Paul Gionfriddo, CEO of Mental Health America

Paul Gionfriddo – CEO of Mental Health America

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

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret, we have seen the GOP version of the health
reform bill and it has generated quite a bit, shall we say co ncern from a number
of sectors, American Healthcare Act goes a long way to reduce benefits for
millions of Americans, eliminates the Medicaid Expansion and reduces the
essential benefits required to be covered by the insurance industry.

Margaret Flinter: And as you might imagine, Mark, there are different views on
how viable this proposed replacement to ObamaCare or the Affordable Care Act
really is. An estimated 15 million Americans would lose coverage and costs
would increase for many consumers. That analysis is corroborated by the
Nonpartisan Congressional Budget Office.

Mark Masselli: States with large Medicaid populations would be especially hard
hit. Ohio alone stands to lose some 16 billion to 26 billion dollars over the next
several years if t he Medicaid Expansion goes away.

Margaret Flinter: Another concerning provision of the GOP plan, Mark, would
eliminate requirements for insurance companies to cover mental health and
addiction services, something that has taken so long to get in place. This of
course has many health professionals deeply worried about their capacity to
continue to confront this still somewhat unmet need, especially in light of the
deadly opioid crisis, something that affects every State, every County in the
country with d rug overdose deaths reaching 50 thousand in 2015 alone. This is
just a national tragedy that knows no boundaries, affects families across all
geographic and socioeconomic sectors and political sectors as well. So, we
thought we would revisit our conversa tion with Paul Gionfriddo, President of
Mental Health America, which seeks to advance parity, coverage, and treatment
for all diseases of the brain including addiction. He is a passionate advocate at a
time when we really need to have this conversation.

Mark Masselli: Indeed Margaret. Lori Robertson also stops by, the Managing
Editor of FactCheck.org, looks at misstatements spoken about health policy in
the public domain, but no matter what the topic, you can hear all of our shows by
going to www.chcradio.com .

Margaret Flinter : And as always, if you have comments, please email us at
[email protected] or find us on Facebook or Twitter , because we love to
hear from y ou. Now, we will get to our interview with Paul Gionfriddo in just a
moment.

Mark Masselli: But first, here is our producer Marianne O’Hare with this week’s
Headline News.

Paul Gionfriddo – CEO of Mental Health America

Marianne O’Hare: I am Marianne O’Hare with these Healthcare Headlines. The
repo rt by the Nonpartisan Congressional Budget Office on the potential impact of
the American Healthcare Act is not sitting well with a number of entities across
the health and political spectrum. The GOP Health Plan is designed to repeal as
much of the Affor dable Care Act as possible. The CBO estimates repeal of the
individual mandate. The elimination of the Medicaid Expansion could cause
States and millions of health consumers their coverage. According to the
Nonpartisan CBO, the American Healthcare Act w ould lead to 24 million
Americans losing health coverage in the coming years, leading to a projected un -
insurance rate of 52 million Americans in eight years, higher than before the
passage of the Affordable Care Act. Cost for insurance would go up initia lly. An
estimated 20% next year, but those who do buy insurance will receive some tax
credits over time. Younger healthier people would pay much lower premiums.
The GOP Bill end up costing older sicker people up to five times as much in
premiums, but el imination of the Medicaid Expansion is expected to have the
biggest impact on the poor and working poor, who now receive coverage. An
estimated 95% of those who receive coverage under the ACA would not be able
to retain it under the GOP plan. Republicans in the Senate have a slim two - vote
majority and a number of Republican Senators are raising concern about the bill
including Senators Susan Collins of Maine, Lisa Murkowski of Alaska , and
Senator Rand Paul of Kentucky, all Republicans. The American Healt hcare Act
will face an uphill battle in the Senate without full GOP support. Relatively, little
resistance has been registered for President Trump’s picked, who had the Food
and Drug Administration; Dr. Scott Gottlieb is an M.D. Wall Street author and
lon g time friend of the pharmaceutical industry working inside the FDA now.
Opponents fear he may be too cozy with the industry and could promote changes
that would put drug approval ahead of consumer safety, although observers note
he is far less likely to act recklessly than some others who were under
consideration. Saving an hour of daylight, but at what cost? It is becoming
increasingly clear that losing an hour of sleep when clocks spring forward to
promote daylight savings time has become a growing he alth concern. Incidence
of stroke, a 25% increase in heart attack, and increased car accidents have been
targeted in the aftermath of clocks being ahead one hour. Sleep researchers
know that even a slight shift in sleep patterns can have negative effects. I am
Marianne O’Hare with these Healthcare Headlines.

