Mental Health Crisis in America: National Council for Behavioral Health CEO Linda Rosenberg on Causes and Solutions

Linda Rosenberg

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Margaret Flin ter : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the health c are of the future. This week, Mark and
Margaret speak with Linda Rosenberg , CEO of the National Council for
Behavioral Health , dedicated to unif ying the voice of America's health
care organizations who deliver mental health and addiction treatment
services . They've just released a study in partnership with the Cohen
Veterans Network that shows America's mental health crisis is a direct
result of lack of access to mental health and addiction services.

Lori Robertso n also checks in , the managing editor of Fa ctCheck.org ,
looks at misstatement s spoken about health policy in the public
domain, separ ating the fake from the facts.

We end with a bright idea that's improving health and well - being in
everyday lives. If you have comments, please email us at
[email protected] or find us on Facebook , or Twitter, i T unes , or
wherever you listen to podcasts . You can also ask Alexa to play the
program , Conversations on Health Care .

Now , stay tuned for our interview with Linda Rosen berg on
Conversations on Health Care.

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Mark Masselli: We're speaking today with Linda Rosenberg , president and CEO of the
National Council for Behavioral Health , seeking to unify the voice of
America's health care organizations who deliver mental he alth and
addiction treatment and services. Under her leadership, the National
Council advanced the passage of the Mental Health Parity Act in 2008.
Prior to joining the National Council , Ms. Rosenberg was senior
deputy commissioner of the New York State Of fice of Mental Health .
She earned her MSW from Adelphi University .

Linda, welcome to Conversations on Health Care .

Linda Rosenberg : Than k you. Thank you for having me.

Mark Masselli: I don't know if Americans know this factoid, but 20 % to 25 % of
Americans have a diagnosable mental health condition in a given year,
but a majority never seek or gain access to that treatment . Your
organization in partnership with the Cohen Veterans Network just
released a report that reveals a distinct connection between the lack
of available behavioral health and addiction services, and the mental
health crisis we're seeing in the country. There are just so few
treatment s . I'm wondering if you could share with our listeners more
about the study and what it revealed to you.

Linda Rosenberg

Li nda Rosenberg : It revealed some interesting thing s, s ome things we suspected . You
have hunches . You want to make sure that there's data behind it.
What th is survey shows that 6 in every 10 Americans has looked for
help for themselves or a loved one, which is a high number. What it
revealed is that 76 % of Americans believe that mental health is as
important as any medical or physical health condition you could have.
It also, I think interestingly enough, put to rest the myth that stigma is
the biggest barrie r to treatment. We had for a long time a belief that
people didn't look for care because they were embarrassed and
ashamed. In fact, the biggest barrier is people don't know where to go
and they don't know how to pay for it.

Margaret Flinter: Well, Linda , we are very engaged in delivering health care integrated
primary care and behavioral health care to about 100,000 people a
year. Last year , we saw about 100,000 people and about 20 % of them
were seen in not just primary care , but also for behavioral health
services. Those people who are seeking treatment are now skewing to
a younger age , and certainly, as we've all been recognizing, a
significant percentage of veterans are among those who are seeking
help . Tell us about these changing demographics and about the
daunting barriers that still exist to gaining access.

Linda Rosenberg : Interesting ly enough, veterans were more likely to feel comfortable
looking for help . I think that's a testament really to the job the VA,
Cohen Veterans Network , and other veteran s group have done really
to de - stigmatize getting help for things like PTSD , depression , and
anxiety. Younger people is also interesting. I think anyone that has
teenagers or that spend some time looking at these issues on the
Internet will see young peopl e exchanging information very openly in
ways w e certainly didn't when I was at teen , talking about being
diagnosed bipolar . A group of teens gave me a bipolar babe t - shirt a
year o r so ago . They were living with it and had learned to cope.

I think the oth er thing is people who are looking for treatment and
who do get it are very satisfied. That was the other thing th is survey
showed is that treatment is effective . People can get help . We know
that both from research studies, but we also now know it as a re sult
of this survey.

Mark Masselli: Linda, the National Council help ed realize the passage of the Mental
Health Parity and Addiction Equity Act back in 2008 . We were
fortunate to have Congressman Patrick Kenne dy joined us a few years
later on the show , sti ll lamenting the huge challenges in achieving
true parity in the American health system.

Linda Rosenberg : We work closely with Patrick . He is an American hero --

Mark Masselli: Oh, there's no question about that.

