Transcripts For CSPAN White House Mental Health Summit Part 1 20240713

Host also delivered remarks. [applause] thank you so much and for the hard work of your Office Making this event happen that is fantastic work here at the white house people in the know often describe for providing treatment as being in crisis why is in crisis half of the description clicks because 11 million americans upwards of 4 million are receiving no treatment to their lives lost to psychosis untreated serious Mental Illness represents a huge and unnecessary loss of human potential. It also makes our more dire social mission such as random acts of violence and sheltered homelessness Substance Abuse, and the disturbing rise of the rate of suicide i want to emphasize these problems are exacerbated not by serious Mental Illness but exacerbated by serious Mental Illness. Todays historic conversation draws broadly on the expertise of people from many disciplines and experiences and perspectives our goal is to put on the table a robust set of reforms how we go about delivering treatment to persons with serious Mental Illness. The Trump Administration has already begun the process of rebuilding our treatment system this very week the president will sign fiscal year 2020 appropriations bill that makes important in the improvement of the treatment of those suffering from serious Mental Illness. It includes 120 milliondollar increase in the substance Health Administration provides 200 million for Certified Community Health Centers to provide comprehensive services to those suffering from Mental Illness and provides 125 million from project aware that help schools and Community Organizations and First Responders and others to identify Mental Health issues and help those affected get the treatment that they need 19 million from outpatient treatment from criminal and juvenile Justice Programs it with those mental ill individuals away from the criminal Justice System and into more appropriate treatment venues. And it includes 7 million for assertive evidencebased practice where multidisciplinary teams with Personalized Care these funds are just a down payment on what will hopefully be a much larger reform that we will identify and discuss today there is much more work that needs to be done. To start us off in our conversation we have with us this morning doctor drew pinsky i can think of no person better able to explain to us how we got into this situation we are currently in order to describe the price we pay as a society for failing to treat persons suffering from serious Mental Illness. You know doctor true one drew from his career in Radio Television including celebrity rehab on vh1 series chronicling celebrities struggle for sobriety also rehab that follow the experiences of everyday people battling addiction. Also the author of several books including putting broken lives back together again all the while pursuing this very successful media career he maintained an active medical practice belongs to both the board of internal medicine and the american board of addiction medicine and for many years assistant clinical professor of psychiatry at school of medicine and holds professorships with departments of medicine and pediatric and adolescent medicine. Plus doctor drew has served for over two decades as a medical director for Chemical Dependency Services and the hospital psychiatric facility in pasaden pasadena. But i think his greatest and most endearing characteristic is his habit of telling the truth just as he sees it so welcome doctor drew to the stage to kick us off in our conversation thank you. [applause] thank you very much. I am sure my directness makes people uncomfortable and nervous but well see if we can have at it it is such a privilege to be here you have no idea how excited i am. I am just one physician just one doctors perspective on the history over the last as an internist and then to take care of because it was a mess in there for 30 years with Brain Disorders the way that like you were treating heart conditions but it get sick like every other organ but then much to my chagrin the last ten years i have watched the entire system unravel and dk to the point i wake up every day upset immobilized concerned, freaked out and i want to share with you a little bit about the history of how we got here. Theres a lot yet to be said that if we dont pray this with an understanding of what mistakes we have made we will miss the big picture. Relying heavily on the text of doctor toris book he said very coyly a few minutes ago he said yes we made a couple of mistakes and yes mistakes were made so we become falsified in laws and practices between 50 and 60 years old so i will take you to this brief history. 