Congressman Patrick Kennedy on Pandemic’s Impact on Increased Awareness of America’s Mental Health and Addiction Crisis

Congressman Patrick Kennedy

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M oderator : 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 hea lthcare of t he future.

This week Mark and Margaret speak with former Congressman Patrick
Kennedy, Mental Health and Addiction Activist and founder of The
Kennedy Forum dedicated to advancing policies and best practices
improving access and outcomes fo r mental health and addiction
treatment , h e discusses the dramatic rise in mental health and
addiction crisis, in the wake of the pandemic. The Mental Health
Parity, that he cosponsored in 2008 and how the Biden
administration’s policies to address some of the barriers st ill at play.

We check in with FactCheck.org’s Managing Editor Lori Robertson,
who looks at misstatements spoken about health policy in the public
domain, separating the fake from the facts . And we end with a bright
idea that's improving health and well bei ng in everyday lives.

If you have comments, please e - mail us at [email protected] or find
us on Facebook , Twitter , or wherever you listen to podcast s . And y ou
can also hear us by asking Alexa to play the program. N ow stay tuned
for our interview with Congressman Patrick Kennedy here on
Conversations on Health Care.

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Mark Masse lli: We’re speaking today with former U.S. Congressman Patrick Kennedy,
founder of The Kennedy Forum which seeks to advance policies an d
programs that advance mental health parity and equal access to
treatment.

Margaret Flinter: Congressman Kennedy was a chief sponsor of the Mental Health
Parity Act which passed in Congress in 2008. Also founder of One
Mind for Research and a coauthor of a Common Struggle which
c hronicles his only family’s generation ’ s long struggle with mental
health and addiction challenges. Congressman Kennedy, welcome
back to Conve rsations on Health C are , it’s been quite a few years.

Patrick Kennedy : Thank you. It’s gr eat to be with you guys again and thank you all for
all that you've done in your lives and careers to advance public health,
I'm really pleased to be with both of you.

Mark Masselli: That’s great. And you know you've called the COVID - 19 really a
watershed moment for mental health, obviously COVID - 19 really, it
increase d the unmet mental health and addiction needs, really i t ha s
led to increase depression, anxiety, overdose, all across the country.
And the pandemic truly amplified the awareness of this perva sive

Congressman Patrick Kennedy

issue of unmet mental health needs, just put this in context for our
listeners.

Patrick Kennedy: Well, it’s hard to imagine where healthcare doesn’t include mental
healthcare , w hen we know if the neurobiology behind depression and
anxiety, addictions of all kinds, schizophrenia. We know these are all
biological, heavily genetic illnesses, just like other illnesses. And you
know I was honor ed to be the author of the Mental Health Parity and
Addiction Equity Act that passed in 2008. And frankly it kind o f went
under the radar screen, most people don’t even know it’s the law.
And because of the shame and stigma around mental illness and
addiction we've never created a movement like breast cancer or AIDS
movement. There is just been no public advocacy to sp eak up when
you think of it in relationship to the fact that it effects every single
American.

And the pandemic clearly, I think brought us out of the closet,
because everybody could identify with what mental health meant
after the pandemic, because everyb ody was affected either directly or
through their family directly, the anxiety, the dislocation, all of that
rolled into a lot of other things including the racial pandemic. And
there is just an awakening right now, it’s kind of a moment of clarity is
what we say in recovery, you know where I think as a nation we finally
come to the realization that we've been in denial . Y ou know if you
wanted to compare our country to someone who has been sick and
hasn’t recognize their illness, because the real characteri stic of mental
illness is the failure to have insights into your illness.

I've been in active addiction most of my adult life, I never understood
how dysfunctional, how ill I was . A nd of course we all know about the
enabling that goes on around us with all of our friends and family. And
in essence it take s them hostage too, because once someone around
you is suffering, you're suffering too.

We as a nation ha ve just really never wrapped our arms around, how
much of an elephant this is in our nation’s living room and how we as
a society have failed to even have the conversation. So I think that
both on a personal level and on a societal level, we're ready to have
that conversation . A nd to your point, the indicators are off the charts,
I mean we're losing twice as many people as we lost during the height
of HIV/AIDS crisis. And we're spending one - fifth the amount of money
as we dedicated to fight HIV/AIDS.

