Transcripts For CSPAN2 White House Mental Health Summit Part 1 20240713

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 provide a service and you will need Different Things in a general medical system to stick this into that system simply will not work for ive been to a million meetings we had all the providers we could possibly have but if you cant get to the provider what good will that be . So in faith communities were training clergy and staff to explain the difference between the different types of providers they dont know lmft or psychiatrist. They dont know the difference. They will send someone with bipolar disorder in the full delusional fit to lmft they have no idea now we train them how to do that they have over a thousand providers in the network in houston they are excited about being involved with faith communities they just want to care for people and get better we put Peer Delivered Services it is evidencebased. I am a neuroscientist that is my phd i spent ten years looking at the evidencebased materials cbt dbt. And with that Faith Community as well as incorporating telemedicine the federal government is about to do 988 that is great how about before they are super suicidal with the support line and then to take preexisting institution and here is our entry points to put the same types of services there the people are waiting all we have to do is provide the training and then we can use the resources we have within the Mental Health care system for those that are the most severely ill absolutely need beds and acute care we need all of that but if thats where we work will not do us any good. And as an aside i know the system fairly well i had a Family Member the other day that needed to see a therapist i spent three hours on the phone calling through her Health Insurance and was unable to find her an appointment because only two places answer the phone. Wanted to provide the service and the other never called me back and i know what im doing. I could not get her care. I had to go with a direct pay place that i knew i could get her in and they do a good job and thankfully she had the resources to do that but most people dont have resources. We can provide care at a much lower rate. If we just do it smarter and with the intensive Outpatient Program in 12 months doing it with 1700 and i pay for all of their medications as well. Why is my state say they pay between 254,000 a year to get through a program without the same kind of outcomes . I dont understand i think its a bureaucracy. [applause] and to get questions from the audience what i would like to do for a few minutes. Lets start with you. In terms of the imd exclusion that they express concerns if we live the imd exclusion we open the door to institutionalization of thousands of people. Do you have comments about that . It will not open the Door Community treatment will always be cheaper and government will always will be a cheaper option if it is effective. But then go back to snakepit conditions of the past of one flew over the cuckoos nest but it is the lack of money for hospitals that created substandard conditions allowing them more money that is truly therapeutic. And to have the panelist speak about the continuum of services that are needed to support the seriously mental ill. What do you see as a continuum of care what happens if you dont have those kinds of services . But these fights over scraps so now we are worried about inpatient versus community when we need both so the entire community is altogether that we need all aspects going in the same direction everything from philanthropy to the government, providers Little Things to train every county to say this is great we need officers trained but we need to get officers out of this business in the first place that is where we are looking to go if we see that is all or nothing what we want is a system yes we do need beds because the illness can be severe we want to keep you in the Community Getting the treatment you need without falling apart unnecessarily because thats how we decide care. Involved in licensure to develop new levels of care we simply dont have them on the Mental Health care system i can name them off from the school nurse or the pentagon for the paramedic all the way to the sophisticated we started moving down with the pierce specialist but burdens on the back of the individuals its very expensive you have to spend a week in austin on your own tab 700 for the program and then you have to pay for the test and then is medicaid reimbursable by insurance . Who will hire that individual so we have to work with those organizations as well estate licensing boards so something that fits between the family and that you take care Nurse Practitioners and telemedicine not just putting the puzzle together. What are your thoughts on the focus on serious Mental Illness . Most people can live in the community we dont have enough clubhouse programs for the serious mentally ill that Many Community programs will exclude somebody because a Substance Abuse disorder or a criminal history because they have a behavioral issue or because they are homeless so most of these Community Programs are not serving the seriously ill a lot of that has to do with not being what reimbursed to take care of a difficult patient talking about continuum of care as long as is focused on the seriously ill housing is a big one where its not with this driveby Case Management they need much more support they need congregant living but we are supposed to believe everyone can have a driveby case manager and that will work and it doesnt so continuing care yes been focusing on the seriously ill and i would argue that hepa can help parents deliver the continuum of care if i can know the diagnosis of what medications my loved one is on i can provide transportation and medication and some of those services