Dr. Jeffrey Borenstein, President and CEO of the Brain and Behavior Research Foundation

Mark Masselli: This is Conversations on Health Care. I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret, it’s May so we are looking at several health
commemorations of note. We have the National Women’s Hea lth Week to
encourage women to make their own health a priority.

Margaret Flinter: This includes National Women’s Checkup Day which
encourages women to get all of their well - woman visits, very important.

Mark Masselli: It’s important to note, Margaret, th at these preventative well visits
are largely covered by the Affordable Care Act. These preventative primary care
visits are automatically covered . That’s great news.

Margaret Flinter: It is, and it really represents a sea change from years gone by.
So many women, particularly those who are economically challenged would put
off the most important screenings for women’s health issues . B ut under the
ACA, most of these essential pr eventative screenings are automatically covered
for everyone, no deduct ibles, no co - pays. And I think overtime that’s going to
really encourage women to take greater charge of their own health and health
care.

Mark Masselli: May is also mental health awareness month. It’s truly one of the
great unmet needs in the health c are arena, and one of our guests today is quite
knowledgeable about that.

Margaret Flinter: Dr. Jeffrey Borenstein is the President and CEO of the Brain
and Behavior Research Foundation .

Mark Masselli: There is quite a bit of promising brain research o n the horizon,
Margaret, and behavioral health is starting to get the attention it deserves in the
world of overall health.

Margaret Flinter: And FactCheck.org ’s Managing Editor, Lo ri Robertson , will be
stopping by . She is always on the hunt for mis stat ements spoken about health
polic y in the public domain

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.
Marga ret Flinter: We will get to our interview with Dr. Jeffrey Borenstein in just a
moment.
Mark Masselli: But first , here’s our p roducer Marianne O’Hare with this week’s
Headline News .

(Music)

Marianne O’Hare: I am Marianne O’Hare with these Health Care Headlines .
Bird flu continues to invade the avian population across the country, and the
federal government is springing into action. So far, the flu hasn’t mutated into a
human threat, but the federal government is spending $330 million to slow down
th e spread of the avian flu. In Minnesota, where over 5 million turkeys have been
put down due to the bird flu epidemic, plant workers are being furloughed, and it
could have dire consequences on the Thanksgiving turkey market later this year.
Bird flu has spread across the entire country at last count.

One of the tenets of the Affordable Care Act is that women shouldn’t have to pay
more for health care just because they are women, and a level playing field of
preventative care and screenings as well as bi rth control would be provided
without co - pay to all insured women , b ut a look around the country shows many
places where the contraception isn’t being covered. One of the s tudies focused
on contraception, while others looked at a range of other women’s he alth issues
among the companies not complying with the law’s requirements in at least some
states, Aetna, Cigna, Physicians Plus and Anthem Blue Cross and Blue Shield.

If you want to get an idea of how teens might approach drinking behavior, look to
the f ather. According to a recent study out of Taiwan , a long term study looked
at teen drinking behavior as influenced by parental behaviors and found dads
drinking had more influence on the young adults’ behavior overall, but it might
also be a case of do as I say, not as I do. Boys whose fathers were non -
drinkers, or who were drinkers but were against underage drinking, had a 39% to
73% reduced risk of drinking alcohol, compared to boys who se fathers were
frequent drinkers with a favorable attitude towards underage drinking. And boys ,
knowing his father was against drinking had stronger effects according to th e
study. And girls with a non - drinking mom , who is against underage drinking, had
a 77% reduced risk of drinking. So maybe there is somethin g to j us t s ay n o. I
am Marianne O’Hare with these Health Care Headlines .

(Music)

Mark Masselli: W e are speaking today with Dr. Jeffrey Borenstein, President and
CEO of the Brain and Behavior Research Foundation, the world’s leading private
funder of mental hea lth research which was awarded over $300 million in
research grants since its inception. Dr. Borenstein is a board - certified
psychiatrist. He also serves as Editor - in - Chief of Psychiatric News, the
newspaper of the American Psychiatric Association. He i s an Associate Clinical
Professor of Psychiatry at Columbia University College of Physicians and
Surgeons . Dr. Borenstein is a Fellow of the New York Academy of Medicine, and
serves as Chair of Psychiatry at the academy. He 's earned numerous awards
inclu ding the Federation of Organizations Community Mental Health Man of the

Year Award. He earned his undergraduate at Harvard and his M . D . at NYU. Dr.
Borenstein, welcome to Conversations on Health Care .

Dr. Jeffrey Borenstein : Thank you for inviting me . I am happy to join you.