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 at the
Connecticut State Legislature and as Mayor of Middletown, Connecticut. He has
written extensively on behavioral health issues including his critically acclaimed
book, Losing Tim, How our Health and Education Systems F ailed M y son W ith

Paul Gionfriddo – CEO of Mental Health America

S chizophrenia. He is a graduate of Wesleyan University and a good friend of
ours. Paul, welco me on Conversations On Healthcare.

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

Mark Masselli: When you look at the stats, you realize no one is immune, it is
estimated that one in five Americans will have some diagnosable mental health 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 needs in this
country and why diagnosis and treatment pose such a challenge.

Paul Gionfriddo : Well, for the lo ngest time we have treated mental health
concerns and conditions as public safety problems and not as public health
problems. As a result, when we deinstitutionalized our population in the 1980s,
when we closed our State Mental Health beds and facilities, we reopened them
as County jails. That puts a real damper on people willingness to seek help and
to take out into the open the kinds of symptoms they’ve got, what mental health
month has been about is taking a month where people can talk about mental
hea lth openly. People can talk about what it feels like developmental illness
openly and we can begin to move from this public safety model to a public health
model and get services that are integrated into the regular healthcare delivery
system.

Margaret F linter: Well, Paul , now you are at the helm of the nation’s oldest
organization dedicated to promoting earlier diagnoses and improving access to
mental health services, so talk with us about the key goals of Mental Health
America and how your efforts like your B4Stage4 Program are really positioned
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, behavio ral health, and other services such as education services, housing
support, employment support for those who need them. So, we have mental
health concerns and conditions the only chronic diseases we wait until stage 4 to
treat. So a year and a half ago, we launched our B4Stage4 initiative, which is
designed to move people’s attention upstream in the process, to have people
think about intervening at stage 1 or stage 2, not waiting till a crisis has occurred
and we put a lot of our resources launching an o nline screening program to be
ubiquitous screening the goal of everyone in America, because we believe that
kids should be screened for mental health concerns frequently as they are
screened for vision or hearing. We think adults should be screened as fre quently
as they are screened for blood pressure and the U.S. Preventive Services Task
Force agrees with us. They think everybody over the age of 11 ought to be
screened manually for mental health.

Paul Gionfriddo – CEO of Mental Health America

Mark Masselli: Well, Paul, you just announced this ambit ious initiative with the
Walgreen chain 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 nee d in a
timely fashion?

Paul Gionfriddo : Millions of people come to us via our website and through
social media and millions of people visit Walgreens website, so initially we put
this together to operate in this virtual environment, where people go to
MH A.screening.org, they are able to screen anonymously using the very same
clinical tools that, 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 ’ve got and what Walgreens is going to be able to provide are
some more linkages to their chat with the pharmacist program for example or
local affiliates and we have 100 of them around the country, we will be in a
position to take referrals as well and ge t people connected to local providers and
other support services in their communities.

Margaret Flinter: I am interested in this breakthrough system that Walgreens in
that that facilitates interaction with clinicians online and includes the medication
ad herence tool. Talk about how emerging technologies like this are making a
large scale program possible in way that would have been very difficult to
achieve in the past.

Paul Gionfriddo : Yeah, in the past we were pretty much tied to physical
locations. They pretty much have to go to someone or some place, you know in
recent years, the online environments have changed this dramatically and there
are lot of services that are moving into digital space. The best ones are Fitbit,
which give you instantaneou s 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. Young people especially are interested in using these kinds of tools. Three
quarters of the people who use our s creening tools are under the age of 25. Two
thirds of those people tell us they’ve never been diagnosed with anything, pretty
hard to get somebody to adhere to treatment. They may have never received a
diagnosis. So what we are tying to get them to do i s take the next step with
some of these tools and actually be willing to talk further about it, be willing to
take the results to a clinician at stage 1 in the process, where recovery comes a
lot easier.

Mark Masselli: We are speaking today with Paul Gio nfriddo , President and CEO
of Mental Health America, the nation’s oldest community not for profit
organization committed to improving mental health in this country. Paul, you’ve
written about your own personal experience navigating the mental health syste m
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 screening treatment options more difficult for families

Paul Gionfriddo – CEO of Mental Health America

to access. I wonde r 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’s 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 him about six weeks ago and he was doing very well and ho ping
at this point to stay in services, but all too frequently when he has come back in
to housing first, he has 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 are coming out of our
State house rules were adults and people w ho were going into them were kids.
Half of all mental illnesses emerge by the age of 14 and these are childhood
diseases, childhood problems and we never built a system of supports around
our children. What happened to Tim is what happens to a lot 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, so I think that that’s the mistake we made a matter of
publi c policy in the course of the last 30 years or so, we are continuing to see
policies in America that are going to continue to put more people like Tim out on
the streets and we at Mental Health America are really trying to put in place
policies that will r ecognize early, it will get services to kids in the schools, in their
communities early on and it will change the trajectories of these kid’s lives.