1945 a young psychiatrist name to felix to have the Prestigious National government to redirect priorities non elected official and this one man and the initiative picks up from world war ii because of the Service System testified Mental Illness is the greatest cause of loss of manpower and it became clear in testimony that amongst the men rejected , 18 percent were rejected because of Mental Illness 14 because of mental retardation at that time other Neurological Disorders 30 percent due to mental disability and that was eyeopening at the time it was the first time a government had that data confronted with that data. Congress proposed a national Mental Health plan. With neuropsychiatric disorders and for other purposes this is doctor felix mean job he is a psychiatrist that showed up in 1945 and said champion in the bill i wanted and broad language but there is literally nothing i cant do a nonelected official running around our government changing the name to national Mental Health because he wanted to carefully steer this away from anything about Mental Illness because at the time the idea of Mental Illness was something that was stigmatized and growing consensus which was bizarre that institutions created Mental Illness and caused Mental Illness. Imagined that. Cosponsored by a young senator of john Kennedy Felix was aware his sister had Mental Illness and he began plotting and figuring out a way to use president kennedy for his and. In the history of rosemary is sad not entirely clear what she had whether a psychotic illness or Substance Abuse that she was behaving badly and the kennedys needed it to stop. Joe kennedy at the time consulted throughout the land for the greatest psychiatrist available and they suggested they pursue the breakthrough treatment at the time was a frontal lobotomy but of course the consequence change this woman permanently and i would say that i have heard the matriarch of the family felt worse about this that even the assassination of her sons killing the individual as we knew her because of bad behavior. The commissioners report was an ideological document when it came out and i hope the take away from a lecture today is that when clinicians and politicians and scientists develop a position that becomes more theological than scientifi scientific, run. It is always a disaster. In addition to the decay of the Mental Health Delivery System in the middle of the Opioid Epidemic i saw what happened when peak pain became the sign in pain controls whatever the patient says it is they declared themselves a white hat profession to save poor people from pain as somebody who was objecting being killed now that joint commission with the department of Mental Health and state medical societies were on board that i was threatened constantly with retribution from various administrative organizations not filling out the happy side signs in the middle of a call those vital signs they were always unhappy they were within drug withdrawal but if i didnt make it in that moment i was literally in danger of criminal prosecution for patient abuse for an adequate treatment of pain. If you dont think there were prosecutions did not send shockwaves through my profession thats why we send everybody to Pain Management it was no longer malpractice it was criminalized. Beware when clinicians and politicians and scientists develop theology and dont remain objective and scientific. So this is a theological document primarily the following statements and recommendations were beyond remedy this was a one or 200 year series of developments. The future services should be community Mental Health service centers. Do not get me wrong im not out dating those Community Health centers as interpreted it was mental Health Centers designed to prevent Mental Health problems but not use the word illness preventing Mental Health issues is something they had no idea what to do i would dare say we have little ability to do it today but almost no directive toward the treatment of psychiatric illness in the outpatient setting and the federal government would participate and i would share with you that is a massive departure a nonelected official a professional board shifting to the state and in previous years to be proposed to president pierce to deliver the Mental Health delivery a provision of the constitution the state should be managing this properly left to the state and counties. Much like president kennedy appointed Mental Health for this and along the same time which promised the medicalization of psychiatric illness. He was assisted with two psychiatrist one who would succeed felix as director of the nih. And one of those incarnations grew out of the opiate center and it was very interesting plate but there were accesses so we have from 1946 through 1970 the Mental Health policy was dominated by three physicians and those with custodial care one summer in a Colorado State hospital for the chronically mentally ill and then trained as a pediatrician and briefly visited a couple of State Hospitals in massachusetts he was at the federal Narcotics Treatment Center not a place for the chronically mentally elbow they could go as opposed to prison as an Opiate Addict and sent to the object and literally never set foot in a State Hospital and they were charged with resources to be maintained by the state for hundreds of years at the same time our culture had run amok published in 61 the illness did not exist dare i say felix adopted this as a philosophy arguing Mental Illness was the institutionalization one flew over the cuckoos nest 1962 came around robert the Us Interagency Council allowed me to use his rhetoric for one flew over the cuckoos nest they thought they were watching a documentary they were watching a fictionalized account a movie about an Imaginary Institution and then scenes like publication with the sane and insane places these are the boundary problems that were going all the time he took students and pretended to be patients to go into a hospital the whole thing maybe not the whole thing but there were narrative excesses and it is the equivalent of medical students to vomit blood and criticize the er staff light criticizing for having a g. I. Bleed. Literally thats what they did. Im moderately upset about all this. [laughter] president kennedy signed