Mark Masselli: One in four Americans will in their lifetime suffer from some form
of mental illness . A nd according to some estimates, mental illness will be the
most dominant hea lth condition within a decade . A nd I am wondering if you
could just take a moment and tell our listeners, give them some more insight into
the mental health issues affecting the population.

Dr. Jeffrey Borenstein: Basically everyone has a friend or a loved one who has
experienced a psychiatric conditio n such as depression, bipolar disorder,
schizophrenia, anxiety disorders, chemical dependency , e verybody has
somebody important to them who has been touched by these conditions . A nd
the fact that one in four Americans will at some point have one of these
conditions, that statistic speaks for itself in terms of how widespread it is. And I
think it’s important for people to realize how common these conditions are so as
to make people more comfortable to speak about them, and most importantly, to
seek treatm ent.

Margaret Flinter: Well , Dr. Borenstein there is this ever - widening list of official
diagnoses in psychiatry and behavioral health which are laid out in great detail in
the psychiatric professionals ’ guide to behavioral health diagnosis known in
shor thand as the DSM or the long form Diagnostic and Statistical Manual of
Mental Disorders . The most recent edition, the DSM - 5 I know has been updated
to include a more comprehensive list of disorders, but it’s nothing that you would
send the untrained reade r to for information ; it’s really for the professionals. But
we understand that the American Psychiatric Association decided to produce a
companion book written in plain English for the average person to help them in
grappling with mental health diagnoses and understanding what they mean. Can
you tell our listeners about this book , Understanding Mental Disorders: Your
Guide to DSM - 5, and why the new book is so important for those trying to
navigate and understand this world of mental illness and mental he alth?

Dr. Jeffrey Borenstein: Yes. I ha ve the privilege of serving on the editorial
advisory board for this consumer’s guide to DSM - 5 , Understanding Mental
Disorders. So the DSM - 5, the version developed for professionals, really is a
guide book for psy chiatrist and other mental health and oral health care
professionals making the diagnosis of different conditions developed with the
input of experts throughout the world in various parts of mental health. The top
experts were able to review the most curr ent scientific information . The new
consumer guide has been developed so that this information is available to the
general public so that people who may be concerned that they are experiencing
a condition can actually go to the book and see the informatio n written in
layperson’s language that takes into account this cutting edge information. So

this new book really serves as a way to empower people to understand these
disorders and empower them to get help.

Mark Masselli: I understand that the book has certain narratives from actual
people who have experienced many of the symptoms of common mental health
disorde r s . And many of the common mental health illnesses depression,
schizophrenia, anxiety share some commonalities which often make
understanding th e nature of this order difficult for family members. Can you
share some of the examples with our listeners?

Dr. Jeffrey Borenstein: So it’s one thing to have the listing of diagnostic criteria
and other aspects, and it’s important for people to have tha t information . B ut it
really reaches home for people when they hear the real story of somebody who
may have experienced some of those symptoms and then were able to get
treatment and move forward with their life. That’s a very powerful message. It’s
a m essage of hope, and also, it’s a message that you are not alone; there are
other people who have this same condition.

Margaret Flinter: You know, Congressman Patrick Kennedy wrote the forward to
the book, and he has been a guest on our show and has long advocated for
patients to have access to mental health coverage. The Mental Health Parity
and Addiction Equity Act was passed in 2008 and has since been extended to
patients covered by Medicaid. But even with that , we seem to still be a w eighs
off from r eally guarantying access to care for many of those suffering with mental
health issues. Talk with us about this huge gap in the health care system .

Dr. Jeffrey Borenstein: Yeah. Margaret, this is such an important issue. One of
the problems with regar ds to the Mental Health Parity law is making sure that that
law is implemented on a state - by - state basis to its fullest so that there aren’t
roadblocks put in the way of people who need to access care. There shouldn’t
be any difference in accessing mental health care than there is in accessing
physical health care. So one of the benefits of people having understandable
information about diagnoses is that having that information helps empower them
when they are hitting those roadblocks with some of the ins urance companies
because if the insurance company is saying, “No, we don’t feel that you require
treatment,” the person can say “You know what , I actually have the criteria, and
my loved one is experiencing these symptoms that are written in the criteria.” So
people need to stand up to an insurance company that may try to block access to
care by not fu lly implementing the parity law, and that needs to be very strongly
answered. So I think that people’s knowledge about the parity law and ability to
advocat e for themselves for their loved ones is extremely important.

Mark Masselli: We are speaking today with Dr. Jeffrey Borenstein , President and
CEO of the Brain and Behavior Research Foundation, the world’s leading private
funder of mental health research . Dr. Borenstein is a board - certified psychiatrist.
He is an Associate Clinical Professor of Psychiatry at Columbia University

College of Physicians and Surgeons. You know, I want to talk a little bit about
the large number of veterans that have been ret urning in this last decade from
wars around the world. I wonder if you could sort of illuminate the problems that
our nation’s veterans and their families face d particularly in areas of mental
health needs and what do you see as a viable solution to this enormous and
complex challenge?