Linda Rosenberg

Linda Rosenberg : -- in terms of the work he did and the work he does . I think what
we're seeing is parity has had an e ffect mostly on hospitals,
residential treatment beds, inpatient service. It's had less of an impact
on community - based services, which of course for a chronic illness are
part of t he continuum. It's the way you avoid going into the hospital.
Patrick and many groups are still working to make sure that insurance
departments in states enforce parity and that state legislation support
federal law. He hasn't stopped, and neither have the groups working
with him .

Mark Masselli: Neither have you . You had some changes in that 10 - year period . You'd
have the Reauthorization Equity Act of 2016 . You had the Affordable
Care Act . How have those helped move the ball forward?

Linda Rosenberg : I thin k that the biggest success of the ACA , others may disagree with
me , has really been the expansion of Medicaid . What that has
resulted in is people with addictions getting treatment who could not
get any care before at all . You didn't qualify for Medicaid o r for Social
Security Income because an addiction was your primary disorder.
When states expanded Medicaid and it just became an income test,
then people with addiction started to get the help they desperately
need . During the time of an opioid epidemic , r esulting in so many
overdose deaths, this has been a major success. I'd say after once it's
done in a state and the political posturing is over, there's been little
fuss or muss , and people have gotten care who didn't have care
before.

Margaret Flinter: Ou tside of some of our more formal systems, I would love for you to
have a chance to talk about what I think one of your truly wonderful
and ingenious grassroots efforts , launched by the National Council ,
and that's the Mental Health First Aid Initiative . Th is is a program that
is aimed at providing everyday people with the training and the skill
set necessary to recognize and to respond in an appropriate way to
signs of mental health or addiction problems.

You've got a great tagline , Anyone , Anywhere Can Ma ke a Difference .
I understand over a million people have been trained through the
program. Talk for our listeners about the genesis of this Mental Health
First Aid , what the training is all about, what the results have achieved
so far , and what are you thi nking about for its future .

Linda Rosenberg : It's really opportunity meets being prepared to take advantage of
opportunity. We heard about it on a phone call back in 2007. It was a
program that started in Australia , now in 24 countries . I just love the
ide a of Mental Health First Aid . I ' m somebody who 's been trained in
CPR and I thought why not . I ' m much more likely to see someone in
emotional distress than someone having a coronary event. Yet few
people feel comfortable dealing with mental illness es everyt hing from
addiction s to anxiety , and to people thinking of taking their own lives

Linda Rosenberg

of suicide.

I took a course and we had staff take a course , and we all said, hey,
this is really outstanding. We had the people from Australia come
over and we began to roll it out. I think what's really special about it is
it teaches you to have these uncomfortable conversations to listen
non - judgmentally, but also because it's taught by local instructors ,
and there are about 14,000 instructors in the U.S. , because it's taug ht
by local people , t hey know the resources in their community , and
they're able to let people know where you can go to get some help ,
whether it's a m 1 - 800 hotline , or it's a mental health clinic , or it's a
primary care doc who does collaborative care, wh ich means he has
access right in his office to behavioral health specialists . That is very
exciting. It's well researched. Th is has a strong research base.

Most recently , a piece of research came out here out of Colorado and
the university there that show s that people retain the gains they
make even six months later , and continue to use the skills that they
were taught. We do have other plans. We're looking towards putting
part of it online , so people can both do part of the work in their
comfort of their own homes, but part of it will continue to be live with
a group because so much rich exchange goes on when people interact
together and share their own stories.

We're looking at a teen version and we're excited that about 1.4
million people have taken the course. It's been a major success . We're
very lucky at the National Council that our board has invested heavily
in this and believes it's their obligation to make sure we have an
educated public. I think that's part of the demand we're seeing . Now
of cour se , we have to make it as easy for them to get help . That's the
big hurdle now .

Mark Masselli: We're speaking today with Linda Rosenberg , president and CEO of the
National Council for Behavioral Health .

Linda, I was thinking as you were talking about the collaborative care
of the doc with the resource in his office that the National Council has
long advocated for embedding behavioral health services in primary
care settings . We had Tom McLellan , the CEO of Treatment Research
Institute , who talked to us abo ut the vital approach to managing
chronic nature of substance use disorder over the long - term includes
integrating it into primary care. I wonder if you could just talk about
your research and advocacy in this area about embedding behavioral
health and pri mary care.

Linda Rosenberg : It is difficult. It's a major change. Mental illness was always the
purview of the state , state hospitals where far away , in rural areas ,
very often , i t was not seen as part of general health care . When the
National Council got involved in this and began to think that this isn't

Linda Rosenberg

right and many people aren't getting care , and when they're getting
care in primary care isn't as good as it could be because the
practitioners are n't trained and they have many other things they
were att ending to . I think we're seeing it slowly happen.