So and I can tell you as a member of many who are on the frontlines,
we haven't barely scratch ed the surfac e for tackling this illness. And
it’s all seen through the prism of the money . A nd it’s the famous
words, if you really want to know where someone’s priorit y is , follow
the money. And the money has not come in to this space. We still
treat mental health an d addiction as a grant . I t reflects the fact that

Congressman Patrick Kennedy

insurance still does not reimburse for mental illness and addiction in
the same way that it reimburses for medical and surgical care as is
required under federal law.

I mean if this were any other illness, we would have been doing a lot
more by now. We spent trillions on cancer and thank god, we did. But
no one ask ed when we were spending that money, was it worth it.
We all knew as a nation that it was good for us collectively as a nation
to lead on biomedic al research in the cancer. We've not done the
same in terms of our neuroscience priorities. And we certainly in
terms of the application of federal law, never done what we needed
to do in terms of enforcement for the provider end, to make sure
more America ns get access to mental health services as they are
today.

Margaret Flinter: Well, Congressman Kennedy, I'm going to ask you to do something
that might be challenging. I'm going to ask you to find some silver
linings here, about what might be happening tha t might give us some
hope for some change down the road. We need a couple of things
certainly integration of c are, bringing primary medical care if you will
and behavioral healthcare together, not separating them out into
domains. Certainly equal treatment coverage for mental health and
addiction services under all payers and insurances . S hare a couple of
things that you've on your radar that you're really fighting for or
advocating for that you think help us move pass this public health
crisis.

Patrick Ken nedy: Well, I couldn’t be more excited for where we're. I believe mental
health care will be reimbursed. Mental health care will be reimbursed
service within every public school in the nation within the next five
years. I think if we want to address mental health of our children,
which is also at the tip of this pandemic, we're going to need to do
that. I think we're going to have mandatory Social - Emotional Learning
curriculum in every public school in America. I think we're in terms of
criminal justice, I think we're going to have a whole new view of how
we view recidivism. And we're going to understand that so many who
are in the prison system are people who are victims of severe trauma
and I think if we address some of that, we're going to reduce
recidivi sm, because hurt people, hurt people. And if we understand
that we're going to start to treat the hurt, so we can reduce the total
number of people that are continuing to be hurt in this cycle of
violence.

I think that workplace I think they are going to b e huge changes in the
way mental health is now seen as a priority. I think there is greater
Neuro - Literacy, in other words I think there is going to be a greater
understanding for mental health hygiene. And I think that we're going
to have as a nation want to have a toolkit to learn how do we

Congressman Patrick Kennedy

modulate our own emotions, how do we identify counterproductive
thinking patterns. And how do we learn about our brain, our
neurobiology, how our thinking affects our acting and how to
interrupt you know behavior by mo ving upstream. I think all of these
things mean that we're really in the golden age of understanding
mental health in a whole new way, not just as a mental illness, but
really every one of us, on the spectrum has from time to time various
challenges a nd al so what do we do to maintain our mental wellbeing .

So this is not a purview of just people with a diagnosis under DSM, it’s
really all of us. And I think that’s an exciting change that I have seen
throughout this pandemic is now everybody is recognizing th at they
need to strengthen their toolkits, to help their own mental health.

Mark Masselli: You know I was thinking as you were talking about this golden age of
mental health awareness. Just the struggle that you went through on
crafting the Mental Health P arity Act, in 2008 where you probably
needed a lot of charts and graphs, but you started of this conversation
that people are starting to feel this, it’s in their household, it’s in their
neighborhood, whole different experience in terms of promoting the
a dvocacy work you' d to do, that this is now something that ’s shared
by everyone.

And I'm just wondering now you ’ve got the Biden administration in -
charge, what are the policies that they are going to put into play, to
increase this momentum. We cannot miss this opportunity because
the window we know will close, right. We've all been on this cycle
where there was domestic violence or HIV or whatever, but right now
we ’ve got the Biden administration in - charge, you've been lauding
them around the American Recov ery Act, really this wider access to
buprenorphine, a bigger role for things that we're fascinated about in
the fairly qualified health center community , health center world, but
community mental health as well organizations. So walk us through
this unique moment that we've in time.