Dr. Jeffrey Borenstein: Yeah. One of the tragedies relates to the issue of
suicide, the staggering number of active service members who continue to die by
suicide . A nd I think that it’s extremely important all service me mbers have
access to care. The issue of post - traumatic stress serving in such difficult
circumstances, many of the service members had to go back over and over and
over again, which is extremely stressful, not only for them but for their families as
well, and it’s important to make sure that we have support available for the
spouses, for the children of our service members. Often with a little bit of support
and help, they are able to live their life fully and be an important part of their
communities.

M argaret Flinter: Well , Dr. Borenstein , you know, it’s a tenet of primary care that
its care that’s delivered close to where people live, work, play and pray. In the
world of community health centers, which is the domain that we are most familiar
with, th e integration of behavioral health and primary care and integration at all
levels, the integration of the data within the electronic health record, all under one
roof, is a movement that has really developed traction in recent years. Tell us
what the pers pective is from where you sit of just how much traction that is
gaining ?

Dr. Jeffrey Borenstein: The majority of people in this country who have a
depression for example, do not seek or receive help . A nd those who do receive
help, often the treatment is by a primary care doctor, and often it’s not fully
adequate treatment. So the integration of mental health services is crucial, and I
think that the movement that’s occurring of really working collaboratively with
primary care physicians and other medica l professionals will have a tremendous
impact on the well - being of individuals and overall in society. For people with
illnesses such as schizophrenia, the average lifespan is 20 years less than
people without that illness, and that is typically due to me dical issues. If a person
has a heart attack, the most important risk factor for them is -- even more
important that high blood pressure or high cholesterol is untreated depression. A
person with untreated depression is at great risk of a bad outcome, bu t it shows
the close relationship between the brain and the rest of the body, and we need to
make that relationship on our end as physicians and other health care providers
just as close.

Mark Masselli: Dr. Borenstein , let’s take a look at the works be en accomplished
at the Brain and Behavior Research Foundation . About $325 million in grants
have been given directly to researchers in brain and behavioral health research.

Could you tell our listeners about your mission, and what on the horizon looks
like a promising research?

Dr. Jeffrey Borenstein: We have an extraordinary scientific council, and the
council consists of the top brain researchers, psychiatric researchers in the
world. All of our funds come from private donations, and because of the sup port
of two family foundations, every dollar given for researcher goes directly to
research. We are able to support new and innovative ideas that aren’t yet ready
to get government funding. Often you need to have enough pilot data to get
funding from NIM H, etc. We are able to give them that support to get that pilot
data . A nd one of the statistics that I think demonstrates our success is that over
$325 million in grants that we have already provided has resulted in over $300
billion in additional suppor t to those scientist s , which is an extraordinary
statement about the scientists and really about our scientific council selection
process.

So, one of the areas that we were early supporters on and now we've gained a
lot of traction, has to do with rapid - a cting antidepressants. As you are aware, the
current medications can take two to four to six weeks to have an effect. The
rapid - acting antidepressants have an effect within a few hours. If you think about
the potential of that if somebody is depressed a nd at risk of harming themselves,
they may need to be admitted to a hospital for treatment. If the rapid - acting
antidepressants are fully developed, such a person can go to the emergency
room, receive the medication and safely go home and go to work or go to school
the next day and move forward with their life. And that’s something that I am
very excited about. I think it’s going to happen in the next period of time.

Margaret Flinter: Let me ask you about just one other area. Certainly a growing
body of data and research looking at the impact of emerging technologies on
health care delivery and outcomes and we are seeing things and doing some
research of our own in areas like remote patient monitoring, Telehealth and also
mobile health platforms that h elp clinicians across all the disciplines to meet the
needs of patients wherever they are , you know, not just in our office but wherever
they are. What are your thoughts on how technology is playing a role in some of
the new treatment protocols being cons idered to meet the growing demand for
mental health, and maybe share some of your concerns and hopes with us about
this domain ?

Dr. Jeffrey Borenstein: Yeah. I think that what you brought up about meeting the
needs of patients wherever they are is a tre mendous opportunity for us . S o that
for somebody who -- it’s difficult for them to have access to get to a physician’s
office or other health care professional’s office, to be able to do that with current
technology is a tremendous opportunity and can mak e a big - big difference in
people’s lives. So I see that as being a real hopeful aspect of technology. And
then the other area of technology in terms of research has to do with the new
technology that we have developed in terms of genetics, being able to really

study the brain with the technology called optogenetics , which is an extraordinary
technology that is now being used in thousands of labs around the world to study
the brain, and this received early support from our foundation a number of years
ago. So I think that technology will help us better understand the brain and
develop new treatments.