legislation of the state Mental Hospital onto the course of extinction that was the purpose however no plan on what to do with the discharge patients no plan for dealing with the resistant care patients we told you that legislation was focused on prevention and the evidence at that time showed that it made things worse so we have the imd exclusion a continued massive effect of custodial care needs i call on this administratio administration, please there is something there to make a massive difference so because there was no resources and no plan the patients were pouring out of the State Hospital by the hundreds of thousands going to nursing homes, prisons, the streets and death those with a four potential outcomes. And at the same time the grounds for the treatment of the mentally ill the need for treatment prior the need for care the group of physicians there were accesses as a result im not defending the need for care but overnight from need for care to harm self or other for the justification to bring somebody with a serious illness into the hospital overnight there is a giant distance we can close a little bit. Seventytwo the only justification the aclus should be nothing less than the abolition of involuntary hospitalization thats like saying when my patients become in distress the oxygen saturation levels are below 80 we cannot involuntarily do anything with that patient because they didnt tell me they want it. And of course fiscally conservative state governments are not so happy with this civil rights are very happy no clinical judgment represented this group and we talk about millions of people and finally because of Community Mental Health Centers that were inadequately funded i would say the entire structure and philosophy was flawed finally close the centers and block grant the money back to the states as an abject failure. And quoting from doctor toris book appropriately summarized with the knowledge 100 years to achieve maximum size precipitous attempt to move into settings that did not exist must be seen as incompetent at best and criminal at worst. Know what we are up against in addition to this history which was ill advised is now a series of laws put in place like in california the act which affords no consistency in treatment this is a task force that suggested untreated Mental Illness is a leader to the system and city streets are the open air asylum with people with Mental Illness are brutally victimized and i. The act maintains the silent genocide on our streets if you are so severely mentally ill that you can be held against your will and that requires only the most severe states of psychosis and say i will kill myself or somebody else and and up in the er and on the 72 hour hold then say four hours later i thought better of you can answer the new non the next two questions do you have food give a place to live than thats it youre out no treatment. No assessment no ability to determine probabilities of future success you can just go. The idea is that these are so right to outweigh the evident need for treatment and families are left desperate i work with state senators in california who have gone up with family please let us help our homeless loved one we have doctors in bed and money and places to live and sleep and eat help us get them home so we can treat them and we are told by sacramento to take a hike. Who do you think you are . . There is resources for these people and they are dying of three a day in the l. A. County area. To my friends and colleagues and representatives in california what does the body count need to be before you give up crazy ideas like building for walls to treat Mental Illness this is the current policy we are pursuing in california if we just have housing it will and 60 through 85 percent of the patients are resistant a vast majority have serious Mental Illness and drug addiction and for walls will not do anything you they even go when i was working with the board of supervisor touting he put out a bag of showers i said how did that work out he said on average it took 14 contacts to get one person into one shower. Its a Mental Illness its a serious condition. At its core it is the symptom we are managing that is a deficit of selfawareness the person with a disability is unaware having it first named by the famous astrologist the babinski sign which you are doing is a narrow exam that the very first thing you are taught about. To characterize the term these clinicians eat all the time in a stroke somebody has a right cortical stroke the left side goes out and the patient doesnt know it literally you can show the patient your hand it flops over the same develops in dementia we rush and we would be considered inhuman not to rush in they dont have insight into whats happening encephalopathy stay with stay away from you dont want help but if that evolves in the psychiatric illness to get them from dying and manic psychosis it is the same biology and other brain conditions but people are dying what does the body count need to be before we will try something a little different yes there were accesses for the need for care they were maniacs they were taking it out of their shirtsleeves and doing lobotomies i took care of those patients 30 years later trust me it was a mess it is not a good form of treatment. They were underfunded and understaffed and to allow them to happen some better understanding of these brain conditions that are wellequipped to help us but that is privileged by the loss we cant do anything they say