Patrick Kennedy: So we're now looking at all aspects of health. And I really appreciate
that Biden administration has fantastic policy advisors at every level
of government. And t hey understand, you got to deal with the social
d eterminants of health. We got to understand the impact of the racial
discrimination that so many of our fellow Americans have been
suffering from for years, and many times unaware of how that affects
them because it’s more vicarious. They see people who lo ok like
them, beaten and killed on TV. And that t rauma has never fully been
dealt with, we've to deal with it . I think the Biden administration is
committed to doing . B ut now as we're moving towards value - based
care, we're looking at the idea that we wrap services together a nd
we're identifying, do they have a stable place to live, that’s going to
make a huge difference in their success, in managing their mental

Congressman Patrick Kennedy

health and physical health. And then if we start to look at the bottom -
line, we'll see that thes e things that may not be medical may actually
have as big and if not more of an impact on the medical spend, is
there anything else that we could look at. We never would have had
that perspective a few years ago.

And so I really think, this is the exciting age, because the bottom - line
is mental health maybe the biggest force multiplier that the medical
system ha s never seen before. And once they start to evaluate, that
the dollar in, is worth you know four out, if they are investing in
mental health, maybe we don’t want parity, because we're going to
be getting more than our fair share because people finally realize that
this is a part of the system we ’ve never wrapped our arms around.
We ’ve never properly focused on quality so that we can actually ha d
expec tation that people get better. We ’ve never brought in the value
of technology as a remote monitoring device, to keep people like
myself who have a both mental illness and addiction, are better able
to monitor that like a FitBit, right.

We're now able to ta ke facial recognition with the telemental health
and assist clinicians and being able to better diagnose us. We're going
to be able to take voice recognition and modulation tell where we're
in the mood meter. We're not going to be casting people out into t he
hinter world, when they leave the doctor’s office. They are always
going to remain connected. And for people with a pernicious illness
that’s constantly looking to take people down, such as addiction and
mental illness. This new environment is very cond ucive to the kind of
wraparound care that we ultimately have always wanted. And now I
think we're going to start to get through some of the reforms that
CMMI has taken up and CMS is going to move forward with, and the
payers across the country through this ACO models are starting to
look at as well.

Margaret Flinter: I want to say that storytelling is so important in healthcare and in
policy and politics and every place else. But I'm really curious your
book, A Common Struggle really is very personal, it ta lks about your
own family struggles with these issues and makes the case so clearly,
that th ese transcend any of socioeconomic spectrum. How have your
public revelations and those of other well - known people shifted the
narrative around what we know is trul y a family disease, but for a long
time was the family disease that nobody talked about.

Patrick Kennedy: So we know that if we intervene on Stage 1 cancer, rather than Stage
4, we ha ve a much better shot at saving someone’s life. And that’s
true in mental health and addiction. The earlier they intervene, the
better results. But unfortunately our MO is we wait till someone has a
Stage 4 illness before we actually treat. And that’s exacerbated by the
fact that we want to keep th ese illnesses secret, which ke eps people

Congressman Patrick Kennedy

sicker than they ever need to be.

And the real change we can make that can dramatically change
outcomes is by understanding that these are illnesses that we can
treat these illnesses and the key to it is getting rid of the shame, the
stigma and I've been really after ending the discrimination, because
I'm not sure w e are ever going to get rid of the attitudes towards
people who have these illnesses , because let’s just be honest it’s in
our human nature to judge others, not remembering that no one in
their right mind would act in those ways, if they were healthy. And
when someone is getting up every day and feeding a n addiction of
any kind, they are jeopardizing the relationships with their loved one,
their employers, even their freedom. So they ar e being held hostage
by their illness .

A nd I like to think of mental health care providers as those, 911 you
know special response for ce that go in there and help kick down the
doors and bring people back into the light. And we're only as sick as
our secre ts is this refrain and recovery that we use and it’s very true.
And our country has been sick as we ’ve collectively been keeping this
quiet. And we've to open up. The problem is, how can you expect
Congress to do more if they are not hearing from us. And i f because
we're feeling shamed that it’s easier for them to overlook our interest
in favor of other interest of people that are lot , much louder. So if we
want to see things change, we've to start in our own lives, and we've
to be more open about discussin g these things, so that we can see
more people helped.

Mark Masselli: We're speaking today with former U.S. Congressman Patrick Kennedy,
founder of The Kennedy Forum. You know I want to look at both ends
of the spectrum. You're just talking about the techn ology and sort of
the AI and other things that really can be force multipliers, as we think
about the scale that we need. But I was struck by your saying, early
intervention is the key.

