Masselli: So he founded the e - NABLE network which has massed thousands of
volunteers makers and operat ors of 40 countries around the world providing cheap but
functional prosthetics for children in need.

Dr. Jon Schull: I think we are currently pushing 5,800 identified members in our Google
+ community and we have the followings in the thousands more. We know that we
have delivered about 800 hands and we suspect that this comparable number had been
downloaded by people we can’t track because we have put all of our design on the
Internet.

Mark Masselli: The simple limb designs have become more sophisticated as recipients
of the prosthetic devices provide feedback for designers to make more efficient devices.

Dr. Jon Schull: We are still working on the opposable thumbs we are still working on
individua l finger movements these things grip or un - grip, that’s all they do. So they are
much less functional than our biological hand and they are also less functional than a
fancy myoelectric hand . But for kids it's huge because those expensive devices are
tec hnically out of reach for children who would outgrow them so it doesn’t make sense
for them to get a $5,000 or $10,000 hand . And our hands don’t even pretend to look
like regular hands they look like superhero or ironman hand s and for that very reason
the y are very popular with kids.

Mark Masselli: e - NABLE , a global collaborative network of open source designs linking
to makers with 3D printers to provide low cost prosthetic limbs to children and adults
around the world who might otherwise not be able to afford them, now that’s a bright
idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Paul Gionfriddo - CEO of Mental Health America

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org and brought to you by the Community
Health Center.