im fine and then to change the law we will talk about that further today what about Psychiatric Care . When somebody is diagnosed with a serious Mental Illness it is a template that goes this is what i want you to do with the advance directive when somebody is in the icu their brain isnt working right we should have the same thing with psychiatry. We should have that every psychiatrist and general practitioner should have a template that says the advance directive for healthcare if you go into a serious medical crisis when your brain stops working at the high probability i want to make sure you get back to work to where you can thrive that is the final goal. Remind ourselves the dementia and encephalopathy but dementia is a progressive condition we cannot change and then we jump in on that for schizophrenia if we dont intervene we are condemning them to future deterioration of the possibility to be irretrievable with the treatable disease that can be changed dramatically with Early Intervention the disease we can change the course of and those of which that we cant we jump all over that one. How crazy is that . We must change this. And if you want to see that history in detail read his book its in detail and with their we will move on to our panel. Thank you. [applause] now we moved to the First Panel Discussion for reform the first moderator will be the assistant secretary administrator at the Us Department of health and human services. [applause] [inaudible conversations] good afternoon. Its my pleasure to moderate the call for reform i will start with a dj a former advertising executive has served on the boards of numerous nonprofits in the executive director of Mental Health illness policy board opeds for the Washington Post New York Times wall street journal and the author of insane consequences how the industry fails the mentally ill which has a important conversation to address issues related to serious Mental Illness in this country and also introduced john the executive director by the Treatment Advocacy Center if a loved one has a Mental Illness he is an attorney with 20 years of policy and advocacy experience at federal and state levels and also serves as a member the various coordinating committee and our panelist doctor stanford is the chief executive officer of the hope and Healing Center and is an adjunct professor at Baylor College of medicine in the houston Methodist Hospital association for psychological science on the interplay has been featured in such publications usa today and christianity today the author of several brooks including finding hope in Mental Illness what we will do with this panel is first hear from each panelist who will speak for several minutes and then have questions and answers and then i will wrap up the session for you. The first thing i have to do is to cat dash with the stellar work she is doing with the seriously will on the seriously ill and torri is the godfather of all the changes we see i will apologize ahead of time what i am saying is different from what you are used to hearing because i am not a Mental Health advocate im an advocate for this seriously mentally ill. To put that into perspective 100 percent of the population can have Mental Wellness improved 18 percent have something but 4 percent who are seriously mentally ill and may have a functionally impairment so severe they have trouble coping with activities in the white house hinckley shot president reagan because he knew, not thought he knew that was the best way to get a date that is serious Mental Illness and we are failing people with it now my book argues and by the way if anybody wants a copy give me your card i will send you the book your influential im happy to give it that the reason it is going up because the Mental Health system itself no longer focuses on the most seriously mentally ill they argue we spend way too much money on Mental Health and not enough on serious Mental Illness we went from a hospitalbased system to a communitybased system that injects people that are so seriously ill they would otherwise need hospitals now wraps every important social ill and employing one dash bullying in a Mental Health narrative to serving those issues so nothing is left for them and doctor drew describes the consequences of that failure as a result for 4 Million People have received zero treatment thats why it explains that are 140,000 mentally ill homeless and those incarcerated 750,000 mentally ill on probation and parole and ten times as many people incarcerated for Mental Illness as hospitals so police and sheriffs are over owned with running a shadow Mental Health system that those in the real system no longer treat. [applause] the reason we are not focused is politicians and Mental Health officials are misled by Mental Health advocates they believe advocates rather than their own eyes. For instance they regularly tell politicians mentally ill is no more violent than others. It it is the number one claim that the untreated seriously mentally ill are more violent than others if they are no more violent than others and why i do site nurses where panic buttons and those dont if not the wire psych units locked and others not if no more violent why do we train police to deal with the mentally ill rather than people with illnesses like leukemia . Mental Health Advocates say if we intervene early we can prevent Mental Illness we cannot prevent schizophrenia and the most bipolar disorder to a nobel prize to whoever figures it out with that progression and