Now we're in a 180 school - based health centers. Our focus is to make
s ure that every school from kindergarten or preschool up to high
school, there is a mental health counselor in there. And so we've been
working with School - Based Health Alliance, Robert Boyd and his team,
but both of these are important right. We've seen be cause of COVID -
19 the advent of Telehealth being used in mental health a nd parity
being played between the phone call and the video, the population
we care, living at or near poverty, 90% of the people we care for.
We're seeing this enormous transformation happening, but we want
to also make sure that fundamental, early intervention really and the
schools of the best place to begin this conversation with young
people, to have it as sort of normalizing their experience. And so you
know you told us a little b it and I know you're in the virtual Behavioral

Congressman Patrick Kennedy

Health Tech Summit today, I'm sure you're learning a little bit about
the exciting things that are coming.
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Patrick Kennedy: Well, my wife is a public school teacher, veteran of the classroom, 6 ,
th th
7 and 8 grade for 14 years. The story she tells that she knows which
kids need help. And she has no tools as a teacher to help them. They
are crying out for help and the best thing she can do is send them to
the Principal’s office , that has to change. I believe th e back to school
money a $130 billion has been set aside. Mental health is “optional”.
The Kennedy Forum led by wife Amy really wrote a letter to
Department of Education. We're expecting to get a letter back from
them shortly, recommending series of eviden ce - based interventions
that we can pay for in this narrow finite time. There maybe things that
we could do to bridge these local school systems into an ongoing
continuous funding for school - based mental health , to fund the very
clinics that you've just spo ken about. And if we can tie that to
Medicaid and get waivers to reimburse for school - based telemental
health, we couple that with social - emotional learning.

E ducation today cannot be done without having mental health, social -
emotional learning, coping and problem solving skills, all baked into
the day. I just see this as again, a real historic opportunity for us to
change how we define education a nd not segment it away from
mental health or healthcare, but combine the two which is what
you've done so effec tively and why I'm so grateful for all that you've
done to help us advancing in that space.

Margaret Flinter: So I want to talk about another dimension of this that we haven't
really touched on, love the C larion call for behavioral health providers
in ever y school. Where is this workforce coming from? We've talked
about the need to really educate and train, clinically train a whole
new generation of behavioral health clinicians. And some will be peer
counselors, but a lot of people need the full training, l icensed
independent providers whether clinical social workers, psychologist s ,
psychiatrist s , psychiatric mental health nurse practitioners and the
like and we're making our contribution to the effort along with many
health centers around the country around training, we operate post -
graduate residency programs for psychiatric mental health NPs and
interns and externs and post - doctoral psychology residence , i t’s not
enough . A nd that we haven't seen as much of a subject of
conversation, not enough people who c ould treat. Is your institute
and your work focusing in on that next generation of behavioral
health and addiction workforce at all, and if so share with us what you
see are some areas of promise.

Patrick Kennedy: Yeah, so I'm really proud to say, I left p ublic sector, I jumped in to the
private sector, I cofounded a company called Psych Hub. And Psych
Hub is in this space, it’s about educating all of the behavioral health

Congressman Patrick Kennedy

providers to practice in an area of specialty s o that we could get
payers to curate pr oviders based upon those diagnosis that they treat,
rather than being one - size - fits - all, single shingle providers that treat
depression in the morning and eating disorders you know later in the
day. We want to have the kind of personalize d medicine that we
expect in the rest of healthcare. So psych teams, behavioral health
providers that trains regular medical clinicians, because frankly you
know if you're cardiologist, and not dealing with depression, you
know and you're having a post - heart attack patient is four times more
likely to die of a heart attack if they have got underlying depression. I
mean it’s all interrelated, we've to do a much better job at certify kind
of expertise among those who are professionals , but also amongst
everyone else, because i t will be sometimes before we get the
workforce up to speed to carry us, to meet the need that’s out there,
right now it should be all hands on deck .

So not only do we repurpose the primary care system, but let’s
repurpose the specialty system. My sister h ad cancer, they never even
thought of treating her for depression and anxiety as to her oncologist
that was not in his training whatsoever, that’s wrong, that’s got to
change. Then we've got to empower family members , have to be part
of the treatment. So t hey need to be empowered. Then we needed to
have patients, they need to be trained, they need to know what they
should be looking for from the ir therapist. They can’t just walk in and
wonder, as I did for a better point of my life going to therapy, where
a ll I gave was ruminate about the past, as opposed to coming up with
a specific CBT, Cognitive Behavioral Therapy component where I
might acted my way into different thinking which is essentially what
Twelve Step Recovery is so effective in helping you do.

