Holidays & Mental Health: Interventions, Treatment & Equity

former Congressman Patrick Kennedy on Mental Health Parity

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Marianne O’Hare: Welcome to Conversations on Health Care . This week we welcome
back for mer Congressman Patrick Kennedy, mental health and
addiction activist and founder of the Kennedy Forum dedicated to
promoting policies improving access to mental health care in his
ongoing fight for mental health parity .

Patrick Kennedy : We as a nation have just really never wrapped our arms around how
much of an elephant this is in our nation's living room.

Marianne O’Hare: FactCheck.org’s Managing Editor Lori Ro bertson checks in and we end
with a bright idea, improving everyday lives. Now here are your hosts
Mark Masselli and Margaret Flinter .

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Mark Masselli: We're speaking today with former U.S. Congressman Patrick Kennedy,
founder of the Kennedy Forum, w hich seeks to advance poli cies and
programs that advance m ental h ealth p arity and equal access to
treatment.

Margaret Flinter: Congressman Kennedy was the chief sponsor of the Mental Health
Parity Act, which passed in Congress in 2008, also founder of One
Mind for Research and a co - author of A Common Struggle, which
chronicles his own family's generation long struggle with mental
health and addiction challenges. Congressman Kennedy, welcome
back to Conversations on Health Care, it's been quite a few years.

Patrick Kennedy: Thank you. It's great 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,
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
increased the unmet mental health and addiction needs, really, it's led
to increased depression, anxiety, overdose all across the country and
the p andemic truly amplif ied the awareness of this pervasive 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
health care, when we know of the neurobiology behind dep ression,
anxiety, addictions of all kinds, schizophrenia, we know these are all
biological, heavily genetic illnesses, just like other illnesses. And, you
know, I was honored to be the author of the Mental Health Parity,
and Addiction Equity Act, which pas sed in 2008. And frankly, it kind of
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, AIDS
movement . There's j ust been no public advocacy to speak of when

former Congressman Patrick Kennedy on Mental Health Parity

you think of it in relationship to the fact that it a ffects 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 everybody 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's just an awakening right now, it's kind of a moment of clarity is
what we say in recovery, you know , wh ere I think as a nation, we
finally come to the realization that we have been in denial, you know,
if you want to compare our country to someone who has been sick
and hasn't recognized the ir illness, because the real characteristic of
mental illness is the failure to have insight into your illness. I've been
in active addiction, most of my adult life, I never understood how
dysfunctional , how ill I was . And of course, we all know about the
enabling that goes on around us with all of our friends and family. And
in essence, it takes them hostage to o because once someone around
you suffering, you're suffering too . We as a nation have just really
never wrapped our arms around how much of an elep hant 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. And 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 the HIV AIDS crisis. And we're spending one fifth
the amount of money as we dedicated to fight HIV AIDS. So , I can tell
you, as a member of many who are on the front line s, we have barely
scratched the surface of tackling this illness , and it's all seen through
the prism of the money. And 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 into this spa ce . We still treat mental health and
addiction as a grant. It reflects the fact that 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 m ean, 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 asked when we were spending that money was it worth it. We
all knew as a nation that it was good for us collectiv ely as a nation to
lead on biomedical research into cancer . We have not done the same
in terms of our neuroscience priorities. And we certainly in terms of
the application of the Federal Law never done what we needed to do
in terms of enforcement for the p rovider and to make sure more
Americans get access to mental health services as they are today.

former Congressman Patrick Kennedy on Mental Health Parity

Margaret Flinter: Oh, Congressman Kennedy, I'm going to ask you to do something that
might be challenging and ask you to find some silver linings here
about wha t might be happening that might give us some hope for
some change down the road . We need a couple of things, certainly
integration of care, bringing primary medical care, if you will, and
behavioral health care together, not separating them out into
domain s. Certainly equal treatment coverage for mental health and
addiction services under all payers and insurances . Share a couple of
things that you have on your radar that you're really fighting for or
advocating for, that you think help us move past this pu blic health
crisis.