but without hipper relief i cannot the best way to reduce the need for housing is assisted outpatient treatment to allow people to stay in treatment so parents can keep them at home rather than getting orders of protection. Can you describe about club houses . The house is the leading example the International Clubhouse association that those are peer communities they are looked down on the community this is a physical space people with Mental Illness run it and to go on the front desk they answer the phones and that. It could be educational or how to get housing they actually Read Everything that is in their sometimes they start businesses and the single best model everyone in new york city where i live has seriously mental relative once you get them can you talk about the details that one of the really nice things of the program to allow those individuals of getting care in the system and to be served in the community. So it combines the treatment that the individual is already eligible for and in need of with a court order and then to enforce the persons care but really there to ensure care is provided to the person and to provide oversight to show why treatment is provided. And with this program and a longstanding program and to see significant reductions of the most damaging cost with serious Mental Illness and hospitalizations and arrest and incarcerations and violence those you are most worried about it is a great tool in the toolbox you dont want too many people you want to have as many options as possible because this is a serious illness and too often it can be a fatal illness. And how this works with Mental Health professionals and of Community Support surely would be one can you say anything about that . Bad is the key you have to have a network of faith communities connected to a network of professional providers. And not just training the Faith Community that they have to be connected the other thing we found early on of a referral list and just dont have that system well enough so the social worker what she does is finds out all the information plus faith communities always ask a question that they get uncomfortable with so what will happen if i have a highly religious client and so they trust us for that. So on the provider side they are excited about this and the clientele in the caseload and also the more important part with that referral aspect they know that individual can go back and then provide them some support any provider knows if you have a client than they have no support and then to have a prescription we expect them to get better is not faith communities waiting for them to get better and thats what the providers are excited about now if you can show the providers you put in evidencebased types of care things that they understand that a psychoeducational group. And with that curriculum to put the provider at ease because now they have a referral source and then to get better so we run into very few problems to go out to talk to the provider as opposed to say there are providers over there and we will give them a list. There are children that have serious emotional disturbance we should scream every child if we start screaming every child you will end up with a lot of kids to be medicated and treated for illnesses and half of all Mental Illnesses begin the age of 14 with 70 percent of kids adhd that basically a little bit behind their peers in the class especially those of color who are medicated so they are those with serious emotional disturbance but take the issue of suicide that it is increasings we have to focus on suicide whether 54000 suicide those were adults those in charge of fixing things spent 2 million and like 43 million or something on kids some really spending money where suicide isnt so while i am sympathetic to make that compassionate group the new york city mayor to tell the principals what to do but the consultants wont actually those that have Mental Illness. I want to give a plug to the report by the Inter Agency Coordinating Committee to put out a report to congress to take the ball and run with it. But thats one of the big focuses and there are significant section and the promise seeing options on those agencies and with the issues that is the real opportunity to allow those opportunities to bubble up to take advantage of successful things we already see on the ground and to help shape the federal government definitely recommend you take a look. I would say three things we have seen the same kind of interest from schools and faith communities in virtually any type of emotion thats taken down the kid track so we have to provide more training for teachers on the recognition so the schools that provide these types of trading as well so we know the difference between a child and then we made it like this in the normal range that has a serious disturbance and then to provide that training as well and number two with the additional monies for research of those emotional disturbance i just had a book come out and i was surprised with little thought of what the outcomes may be because we dont have anything else. So increased funding its important to have those but we need more constraints those are the biggest things that i see and also to provide research for those ordinarily. There is some mention for the Mental Health crisis and would to give a little advice how we are connecting those services with the Mental Health resources for what people need. And the question you have the answer. The systems for too long were just piecemeal putting it to gather with duct tape wouldnt have time to figure out a system that technically address the various needs. Opening opportunities in a coordinated manner it is strategic rather than reactionary it is a reflection of what we see around the country desperate to help wanting to get their loved ones care. The risk we always