Mark Masselli: We have been speaking with Dr. Jeffrey Borenstein, President
and CEO of the Brain and Behavior Research Foundation, Editor - in - Chief of
Psychi atric News, the publication of the American Psychiatric Association , and
creator and host of Healthy Mind, a syndicated show on PBS, aimed at informing
about and removing the stigma of mental illness. You can learn more about his
work by going to www.bbrfoundation.org or www.psychiatry.org . Dr. Borenstein ,
thank you so much for joining us on Conversations on Health Care.

Dr. Jeffrey Borenstein: Thank you very much.

(Music)

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.org, a n onpartisan, 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 : Well, the field of Republican presidential candidates got larger
this week with the addition of Carly Fiorina, Ben Carson, and Mike Huckabee .
When Huckabee, the former governor of Arkansas, announced his candidacy, he
repeated some old discredited lines on the economy, tax cuts and health care.
On health care, Huckabee said that Washing ton was failing to keep its promise to
seniors. He claimed that “Congress took $700 billion out of Medicare to pay for
Obama C are.” This is a whopper we have written about multiple times. The
Affordable Care Act doesn’t slash Medicare’s current budget. Instead, it reduces
the future growth of Medicare by an estimated $716 billion over 10 years. Most
of that reduction comes from reducing the future growth of payments to hospitals
and payments to Medicare Advantage plan. By reducing the future growth of
Medicare, the ACA actually improves the program’s finances.

Critics of the ACA have long claimed that the $716 billion in cuts hurts Medicare,
but these cuts in the future growth of spending prolong the life of the Medicare
Trust Fund, stretching out the program’s finances longer than they would last
otherwise. We have written before that experts, including Medicare’s chief
actuary, doubt that some of these spending cuts will actually be implemented, but
if they are Medicare would spend less each year tha n it had been expected to
otherwise, allowing Medicare to stretch further the income it receives from payroll
taxes and premiums. We wrote about this claim several times during the last

presidential election, and it looks like we will still need to addres s it in the 2016
race. 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 Annenb erg 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 C onversations on Health Care.
(Music) Mark Masselli: Each week , Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. When 12 - year - old
Spokane, Washington native, Brooke Martin, was given an assi gnment to find a
need and then fill it, she thought of her beloved dog home alone all day. The family rescued dog suffered from separation anxiety or she thought what if you
could create a video link with a smart phone platform, creating a portal to not o nly
check in with your dog and interact with him, but even dispense a treat for them while you are away at home. Her invention, i CP ooch has been launched into the
marketplace with some success. At that time, her grandmother had entered a senior living fa cility and was facing similar separation issues, and she wasn’t
doing well at keeping up on her meds.
Brooke Martin: So I started thinking well, hey, this technology might be really adaptable to , you know, elderly people or just loved ones who are separa ted and have a hard time communicating with each other.
Mark Masselli: So the now 15 - year - old modified her first invention designed for
the family pets to a tool that would allow families to interact with their senior family members remotely via video ch at, not only to keep an eye on the loved one but to make sure they were being compliant with their medications, a huge problem for elders aging in place. So she created iCLovedOnes . Her dad, Chris
Martin, explains how it works.
Chris Martin; It’s a dev ice about the size of a coffee can, and you put it on an
end table or a bedside table near your loved one, and you load the inside of it with plastic dishes or like Petri dishes, and you can put pills in them or candy or whatever you want and you stack tho se up . A nd then what happens is you open
up a free app that’s on your phone or you log in into a web portal, and you can actually launch a video connection with auto answer on the part of the end user.
Mark Masselli: Daughter Brooke Martin says it’s str essful not to be able to
connect with your family elders, especially when you know their health is being compromised by isolation and lack of medicine compliance. Her simple drug -
dispensing system, a series of dishes stacked in a tower like a Pez dispense r

can be deployed remotely by family members via S napchat like mobile phone
connection.

Brooke Martin: And there is a button on the app, and when you press it, it just
dispenses that dish of medication out.

Mark Masselli: iCLovedOnes has won several aw ards and was presented at the
recent American Telemedicine Association conference as a technology to watch.
iCLovedOnes a mobile phone - linked platform that connects family members with
elder relatives, creating video links and allowing them to assist in m edicine
compliance, now that’s a bright idea.

(Music)

Margaret Flinter: This is Conversations on Health Care. I am Margaret Flinter.

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

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