The unfortunate thing is people use the word , integration , like they
use the word , recovery , to mean many things . In some cases , what it's
meant is the state has taken mental health money and merged it wit h
general health care money , and given it to a managed care company
that's now responsible for so called integrated care .

The problem is it doesn't really integrate care on the ground and the
kind of collaborative care is slow. First of all, you've got to have a
team approach . You have to have psychiatric consultation available .
You have to know how to bill for it. Medicare now has a code for
collaborative care, but all of insurance has not caught up yet . This is
going to be a journey, but we can't take ou r foot off the gas pedal.

Margaret Flinter: Well , Linda, Mark just referenced our interview with Dr. Tom
McLellan. He had brought up another astonishing statistic that very
few health professionals have had any kind of formal training in
addiction medicine i n particular . Our research and education arm,
which is our Weitzman Institute , often gets requests to help train staff
in primary care organizations to be better prepared to address
substance use disorders specifically and of course opioid use disorders
in teen - based primary care settings.

What 's the council's take on this or recommendation? I know we've
seen some progress about additional training for physicians, nurse
practitioners, behavioral health people around opioid use disorder .
What are you reco mmending needs to be done around the shift in
general in education and training models for health professionals?

Linda Rosenberg : Yeah. We , for number of years , have actually been doing training in
primary care around SBIRT, the screening and brief interve ntion and
treatment, which is evidence based, trying to help primary care
practices do that screening and do those brief interventions. Tom is,
of course, a brilliant guy and totally right. We're getting some
attention to this in medical schools and certai nly psychiatric residency
programs . The biggest number of professionals that work in mental
health and substance use organizations are social workers and very
little attention has been given to what can we do with social work
curriculum , so that it does in clude the treatment of addictive
disorders.

Alcohol is still the number one killer . We shouldn't forget that . We
had been involved a number of years ago in curriculum change in
schools of social work around integrated care . I think now it's time to
turn o ur attention really to addictive disorders. We need to be a

Linda Rosenberg

learning field, right?

Margaret Flinter: Right , absolutely.

Linda Rosenberg : We need to always be seeing what's the research telling us, how do
we train people , and then how do we change the pract ices, whether
it's in primary care or even specialty care, what has to change in the
workflows to be able to incorporate these kinds of screenings , and
then where do they send people who need specialty care . Do we have
enough resources? This is an evolutio n that we're all part of.

Mark Masselli: Linda , you've talked about your goals . That in an ideal world would be
a mental health clinic in every neighborhood . You've just sort of
waxed eloquently about the change processes that need to go on and
practices t he education that we need . Then we need to send people
who have problems maybe to specialists . I was thinking about the
conversations that we've had with Peter Yellowlees , who was the
p resident of the American Tele medicine Association , talking about his
ea rly work in Australia, using telemedicine to address the gaps in
behavioral health services across low resources areas.

You talked earlier about telepsychiatry. I'm wondering what you see
this emerging tech - based intervention doing in terms of transformin g
access across the country . These aren't necessarily always rural or
frontier places. Sometimes in our inner cities, people do not have
access to the specialty care they need. Where does tele - behavioral
health enter into your larger model that ultimately will end up with
these mental health clinics as in many neighborhoods or a portal in
every neighborhood ?

Linda Rosenberg : Yes, yes, totally , agreed. I don't even think it's that people don't have
access. I think we're raising generations now that want thin gs on
demand, right? I'm waiting for an Amazon package as we talk. I just
ordered yesterday .

Mark Masselli: Is it coming by drone or is it just coming?

Linda Rosenberg : Maybe . I don't really care as long as it gets here , right ? I'm into being
on demand and I like doing things from the comfort of my home . I
think even for the most serious disorders, I was just on a call with
Emory University , and they're looking at connecting people who were
in the emergency room to community - based care. We got into a
major discussion about texting people and emailing them , and
chatting over Skype , all of the things that that state cannot do based
on regulations , but all things that eventually we will do.

Innovation always comes before regulatory change. I think there will
b e a mix. We call it , at the National Council , High Tech and High
Touch . For the last 10 years at our big annual conference , w e've had a
technology track. I must talk to two or three people who are backed

Linda Rosenberg

by invest or money , who have different kinds of techn ologies that
they're introducing. I don't know if any are profitable yet, because
again, who's going to pay for it and how it's going to be paid for.