have is that you call and there is no opportunity there. It is huge but i report that came out a few weeks ago that looked at the reality that parity law is just words on paper in most places around the country you are much more likely to have to go out of network and out of pocket to get Psychiatric Care to wait a week for a physical illness or seven months for a Mental Illness is unacceptable. So we just need to have everything coordinated to have a world where your brain is not part of your body that is just ridiculous and unnecessary limitation we need to get away from. And then and those with serious Mental Illness also thank you to the secretary a czar for his support of the those living with a serious Mental Illness in the nation. So what we are doing at the federal level which is a major priority for the agency and with the course of these illnesses and their families appropriate care must include psychiatric medical services for many, tree treatment of disorders and recovery services. And then addressing childrens needs if we can detect early and illness we can mitigate the impact of the serious Mental Illness to give people more opportunities to live full and Productive Lives in our communities. To have a major resource to make better be do this with a program called project aware with infrastructure in schools and states to meet the Mental Health needs of children and trains school staff on Mental Illness recognition and provides direct services to children and their families. And with the Mental Health block grant with the psychosis programs to provide Rich Services to those with the young people serious Mental Illness in families. And then with those included. Physical services for medical issues, Substance Abuse services but they are also required to provide 24 7 Crisis Center Intervention Services including mobile crisis services. Providing the most appropriate care, and relieving Law Enforcement and associated with bringing people and prices to Emergency Departments. Which has brought for people with serious Mental Illness or crises related to Mental Health issues alone. Since the estates with locating inpatient and residential facilities in real time, we have funded bad registries and 22 states. This helps people to identify inpatient and residential beds in real time. Samsung also funds programs but it just criminal justice issues to treatment programs and diversion programs and assist those with serious Mental Illness for homeless or marginally housed. Community resources are really so important to recovery from serious Mental Illness. And we are very glad to have had that doctor sanford here to speak on faithbased services which can be a huge support to those in need and sensibly recognizes we work with our partners to support such services and we also support services that can provide resources to those leaving with serious Mental Illness and that communities such as educational assistance, help define and implement peer support the services are critically to help for persons able to recover and live a productive live in these services are important and for those with the most serious Mental Illnesses, samsung as an assistant Outpatient Treatment Program that provides Behavioral Health services overseen by quote officials print this program was recently evaluated and report to congress. They reported decreases in psychological distress, use of illegal substances and psychiatric hospitalization, Emergency Department visits from his Mental Health issues in criminal justice involvement. With increases in housing stability and employment, and in providing lac services we must consider the Underlying Services which is based on civil commitment. The strong positive effects of videotape required that we work with states to address civil commitment laws that at the same time we want to the greatest extent possible, to address personal autonomy which is why samhsa is working with the center for medicare and Medicaid Services onsite psychiatric resources. As well as with stakeholders who are examining civil commitment laws but we also have the American Psychiatric Association Working with us. On developing an app for psychiatric it spans directives which we think would be hugely important for people to make their wishes known. More easily anyway. Its finally santa built a National Program of Technical Assistance and program which program is also included for serious Mental Illnesses. His best practices, psychopharmacological center of excellence. Center for excellence for clozapine, which is medication for tonight for treatment of choice for since friday. Contracts for how to set up and implement National Center of excellence for protected health information. It provides training and Technical Assistance for sharing information and particularly information in emergency situations. These national and regional Technical Assistance centers help to increase the access to care by increasing the numbers of providers with training who can then provide the services to those who need it. Our job at samhsa news to make care and Services Available to the most seriously mentally ill. We will continue to work on many fronts to do this and we look forward to continuing our collaborations with our states, and our local partners to implement these supports. Thank you so much. Back. [background sounds] [background sounds] we are ready to start the next, can we have everybody please take their seats. Its not right time. Can everybody please take their seats so we can continue the program. [background sounds] they all got up. Will going to keep things going here. We have another speaker coming break out. So if everyone can sit down. Ladies and gentlemen please take your seats as the program will take place immediately. Is now my pleasure to introduce our secretary for health and Human Services. Alex bizarre. Sworn