Margaret Flinter: Well , Paul , families often encounter the toughest challenges
once kids age out of the s ystem and aren’t eligible for some of those supportive
programs they may have had and certainly as the State budgets are floundering,
we see families finding it tougher and tougher to find safe home and dependable
programs for their adult children, who gra pple with complex mental health issues
and in fact, the Atlantic just had a very powerful article describing the nation’s
jails and prison’s as the largest mental health hospitals in the country. I wonder if
we could talk a little more about solutions. W here are the solutions for these
young adults and older adults now, you know, Tim is an example and Tim has
got the most supportive family in the world trying to help him, but lot of folks
don’t, so what are the solutions to really help these people?

Paul Gionfriddo : Well, I think the simplest solution is in a way the most obvious
one. We’ve asked the members of Congress to include a provision in Federal
Reform Legislation, which remains in the House Bill at this point. It would end
the incarceration of nonviolent offenders with serious mental illness within 10
years. States could do that as well, because there is plenty of money and plenty
of resources out there, but we’ve got to stop putting people in jail and we’ve got
to stop using the jails as trea tment programs for adults. If we did that, we would

Paul Gionfriddo – CEO of Mental Health America

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 is as si mple as that I think, let’s get them out of
the jail, so let’s move the money from the jails out to people back out in the
communities, put clinical support folks, peers, clinicians into the mix as opposed
to just judges and lawyers and police officers.

M ark Masselli: You know, Paul, you’ve talked about getting behavioral health
services to children early on. We’ve also been very committed to sort of
redefining the primary care space and have made available to schools
throughout our State. The opportuni ty to have a behavioralist full time in their
school, but also in the primary care space, you know the embedded behavioralist
in primary care. We really need to take advantage of care delivery system and
try to have people re - imagine the way delivery migh t happen and we note that
the Affordable Care Act is out there trying to promote models aimed at better
outcomes. What do you see as interesting initiatives 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 and informed about
the need for integration of health and behavioral health services. These
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 and others. I really do think we have to b reakdown a lot of the barriers
between the schools and the educators, who understand that their 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 supports into the educational system, but if we then turn
around, have a special Ed system that says if you are going to provide those
supports, you’ve got to pay for them, most schools are going to continue to be
reluctant to do that, so I think we also need to reform some of our special
education laws and may be take a look at allowing mandatory parts of kid’s
individualized education programs be covered, not by the education department,
but by their kid’s private health insu rance, if it is otherwise available to provide
some of those services and supports. I think we should start to re - imagine the
system and say this is about health, not about safety, and we have to pull out
what we’ve done which is in schools, suspension, e xpulsion, with adults it is
putt ing 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 adults with
their families, to keep them in their jobs and within that th e service that’s provided
onsite, well in case of kids, may be it’s provided by a mentor. There are lot of
tools, as I say in the book, it’s a chain of neglect when we don’t do anything and
there are lot of ways to break a chain. You only have to do it i n one place though
and that’s what will change things, so and we just have to get everybody in the

Paul Gionfriddo – CEO of Mental Health America

country, who haven’t envisioned the idea of integrating services yet in many
meaningful way, to just start thinking about it.

Margaret Flinter: But, Paul, you’ve served on the Advisory Council at the
Substance Abuse and Mental 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 the just e normous problem of
addiction right now, particularly opioid addiction. I wonder how your organization
is grappling with this mix of both the mental illness issues and also the addiction
issues that have just so powerfully swept across the country.

Paul G ionfriddo: I think we have something of a different take on it as well. We
have seen certain drugs become gateways and speaking particularly of drugs
like marijuana, which for a lot of our population have been a likely better way to
prescribe it effectiv e self - management of symptoms that it landed people as a
gateway to jail. We need to rethink a lot of the way we fought our war on drugs
here and to make available to people the 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 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 - inc ome communities and
minority communities and it’s only in recent years that people have begun to
notice that actually this is everywhere, I remember, you know, one high - school
principal telling me when Tim was growing up that you know 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 our high - school, but we ignored some of this for an awful
long time and I think we are paying the price.