Patrick Kennedy: Well, I couldn't be more excited for where we are . 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 t hink 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 g oing to have a mandatory social - emotional
learning curriculum in every public school in America . I think 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
recidivism, 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 workpl ace I think there are going to be huge changes in
the way mental health is now seen as a priority. I think there's greater
neuro - literacy. In other words, I think there's 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
modulate our own emotions , how do we identify counterproductive
thinking patterns , and how do we learn about our brain, our
neurobiology, how our thinking e ffects our acting and how do we
interrupt behavior by moving 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 th is spectrum has from time to time various
challenges. Also, what do we do to maintain our mental wel l being , so
this is not the 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've seen
throughout this pandemic as now eve rybody's recognizing that they
need to strengthen their toolkits t o 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

former Congressman Patrick Kennedy on Mental Health Parity

craft ing the Mental Health Parity Act in 2008, where you probably
needed a lot of charts and graphs. But you started off this
conversation that people are starting to feel this . It's in their
household . It's in their neighborhood . A whole different experience i n
terms of promoting the advocacy work you ha d to do. But this is now
something that's shared by everyone. I'm just wondering now you've
got the Biden administration in charge, what are the policies that
they're going to put into play to increase this mome ntum?

We cannot miss this opportunity b ecause the window we know will
close, right? We've all been on this cycle, whether it was domestic
violence or HIV or whatever. But right now, we've got the Biden
administration in charge. You've been lobbying them a round the
American Recovery Act, really thi s wider access to b uprenorphine, a
bigger role for things that we're fascinated about in the Federally
Qualified Health Center, Community Health Center world, but
community mental health, as well organizations. So walk us through
this unique moment that we have in time.

Patrick Kennedy: So we're now looking at all aspects of health. And I really appreciate
that the Biden ministration has fantastic policy advisors at every level
of government and they understand you got to deal with the social
determinants of health. We got to understand the impact of the racial
discrimination that so many of our fellow Americans have been
suffering for years and many times un aware of how that affects t hem
because it's more vicarious . They see p eople who look like them
beaten and killed on TV, and that trauma has never fully been dealt
with . We have to deal with it . I think the Biden ad ministr ation is
committed to doing so.

But now as we're moving towards value based care, we're look ing at it
the idea that we wrapped services together, and 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 health and physical health.
And that if we start to look at th e bottom line, we'll see that these
things that may not be medical, may actually have as big if not more
of an impact on the medical spend is anything else that we could look
at . We never would have had that perspective a few years ago. And so
I really thi nk this is the exciting age, because the bottom line is mental
health may be the biggest force multiplier that the medical systems
never seen before. And once they start to evaluate that the dollar in is
worth, you know, four out if they're investing in me ntal health maybe
we don't want penalty, because we're going to be getting more than
our fair share, because people will 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 tha t we can actually have
expectation that people get better. We've never brought in the value

former Congressman Patrick Kennedy on Mental Health Parity

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 are now able to take facial
recognition with the Telemental health and assist clinicians in being
able to better diagnos e us. We're going to be able to take voice
recognition and modulation and tell where we are on a mood meter .
We're not going t o be casting people out into the hinter world when
they leave the doctor's office . They're 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 conducive to the kind of wraparound care
that we ultimately have always wanted. And now I think are going to
start to get through some of the reforms that CMMI has taken up and
CMS is going to move forward with and payers across the country
through these 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 everyplace else , but I'm really curious, your
book, A Common Struggle, really is very personal, talks about your
own family struggles with these issues, and makes the case so clearly
that th ese transcend any kind of socio - economic spectrum . How have
your public revelations and those of the other well known people
shifted the narrati ve around what we know is truly a family disease
but for a long time was the family di sease that nobody talked about?

Patrick Kennedy: We know that if we intervene on stage one cancer rather than stage
four, we have a much better shot at saving someone's l ife. And that's
true in mental health and addiction . The earlier the interven tion the
better the results. But unfortunately, our M O is we wait till someone
has a stage fo u r illness before we actually treat. And that's
exacerbated by the fact that we want t o keep these illnesses secret,
which keeps people 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 g etting rid of a shame, the stigma . And
I've been really after ending the discrimination because I'm not sure
we're 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 jud ge others, not remembering that no one in their right mind
would act in those ways if they were healthy .