in as president trumps secretary in january of 2018. His current tenure and hss as a second tour of duty at the department. After surfing as general counsel and then deputy secretary 2003 he has its been his career working in Senior Healthcare roles in both the public and private sectors. It is my pleasure to introduce to you, the 24th u. S. Secretary of health and Human Services, alex is our friend. [applause]. Will thank you all, thank you all for being here. I am so glad to be here in attendance at this historic meeting. I believe no administration has ever held a white house meeting that project clear intentional focus on one of the most neglected aspects of our Healthcare System. How we care for americans with serious Mental Illness. So would like to begin by first thanking all of you for being here today. When there is an a policymaker, a Public Health professional, a healthcare provider, a lawenforcement officer, or are involved in this issue and some other way. Most of all i want to thank everyone president who is here because someone in your live has struggled with serious Mental Illness. I have seen serious Mental Illness and its impact on lives and families firsthand. And it worked directly in this field with many of you for the past two decades. I bring great personal tradition as well as empathy to this discussion. So thank you for being here and thank you for being advocates i think you for the work you do every day in the people you love. Risen from has a clear vision for our Healthcare System and its affordable personalized and patient centric and put you in control. Treat you like a human being. The lucky number. He has promised a system that protects vulnerable patients. He provide you with the affordable that you need and the options that you control and the quality that you deserve. Is it too often, our Healthcare System doesnt look like that. And no one knows better than americans experiencing serious Mental Illness. Our families and their friends. To give us what we need to go on healthcare the president has promised to protect what works and fix what is broken and there is no question sadly, that the weight we support and treat americans with serious Mental Illness is broken. According to sampson data, more than 11 million americans had a serious Mental Illness in 2018. A third of them received no treatment in the past year one third. Just imagine if one third of americans with cancer, heart disease, diabetes, received no treatment for those illnesses in a given year. We would recognize it as a national failure. Which is precisely, what we have had for is it too long on serious Mental Illness. Americans with serious Mental Illness died somewhere between 15 and 20 years younger than other americans. 125 of these individuals will die by suicide. About ten times more americans with serious Mental Illness, about 400,000 at any given time, are in jail or prison that are inpatient psychiatric facilities. These are major challenges to overcome which is why he went to work for a president and his administration that are more focused on serious Mental Illness than any previous men administration. That is true all across my department hss and especially of the and Mental Health services administration. From day one are terrific secretary has made it clear that santa should focus on providing scientifically sound and truly evidencebased treatment for serious Mental Illness. As shown through on how weve improved samhsa news Training Programs which we increasingly focused on providing communities with expertise on the ground. Are also supporting treatment to our payment policies. Last november i announced the historic new states in patient medicaid by applying for waivers around the exclusion. We have now proved such to dc, and vermont. In addition, today, we announced Medicaid Innovation model called integrated care for kids. Or inc. We know the providing the break services and treatment when kids began to show signs of Mental Health challenges, is essential to preventing those problems from getting worse. Think model, will support care coronation for kids. So in Mental Health challenges arise, there is a full set of crisis Services Available to address their needs. Support their families, and tackle the problems early on. On top of that, we issued an advisory this year to help states understand how medicaid reimbursement can support schoolbased Mental Health services. We are also looking at how we can clarify and reform privacy regulations so that families have the information they need to help love ones deal with serious Mental Illness. Today, in conjunction with the department of education, a kiss office for civil rights rolled out an updated resource for School Administrators and Healthcare Providers that provides clear explanations and examples and when Students Health information can be shared on hipaa and forgot federal statute for privacy. As part of a broader Regulatory Reform effort, hs is also examining how hipaa cannot be modified for all patients including those with serious Mental Illness. Hs f news center for faith opportunity initiatives is working with partners including many of you here today. To engage more with faith leaders in partnership with medical providers on providing Community Support for those with Mental Illness and their families. These are just some of the ways we are Getting Started and i am excited with where you are headed. The Information News legislation going congress this week, was just as the senate, make substantial investments in the priorities that i have just discussed. That includes a 31 million boost in funding for santos project aware. As doctor mccants just described, project tour support infrastructure and training for school staff around Mental Health awareness, and ways that they can assist children who may need services. It also supports