Mark Masselli: We have speaking with Paul Gionfrid do, President and CEO of
Mental Health America , the nation’s oldest organization dedicated to improving
behavioral health services for all people in this country. You can learn more
about their work by going to mentalhealthamerica.net or following them on
Twitter at mentalhealth.am. Paul, thank you so much for joining us today.

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

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 policy, Lori
Robertson is an award - winning journalist and Managing Editor of FactCheck.org,
a non - partisan, nonprofit consumer advocate for voters that aim to reduce the
level of deception in U.S. politics. Lori, what have you got f or us this week?

Lori Robertson: House Republicans revealed their replacement plan for the
th
Affordable Care Act on March 6 . How does the GOP American Healthcare Act
differ from the ACA. The law keeps several aspects of the ACA including the
requiremen t that insurance companies offer coverage to anyone regardless

Paul Gionfriddo – CEO of Mental Health America

preexisting condition, the essential health benefit requirement that plans must
cover 10 health services including maternity coverage and prescription drug and
the Bill keeps the provision allo wing young adults under the age of 26 to remain
on their parent’s plan. So what is eliminated under the GOP Plan, there is no
mandate to have insurance or pay it back. Businesses with 50 or more full time
workers also aren’t required to offer insurance o r pay penalties; however,
insurance companies can charge 30% higher premiums for one year to those
buying their own insurance , who did not have continuous coverage. The law also
phases out the Medicaid Expansion under the ACA in 2020, at which point, no
n ew enrolment under the Expansion can occur. The Bill does not eliminate the
Medicaid Expansion Coverage for those who are enrolled prior to 2020, but if
they have a break in coverage for more than one month, they won’t be able to re -
enroll. Many of the t axes under the ACA are also eliminated, as are cost sharing
subsidies that lower out of pocket costs. Premium tax credits stay however, but
instead of a sliding scale based on income, as under the ACA, the Republican
plans tax credit are based on age. In surers can also charge older Americans up
to five times more than younger people. The ratio is 3:1 under the ACA and
that’s my FactCheck for this week, I am Lori Robertson, Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck .org is committed t o 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, Lori
Robertson, check it out for you, here on Conversations on Healthcare.

Mark Masselli : Ea ch week conversations highlights a bright idea about how to
make wellness a part of our communities into everyday lives . When Jose
Jeronimo was studying medicine in his native Peru , he encountering a sobering
stati s tic, while death from cervical cancer had significantly been reduced in the
United States, it was still a significant cause of death from women elsewhere in
th e world; some 270 thousand deaths per year.

Jose Jeronimo : There are almost 300 thousand women dying of cervical cancer
every year without any justification and that is a failure of many things, just
seeing those women die.

Mark Masselli: He understood that the greatest challenge was the lack of access
to screening. Dr. Jeronimo decided to make his mission to eliminate that
disparity. He realized that his first step in his campaign to eliminate cervical
cancer deaths was to launch a screening for the Human papillomavirus, the
leading cause of cervical cancer. He knew that identifying those women with the
virus could narrow their search for those who were most likely to have the
disease.

Paul Gionfriddo – CEO of Mental Health America

Jose Jeronimo: There are billions of women in the planet, who a re too old for
this vaccine, they are already sexually active and those women are a high risk of
diagnosis for cervical cancer if we don’t do this prevention with affordable
screening and affordable treatment.

Mark Masselli: He also knew a more portable cervical cancer screening and
treatment tool needed to be deployed in the field, one that came with its own
power source and had the capacity to facilitate removal of cervical lesions in
early stage cancer. He launched the Care HPV Program.

Jose Jeronimo : Creating this, a very portable device, it is powered by a battery,
the device has its own light to illuminate the cervix, to concur with this device,
you have the power to provide the treatment.

Mark Masselli: Jose Jeronimo is the senior advisor for w omen’s cancer with a
reproductive health program at PATH, a nonprofit organization dedicated to
launching innovations to improve global health, where he leads the validation and
demonstration of new molecular technologies for cervical cancer screening.
Si nce he launched his Care HPV program, more than 100 thousand diagnostic
kits and treatment units have been deployed across several countries, providing
early stage treatment and diagnosis for women, who previously had no access.

Jose Jeronimo: Those wome n who are at risk of dying of cervical cancer in the
next year, we need to something now.

Mark Masselli: A cervical cancer reduction campaign fostered by an aggressive
screening treatment program using low - resource tools that are highly effective in
the field, yielding better outcomes for tens of thousands of women, helping them
avoid an early death. Now, that’s a bright idea.

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

Mark Masselli: And I am Mark Masselli, peace an d health.

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