they are funding a lot of First Episode psychosis programs for those that already develop some form of psychosis they claim stigma is the biggest. Nonsense any mom or social worker knows stigma is not the biggest barrier to care theres no doctors or social workers or programs or clubhouses or housing the cost is too high let me say it very clearly the homeless psychotic guy eating out of a dumpster is not avoiding care because he is a dumpster diver he is avoiding care because there is no services for those people i know its politically incorrect to say so but its the truth so with criminal justice and Mental Health conferences i say if you go to a criminal justice conference they will tell you to reduce we have to have enough hospitals they have to keep them long enough to stabilize them police will say that he several commitment standards to get them into the hospital and when the hospital discharges them they have to give them housing or assisted outpatient treatment that is the way to solve the problem so i suggest me with your police and sheriff without Mental Health people in the room so its not politically correct to talk about those real issues that need solving and to solve those issues of assisted outpatient treatment we have to stand up to the disability rights and protection and advocacy to many Mental Health groups that believe being psychotic and delusional is the right to be protected rather than treated. [applause] hopefully john will talk about the specific things into the system we are envisioning about changing commitment standards and the role of medicaid and the assisted outpatient treatment and how handcuffs prevent care from our own seriously mentally ill relatives if you want a copy of my book send me your card thank you for being here and working on this problem. [applause] thank you dj and jonathan. I was given the task to follow doctor drew and dj i hope your sympathetic with my talk. [laughter] i note last night there was a hypothermia alert and it makes me think of Carrie Mcbride and her son who has schizophrenia he began to have delusions this teachers were following him other students were conspiring against him he is convinced his mother started to work with the fbi against him we now know having a psychotic break of those delusions and that process the psychotic experiences are toxic to the brain in much the same way a stroke is. But unfortunately we dont Marshall Services instead it puts up roadblocks she was told there is nothing we can do until he is in crisis when he is dangerous we can get him help. So her son became homeless out in the dc streets in the cold like this. He was homeless for years before carrie could get him help after a few months of care a light switch went off he regained insight started to recover and could participate in care voluntarily. But he lost years to an illness he did not have to experience these are the preventable tragedies we are all here to talk about today and the Reform Efforts we have to focus on so dj and doctor drew so eloquently explained we know what to do we just have to have the courage to do it. Where do we start . We have to have a full continuum of Services Available so people are not forced to wait to crisis before they get care carrie said should not have been told there will be hospital bed once hes dangerous otherwise its the street what other illness do we do that with our only option is a hospital bed . It shouldnt be that way. The reality is without providing care those individuals are in the system that cant say no jails in Emergency Rooms Research Shows ten times as many people with serious Mental Illness in a jail or prison are in a state Mental Health hospital fewer beds per capita than in 1850 Law Enforcement is forced to pick up the slack partnering with the National Sheriffs association earlier this year to do a report what are the experience of sheriffs and other Law Enforcement to address Mental Illness . One fifth of their time is spent responding to or transporting people with Mental Illness at a cost of 1 billion every year. Any Law Enforcement officer will tell you all that money is a waste they are Mental Health professionals this isnt what they signed up for it all the training in the world doesnt make them a psychiatrist it is the wrong system to get care. Thats why you heard so many others Mention Congress needs to illuminate the discriminatory imd exclusion we need to have a baseline of places to get care to build the system from im really proud the Waiver Authority provided with these 1115 waivers to address the imd exclusion recognizes the combination of Community Services and a baseline unfortunately our system for too long has said it is either or and pits advocates against each other we dont do that with any other illness you can have inpatient care with a heart attack but no communities we dont do that we say what services do you need we need to solve the lack of beds we also need to move away from a standard that says you dont get care until you are dangerous Everybody Knows most people with serious Mental Illness are not violent so why do we use that as our standard to decide whether or not you get care thats ridiculous way to provide care so that means most people dont get care instead we need to change that to be more medically based that says provide care to people regardless or not if they are dangerous who cares if they are dangerous to they need medical help can they understand they need that help . Thats the question we need to prioritize care