services for addressing Mental Health challenges and promoting positive environments within schools. Further the appropriations represent increases samhsa news funding. For assisted outpatient treatment or aot. A highly effective method of quote ordered treatment. I want to underscore why i believe interventions like aot, are so important. There is nothing compassionate about loving individuals with serious Mental Illness suffer from lack of food, housing because their illness prevents them from making rational decisions. There is nothing compassionate about loving individuals suffer from symptoms that can cause them to be arrested and often incarcerated for them or not get the care and services they really need. When americans with serious Mental Illness are in crisis, we need to ensure they are connected Psychiatric Care and Community Supports. And in some cases, it requires legal interventions and assertive forms of treatment. President truck is rightly recognized that in the name of autonomy, we have gone is it too far and getting the families and communities to help individuals in crisis. We have the tools we need to help individuals with serious Mental Illness with healthy and fulfilling lives. We need to use those tools. Stripping communities of the ability to provide treatment when need it has had devastating consequences and so tragically visible on our streets and in her presence and we must do better and we will. Finally, underscore that will supporting research on new tools for treating Mental Illness. Made it a priority to support resource on effective interventions on serious Mental Illness and suicide at nih. In march, fda approved the first new drug for major depression in decades. Which received fasttrack and breakthrough designations. All of these are encouraging data points. The occasion of the summit, is just one more encouraging data. On top of all that. As i said at the outset. Our country faces huge challenges around Mental Illness but together, with all of you, working with families and state and local governments with all care providers with educators, with faith leaders and Law Enforcement, we can build a better system. A system that provides all americans leaving with serious Mental Illness with the kind of evidencebased treatment that we would expect from any other health condition. We provide that kind of treatment, americans with serious Mental Illness, can enjoy lives just as rich, long, and fulfilling as anyone else. And that will be a tribute to the work of all of you here in this room. So thank you again for being here today. And i look forward to some further discussion. Thank you. [applause]. I think we have time if you would like for maybe one or two questions. Good afternoon secretary. Thank you so much for your presentation all that good work that you are doing with this administration. It is a privilege to be here. I am from california. My name is cynthia hunt. Im a psychiatrist. As well as a pediatrician. My focus now is in psychiatry. And quite a bit and child that over the last 20 years. I have definitely seen that when we can identify the poor and treat children in early ages through their teenage years and young adulthood, that we can continue help prevent some of the tragedies. There are still tragedies. There are still quite a bit of difficulty in that care. One of the and im excited about the program. I was really like to ask you to go over that in more detail. The schoolbased programs that you have been funding. In the integrated psychiatry, which is been a part of my live for about 30 years, i am able to go into the primary care offices and particularly Community Health centers a few agencies, the Behavior Health clinician have been able to be working and have been working there through grants funding and and she funding. It is amazing when we welcome, and i welcome, i cant work sidebyside with the pediatrician at the family Nurse Practitioner and help identify and support those families and those patients. Many of them need that kind of support and therapy. Some need medication but very excited about ink and would love to hear more. Thank you. Sue met thank you and as you know, more than one in eight kids face a major depressive issue and that some two thirds since 2010 president weve got a real crisis on our hands in terms of child Mental Health issues. Thats one of the things that came out of the School Safety commission. How do we meet kids where they are. And that is why im so passionate about schoolbased Mental Health services because those transition years, but the high school and into college edge transition periods where so many of the Mental Illnesses will manifest. Being able to identify the early signs of that can get kids into appropriate treatment when they are. In a setting that they feel comfortable with. And where they feel wheeling to accept treatment. We actually as part of that visit, we went to wisconsin. We visited the adams friendship middle school. We saw just a shining example of what this could look like and have a School Principal and superintendent really putting Mental Health of the kids foremost in everyones minds. School developed for the teachers, administrators, aides, are just very attuned to all of the warning signs of lack of Community Engagement affection, change in behavior and mood, and are able to actually huddle and look for any outlier and the children who just seem something a little bit off of them. That day that we, that something different. They are not feeling connected it and intervene. And it really just tremendous results there that you saw so i hope that we can continue keep as i mentioned through medicaid extent, our schoolbased services through pulling states. Thank program, that really integrated approach to a kit in crisis. We dont have enough of course, the pediatric sites. We donovan of sikeston we