When someone is getting up every day and feeding an addiction of
any kind , they’re jeopardizing the relationships with their loved ones,
their employe rs, even their freedom. So they're being held hostage by
their illness. And I like to think of mental health care providers as
those 911 Special Response Force that go in there and help kick down
the doors and bring people back into the light. And we're on ly as sick
as our secret , is this refrain and recovery that we use , and it's very

former Congressman Patrick Kennedy on Mental Health Parity

true. Our country has been sick because we've collectively been
keeping this quiet and we have to open up. The problem is how can
you expect Congress to do more if they're no t hearing from us and if
because we're feeling shamed, then it's easier for them to overlook
our interests in favor of other interests of people that are much
louder. So if we want to see things change, we have to start in our
own lives. And we have to be more open about discussing 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 . I want to look at both ends of the
spectrum . You were just talkin g about the technology 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 you're saying early
intervention is the key. Now we're in 180 school based health centers .
Our fo cus is to make sure that every school from kindergarten or
preschool, up to high school, there's a mental health counselor in
there and so we've been working with school based health a lliance,
Robert Boyd and his team. But both of these are important, righ t?

We've seen because of COVID - 19, the advent of Telehealth being used
in mental health and 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 enor mous transformation
happening. But we want to also make sure that fundamental, early
intervention really in the schools and the best place to begin this
conversation with young people to have it as sort of normalizing their
experience. So you know, you tol d us a little bit and I know you're in a
Virtual Behavioral Health Tech Summit today, I'm sure learning a little
bit about e xciting things that are coming.

Patrick Kennedy: Well, my wife is a public school teacher, veteran of the classroom,
sixth, seventh and eighth grade for 14 years. The story she tells --- she
knows which kids need help, and she has no tools as a teacher to help
them. They're crying out for help. And the best thing she can do is
send him to the principal's office . That has to change. I bel ieve the
back to school money $130 billion has been set aside . Mental health is
“ optional . ” The Kennedy Forum led by my wife Amy, really wrote a
letter to Department of Education . We're expecting to get a letter
back from them shortly recommending series o f evidence based
interventions that we can pay for in this narrow finite time .

There may be 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 spoken about. And if
we can tie that to Medicaid and get waivers to reimburse for school
based Telemental hea lth, we couple that with socio - emotional
learning . Education today cannot be done without having mental

former Congressman Patrick Kennedy on Mental Health Parity

health, soci o - emotional learning, cop ing and problem solving skills all
baked into the day . I just see this as, and again, a real historic
opportunity for us to change how we define education and not
segment it away from mental health or health care but combine the
two, which is what you have done so effectively and why I'm so
grateful for all that you've done to help us advance in that space.

Margaret Flinter: So I want to talk about another dimension of this that we haven't
really touched on. Love the clarion call for a behavioral health
pro vider in every school. Where is this workforce coming from? We've
talked about the n eed 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 ful l training licensed
independent providers, whether clinical social workers, psychologists,
psychiatr ists, psychiatric mental health, nurse practitioners and the
like. We're making our contribution to the effort along with many
health centers around the cou ntry around training. We operate
postgraduate residency programs for psychiatric mental health NPs ,
and interns and externs and postdoctoral psychology residents. It's
not enough and that we haven't seen as much of a subject of
conversation, no t enough peo ple who could 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 as some areas of promise.

Patrick Kennedy: Y eah, so I'm really proud to say - -- I left the public sector I jumpe d into
the private sector, I co - founded a company called Psych Hub. And
Psych Hub is in this space. It's about educating all the behavioral
health providers to practice in areas of specialty so that we could get
payers to curate providers based upon those diagnoses that they
treat, rather than being one size fits all single shingle providers that
treat depression in the morning and eating disorders later in the day.
We want to have the kind of personalized medicine that we expect in
the rest of healthcare. So Psych Hub trains behavioral health
providers, it trains regular medical clinicians because frankly, you
know, if you're a cardiologist and not dealing with depression, you
know, and you're having a post heart attack pat ient it is four times
more likely to die of a heart attack if they've got underlying
depression. I mean, it's all interrelated . We have to do a much better
job at certify kind of expertise amongst those who are professionals,
but also amongst everyone else because it will be some time 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 . M y sister had 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

former Congressman Patrick Kennedy on Mental Health Parity

treatm ent. So they need to be empowered . Then we need to have
patience, they need to be trained, they need to know what they
should be looking for from their therapists . They can't just walk in and
wonder, as I did for a better part of my life, going to therapy, where
all I did was ruminate about the past as opposed t o coming up with a
specific CBT - Cognitive Behavioral Therapy component where I acted
my way into different thinking, which is essentially what 12 - step
recovery is s o effective in helping you do.