for the most seriously ill programs like assisted outpatient treatment unfortunately the system right now incentivizes the most seriously l2 fall through the cracks if you are provider 75 or 100 patients you dont get paid anymore to deal with the scary guy or the difficult patients there are no incentives to say not the criminal Justice System. Is just not how it was designed you have to solve that problem a few days before christmas this is how things are changing across the country every Community Talks about this new york city Public Advocates and now a groundbreaking import just report to criminalize the response entirely in San Francisco Mental Health program for 1000 treatment beds and just the prioritization of the most seriously ill the 4000 people around San Francisco who are obviously in need of care but just are not getting it l. A. A few weeks ago got the Pilot Program to add another 500 beds but really trying to figure out Innovative Solutions to go to italy to say they have a whole new model how we treat Mental Illness lets try it here the status quo was it working lets do new things and im especially encouraged by how the federal government has engaged on these issues because as you all know our organization and chairman murphy sitting in the audience today really galvanize an effort to say you are not taking Mental Illness seriously and things have changed since then the states are stepping up to take advantage of that opportunity just in the past year we had eight states adopt new outpatient treatment was 48 states across the country who now prioritize the most seriously ill who were being left behind there are so many opportunities right now it is an exciting moment that doesnt come around very often and taking advantage of this moment in time. Thank you. [applause] and i have the honor after going everyone and using the word system a lot that i dont think we even have a system of the disjointed set of resources that are almost impossible to access and completely disconnected from one another and to be on that continuum moving them along people have to go to the highest level providers immediately there are points you just expect to get to so im so jaded about this system i left academia and decided to go back to my hometown in houston and fix the problem so we will just change it in houston because i question if we can fix it from the top down with no entry point into a continuum that doesnt believe it exists so we have to be smart you dont want to work hard you want to work smart so the reality is we know where people will go first when they struggle we know half are in place by 14 years old but we also know Mental Health america earlier this year reports the average period of time from the onset of symptoms is 11 years thats not a functional system you can even call that a system thats a joke i am part of the system and thats a joke 11 years kids come back in 11 years the majority of people to engage the system in crisis that Mental Illness is the only thing we talk about and that that time it isnt too late for that intervention so where do these people go first . They go to clergy first thats what data shows us i learned that in graduate school eons ago they dont go there because they expect the clergy to treat them or even because they even know they have a condition but they show up because somebody in there is supposed to help me and i need something we also know faith communities are associated with homeless already with minority groups so its particularly difficult to get access care so why are we not going into faith communities to the gatekeepers less than 10 percent of clergy ever make a referral. We know they are going there first why are less than 10 percent making a referral . I wrote a wonderful paper that says how clergy would see the individual and make the referral with a gatekeeper model i have trained 2000 clergy in 2001 in houston alone when i tell them that there is an audible gasp they have no idea they are more likely to come to them first they have no idea looking at accredited seminaries of north america virtually zero provide any training in relationship to Mental Health. The data is right there so what can you do . What is even possible that on the efficacy of Peer Delivered Services or evidencebased care and support groups there are all types of things that we can do in that setting to build that continuum of care doesnt start at the front door of the psychiatrist it has to be a whole set of steps looking at continuum care for medicine now start at the Wellness Club and then all those before hospitalization over a long period of time where is anything like that in Mental Health clinics faith communities are an incredible place to allow true accessibility we also have to rethink what are we actually treating . To use the analogy these are chronic conditions that they are different than diabetes people dont shun you because you have diabetes that people are concerned that they are with serious Mental Illness these require more contacts to the speaker pro tempore the house will be in order. The chair lays before the house a communication from the speaker. The clerk the speakers rooms, washington, d. C. December 23, 2019. I hereby appoint the honorable debi dingell to act as speaker pro tempore on Debbie Dingell to act as speaker pro tempore on this day. Signed, nancy pelosi, speak of the house of representatives. The speaker pro tempore the prayer will be offered by our chaplain, father conroy. Chaplain conroy let us pray