The Kennedy forum

Uniting the community of mental health

To mark the 50th anniversary of the Community Mental Health Act of 1963, signed by President John F. Kennedy, former Congressman Patrick J. Kennedy created The Kennedy Forum. The event, which took place on Oct. 17 and featured panelists and speakers from several different health care sectors, addressed mental health care issues including policies, research and treatment.

Patrick Kennedy launched the Forum by saying, “Civil rights are the struggle of our era.” The on-going fight for parity since Kennedy’s legislation was passed has continued to be a top priority for advocates, he noted.

Steven S. Sharfstein, M.D., M.P.A., president and CEO of the Sheppard Pratt Health System in Baltimore, pointed out that as far back as the Eisenhower administration, serious efforts have been undertaken to provide help for those with mental health issues. A five-year mental health commission at that time recommended a bolder approach through early intervention/prevention, he said, pointing out that 1,500 community mental health centers received federal funding on a declining basis over eight years.

Unfortunately, the act that supported the program expired in 1981, due to fiscal issues and requirements that were difficult to initiate. He said, “We need to have tertiary prevention to capture JFK’s vision so people will live in the community. Someone diagnosed with early psychosis has a better chance for recovery now. The basic belief is that people have the right to live and work in the community.”

One of the biggest stumbling blocks to long-lasting and viable solutions is the financial support to fuel programs that address mental illness. Reports indicate that less than one percent of the 4,000 foundations in the country focus on mental illness.

Ashbel Wall, director of the R.I. Department of Corrections, said that jails have become dumping grounds for the mentally ill. “We have a ‘no-refuse’ policy. Prison is considered a safe place,” he said, but emphasized that correctional institutions are not designed to care for the mentally ill. “Inmates with mental illness are significantly over-represented in super max facilities. They become difficult to manage and have trouble following rules. They languish and decompensate and then suffer administrative segregation.” Fortunately, R.I. has a community mental health system that is responsive to the needs of the correction system and through a contractual agreement offers a gateway program to recovery in the community, he added.

Veterans comprise another growing segment of community whose needs are unmet, according to Paul Rieckhoff, founder and CEO of Iraq and Afghanistan Veterans of America (IAVA), which he created in 2004. He emphasized the importance of dealing with veterans’ mental health issues, which sometimes lead to suicide. “Twenty-two veterans commit suicide daily. This is more than we lose to the enemy,” he said. “Connection and hope prevent suicide. Federal leadership needs to bring together a number of communities. People think vets are a government problem. It’s an epic public health challenge.”

Rieckhoff is attempting to unite these veterans using modern technology. “IAVA has 200,000 members that have a commonality of experience that transcends geography. Our Facebook page has 400,000 members,” he said. “In the old days, vets would connect via the vet’s hall. Now the Internet is the next generation of vet’s halls. We can get together as a community and plug into resources.”

The Affordable Care Act offers some promise for better treatment options, according to Gary Gottlieb, M.D., M.B.A., president and CEO of Partners HealthCare. He applauds the ACA as a concept that “presents a new vision that includes the whole human being.” He anticipates more cooperation between mental health specialists and primary care physicians and pediatricians because of this legislation. The co-location of psychiatric services and PCP offices, pediatricians, family medicine practitioners and other medical health care disciplines offers a way to proactively provide mental health treatment for many illnesses.

Gottlieb also said that investing in telemedicine would have several advantages including instant access to mental health care. “There are a variety of apps that can monitor mood, behavior and quality of life and functional assessment via the Web,” he said. “This would reduce ER visits.”

Pamela Hyde, administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), hailed the 1963 legislation as having had some major positive effects on cultural and social factors. She said that care and function are being restored in spite of harsh environmental conditions.

Former Oregon Senator and President of the Broadcasters Association Gordon Smith emphasized that mental health is not a partisan issue and requires the efforts of many segments of society, including the press. He urged reporters and broadcasters to utilize “constructive talk” when presenting stories about mental health.

William Emmett, consultant for Senior Policy Advisor for Magna System, Inc. and one of the Forum’s organizers, summed up the underlying theme of the conference best: “The community of mental health – It’s all of us.”