Michael Phelps is all over TV , advertising Talk space , where you can
get evidence - based treatment via a Sk ype like device . I do think those
things are going to be integrated in all of health care and specifically
in mental health and addictions care.

Margaret Flinter: Well , that is wonderful . I do want to give a shout - out to Veteran s
Affairs who I understand h ave completed more than 2.5 million
telehealth visits for mental health and particularly focused on PTSD ,
so really been great leaders in that area.

We have been speaking today with Linda Rosenberg , the president
and CEO of the National Council for Behavi oral Health . You can learn
more about their important work by going to the nationalcouncil.org
or follow them on Twitter @National Council .

Linda, thank you so much for joining us today.

Linda Rosenberg : Oh, t hank you.

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Mark Masselli : At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning journalist and managing
editor of FactCheck.o rg, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.

Lori, what have you got for us this week?

Lori Robertson: In an [inaudible 00:19:39] for USA TODAY , President Donald Trump
made several f alse and misleading claims about the Medicare for All
Act , which was introduced by Senator Bernie Sanders in September
2017. The President claimed that the Medicare for All Act would " cost
an astonishing $ 32 .6 trillion during its first 10 years " . That's an
estimate of the cost to the federal government that ignores the
offsetting savings in health care costs for individuals, employers and
state governments.

Under the plan , health care spending would shift entirely to the
federal government , while people, e mployers , and state governments
would pay less for health care .

Also, Trump wrote that the Medicare for All Act would " take away
benefits from seniors " . The plan calls for adding new benefits to
Medicare coverage, including dental, vision , and hearing aid s, and
eliminating deductibles. The President offers his opinion that it
wouldn't work out that way, but the bill as written would provide

Linda Rosenberg

mor e benefits, not take them away.

Trump also overstates the consensus when he said Democrats across
the country hav e been uniting around the Medicare for All Act . It's
true that 16 Democrats in the Senate have cosponsored Sanders '
Medicare for All Bill , but i t's not clear that Democrats are uniting
around that one proposal. Sanders ' bill is one of a handful of
proposal s in Congress that would expand insurance coverage in
various ways by increasing access to Medicare or Medicaid.

That's my fact check for this week. I'm Lori Robertson, managing
editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to fact ual 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'd
like checked, email us at chcradio.com . We'll have FactCheck.org's
Lori Robertson check it out for you here on Conversations on Health
Care.

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Margaret Flinter: Each week , Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. When it comes
to walking the walk , Chester County , Pennsylvania is on it . To
celebrate National Public Health Week , county health officials decided
to issue a challenge to members of their community to log a collective
billion steps last year .

Jeanne Casner: St arted with a National Association of County Officials Conference in
which they were announcing a national competition to improve
health outcomes in cities and counties. We applied for that while we
were also trying to introduce more physical activity into our health
department Initiatives .

Margaret Flinter: Jeanne Casner , director of the Chester County Health Department ,
says they launched the program , WalkWorks ChesCo! , creating a
website for county residents to log their daily steps , to join walking
group s, issue challenges , and get entire families and neighborhoods
involved with the simple goal.

Jeanne Casner: Really a model for getting individuals up and walking that takes
multiple approaches and hopefully starts to inspire that next
generation to be wal king with something simple.

Margaret Flinter: Community , schools, companies , all engaged in walking challenges
and it led to far more people participating t hroughout the county.

Jeanne Casner: We actually have a website where people can go and check how ma ny
steps and how many walkers , and look at competitions. That's really

Linda Rosenberg

what starts to spur it, and then having a couple trusted organizations
participate in a walk.

Margaret Flinter: In just six months , some 3 , 000 participants were able to log over a
billi on steps , having reached their goal far more easily than they
originally thought. C asner says they actually ha d to increase their
goals to keep people walking.

Jeanne Casner: Last year, we accumulated about 1.7 billion . Our goal was 1 billion .
We exceeded that. This year's goal is to walk a cumulative of 5 billion
steps . Fitbits and other wearables helps individuals because not only
is it cool to have something tracking without you not even having to
put any effort to it, but it also starts to create some o f that
mechanism where we can collect all the data and actual ly increase
social interaction.

Margaret Flinter: A communit y wide effort, leveraging the power of public and
government entities to engage the community in a collective health
and we llness progra m, creating a user - friendly website for
participants to engage with one another, yielding an increase in
healthy exercise across the population , n ow that's a bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mar k
Masselli.

Margaret Flinter: I'm Margaret Flinter.

Mark Masselli: Peace and health.

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
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listen to podcasts. If you have comments, please email us at
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