We' re trying to make sure that bus drivers, custodians, everybody ,
frankly, there's nobody that can't benefit from some mental health
ally kind of training. As we move to this 988 system, which is going to
complement our 911 system, it's going to be even more important
that we have kind of EMTs for mental health in every community .
That needs we got to build out the infrastructure. I mean, I think
firefighters are already doing a lion's share of this already. We need to
make sure that they really understand th is as part of their core
business, but that they get the complement 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 competent. We don't really have a provider
community that necessarily looks like America . We need to have a
much better representation of all of America in our provider ranks so
that people can feel that they can talk to someone with cultural
competence, understanding cultural framework, and cultural humility .
So a lot to d o but as I said, very exciting , and I think we need to
revamp our tuition loan forgiveness and do our high need categories
for loan forgiveness, and emphasize those areas in mental health is
particularly amongst kids and adolescents which we have such a hu ge
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 Advocate for Mental
Health Parity and Equ al 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 @ PJK 4b r ain h ealth.
Congressman Kennedy, thank you so much for continuing to be a tireless advocate for mental health and addiction parity, and for
joining us again on Conversations on Health Care .

Patrick Kennedy: It's been my pleasure. Thank you both for all 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 health care reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.or g, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U . S . politics.

former Congressman Patrick Kennedy on Mental Health Parity

Lori, what have you got for us this week?

Lori Robertson: Since the 2010 - 2011 flu season, the Centers for Disease Control and
Prevention ha s recommended that everyone , six months and older ,
get an annual flu shot with rare exceptions including those with
allergies to the vaccine ingredients. The CDC’s recommendation is
based on evidence that vaccination can prevent people from getting
sick wi th flu and reduce the severity of disease if someone does fall ill .
For the past ten f lu seasons prior to the COVID - 19 pandemic , the CDC
estimates that on average, vaccination has prevented more than five
million illnesses, over 70,000 hospitalizations and 6 , 000 deaths each
season.

The effectiveness of the flu vaccine varies each year, depending on
how well the strains selected for inclusion in the vaccine match those
that ultimately circulate . But on average, the effectiveness is around
40% in preventing an outpatient medical visit due to lab confirmed
flu. Flu vaccines also tend to not work as well in older people who are
more vulnerable to severe influenza. Still the shots as we said prevent
millions of illnesses and thousands of deaths each season. Only about
half of Americans every year get the flu vaccine.

CDC surveillance data from October suggests the season is getting an
early start and could be worse than normal. In some parts of the
country, particularly in the south , flu activity is already high . So far, it
appears that this year's vaccine is a good match for the circulating
influenza strains. This year for the first time the CDC is recommending
that people 65 years of age and older get a high dose flu vaccine,
since there is evidence that those shots may work better than
st andard flu shots in that group.

And that's my f act c heck for this week. I'm Lori Robertson, Managing
Editor of Fact C heck.org .

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country’s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you’d
like check ed , email us at www.chcradio.com . We’ll have
FactCheck.org’s Lori Robertson ch eck it out for you here on
Conversations on Health Care.

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Mark 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 , ov er half are unintended , and
among teens those rates are even higher. Colorado has been
conducting an experiment for several years to examine what might
happen if sexually active teens and poor women were offered the

former Congressman Patrick Kennedy on Mental Health Parity

option of long term birth control . The f irst question to answer is
would they take the offer .

Dr. Larry Wolk: What was so striking was the word of mouth amongst these young
women to each other and the network of support that was built to
access this program through these clinics really did resul t in these
significant decreases in unintended pregnancies and abortions.

Mark Masselli: Dr. Larry Wolk , Medical Director of the Colorado Depar tment of
Health and Environment.

Dr. Larry Wolk: The result in decrease is 40% plus or minus in both categories
p regnancy and abortion , e ven approaching 60% reduction in those
unintended pregnancies and abortions .

Mark Masselli: There was a significant economi c benefit to the state as well.

Dr. Larry Wolk: We've seen a significant decrease in the number of young moms and
kids applying for and needing public assistance. This will translate into
better social and economic outcomes for these folks.

Mark Masselli: A free long term contraception program offered to at - risk teens and
women trying to avoid the economic hardsh ip of unplanned
pregnancies, leading to a number of positive health and economic
outcomes for all involved . Now that's a bright idea.

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Mark Masselli: I'm Mark Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and H ealth .

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Marianne O’Hare: Conversations on Health Care is recorded in the Knowledge and
Technology Center Studios in Middletown, Connecticut, and is
brought to you by the Community Health Center , now celebrating 50
years of providing quality care to the unders e rved, where healthcare
is a right not a privilege , www.chc1.com and www.chcradio.com .

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