We're trying to make sure that bus drivers, custodians, everybody,
and frankly there is nobody that can’t benefit from some mental
health ally kind of training. And as we move to this 988 system which
is going to complement our 911 system , i t’s going to be even more
important that we've kind of EMTs for mental health in every
community that means we got to build out the infrastructure. I mean I
think firefighters are already doing a lion share of this already. We
need to make sure that they are really under stand this is part of their
core business , b ut that they get the compliment of training, so that
they can do the job that we need them to do as first responders.

And make sure that it’s culturally co mpetent . We don’t really have a
provider community that n ecessarily looks like America . We need to
have much better representation of all of America in our provider
ranks so that people can feel that they can talk to someone with
culture competence , understanding cultural framework and cultural
humility. So a lo t to do but as I said, very exciting. And I think we need
to revamp our tuition loan forgiveness and do our high need

Congressman Patrick Kennedy

categories for loan forgiveness and emphasize those areas in mental
health is particularly amongst kids and adolescents which we've such
a huge pain point on. And we need to do all those policies to help
meet the need as it is today.

Margaret Flinter: We've been speaking today with former U.S. Congressman Patrick
Kennedy, founder of The Kennedy Forum and an advocate for Mental
Health Parity and Equal Access to Care. You can learn more about his
vitally important work by going to www.patrickjkennedy.net or the
www.kennedyforum.org , follow him on Twitter @PJK4brainhealth.
Congressman Kennedy, thank you so much for continuing to be a
tireless advocate for Mental Health and Addiction Parity a nd for
joining us again on Conversations on Health Care.

Patrick Kennedy: It’s been my pleasure. Thank you both for al l of your service.

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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 healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactC heck.org, 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?
th
Lori Robertson: Federal Health Officials testified at a May 11 Senate Committee
Hearing that about 60% of their employees have been vaccinated
against COVID - 19 so far. But viral online post s have distorted their
comment to misleading ly claim that half of the employees are
refusing the vaccines. The officials did not say anyone had refused to
get vaccinated.

In the Senate hearing, Dr. Anthony Fauci, Director of the National
Institute of Allergy & Infectiou s Diseases, and Dr. Peter Marks with
the Food & Drug Administration, both testified that about 60% of
their employees ha d been vaccinated. Bu t viral social media post
distorted those comments, falsely claiming that 40% to 50% of CDC,
FDA and National Institute of Health Employees were refusing the
COVID - 19 vaccine. One problem with the claim is that the CDC
director didn’t give a figure on how many CDC employees have been
vaccinated And Fauci is director of one institute among many that
make up the NIH. But more importantly none of the federal health
officials said their employees were refusing to get vaccinated.

An FDA spokeswom a n told us the a gency wasn’t requiring staff to
report their vaccinations, so it doesn’t know the exact percentage,
who have been vaccinated. And the NIAID, which Fauci heads, told us
the percentage of NIH staff who got vaccinated at NIH or reported
nd
being vaccinated elsew here, is close to 67%. As of June 2 , nearly

Congressman Patrick Kennedy

52% of all adults in United States were fully vaccinated. And that’s my
fact check for this week, I'm Lori Robertson, Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual ac curacy 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 e - mail us at www.chcradio.com , w e'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

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Mar k Masselli : Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Of the 6.6
million births per year in this country, over half are unintended. And
among teens those rates are even higher. Colorado has been
conducting an experiment for several years to examine what might
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Larry Wolk: But what so striking was the word of mouth amongst th ese young
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Mark Masselli: Dr. Larry Wolk, Medical Director of the Colorado Department of
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Larry Wolk: The result in decrease is 40% pl us or minus in both categories
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Mark Masselli: There was a significant economic benefit to the state as well.

Larry Wolk: We've seen a significant decreas e in the number of young moms and
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Mark Masselli: A free long - term contraception program, offered to at - risk teens and
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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masse lli.

Margaret Flinter: And I'm Margaret Flinter.

Congressman Patrick Kennedy

Mark Masselli: Peace and Health

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M oderator : Conversations on Health Care is recorded at WESU at Wesleyan
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