dont have enough pediatric psychs especially. We have of course internal medicine in general medicine and having to practice adult lot of the psychiatrist, delivered in this country. So for our kids, how can we envelop them. When they are in crisis per this really what ink is going to try to test different models and then see what works and then generalize that more broadly. So thank you very much. Thank you mr. Secretary. Thanks for putting this together today. I am a state rep. Mary. I met grandma and a nurse. So as a legislator, and i am chair among states 26 milliondollar health and Human Services budget. How can we as lawmakers interstates, work with you as our federal partner to improve the lives of our Family Members and constituents who have Mental Illness. Thank you for that. One think that i think of those in you are in those states you can do, is be looking at the exclusion waivers that we have done. We have done 27 imb exclusions for Substance Abuse and to i mentioned in my remarks for dc and vermont rn serious Mental Illness. Inpatient beds are not the solution to everything but having inpatient beds available, is an important enduring with serious Mental Illness. We want to be wheeling partners. If your state has not taken us up on that, where open for business on the exclusion front. In addition, when we have the schools safe safety meetings with the president in the last couple of years, from one of the things that i have really been struck but is the crisis intervention. As need it. I saw a great example out of arkansas. Where if you think about it from the perspective of a police officer. If youve got somebody who is in crisis and the solution is to bring somebody in to an emergency room. And you have to be an emergency room for ten to 12 hours waiting to find an appropriate psychiatrist who is able to do an evaluation and they get to work with the quote system to get the person in care etc. And that becomes a six and a seven and a ten hour process for the officer. That is mightily to certain choices on the street we do look at somebody in crisis. Imagine a different model of crisis intervention set of services where you actually have a hub and spoke, very efficient model, for helping officers bring individuals and you are in crisis but with a very professionalized approach where thats a ten minute interaction to bring the president , you can cite there knows how to do with the quote system and does the evaluation and very efficient very patient centric, and as a whole different set of behaviors in terms of intake and thats why the ot program is so important. Just make sure that those resources are available as a backup for officers, for patients, for people who should be patients. We have got have a better system in place and i think some of the state based models, other states are help look at ones that are working to help individuals in crisis because we have got to get better at that. As i said, having people on the streets when we have so many tools. So many tools that can help people live a fulfilling live but theyre not in a state of mind where they are able to actually make it rational choice of that at the moment. And Family Members may not even be able to help them with that kind of a choice of treatment and medicines etc. That may be able to just get them on the feet. Help them live an independent and fulfilling live. Those of the kind of think so we can do. Well thank you all, i know we have a lot of question. I do need to keep us on schedule. Weve got a really full great agenda. Hey you all very much for working on this with us. And for helping all of the individuals in this country who suffer from serious Mental Illness. Thank you. [applause]. [background sounds] [background sounds] moving directly into our next panel. This is the group of state and local officials and they are here to share our perspective on how the crisis of serious Mental Illness left untreated is impacting their communities. It is here with us some of the innovations thats going on. The considerable innovations thats going on at the local loophole to address this crisis. So immediately, to my left, is lori chris, lori is the director of the Ohio Department of Mental Health and Addiction Services which means that she is the member of governor mike duanes cabinet. Sheep are prior to her Government Service she led a Behavioral Service ngo and is 27 years of experience in the Behavioral Health field. She started when she was in kindergarten. [laughter]. And i just want to fight for you than ohio, is the county administered state which means that she is responsible for working with the counties to implement a number of the programs for which she is responsible. Next lori is state senator jane nelson, from texas. I jane. Thank you for being with us. Senator nelson is the chair of the Senate Finance committee. And cochair of the transposition legislative oversight committee. We just monitoring the reorganization of texas is, health and Human Services agencies. Therefore she says at the center of the Mental Health Reform Efforts in the state of texas. Next to janus alan stone, helen is the county commissioner for georgia, which includes the city of savannah. The community of 300,000. Southeast georgia. She led the creation of the first behavioral Health Crisis center in her county. And she is also an active member of the National Association academy. Which i have found to be a very constructive voice and the Human Services reform. She could tell is about a project in collaboration with nico as well as her own work in that county. Winning the award for having traveled the firm this to be with us today, is sheriff bent will think her, from kootenay, county idaho. Has brought only the sheriff there but also the president of the idaho Sheriffs Association and former president of the western Sheriffs Association. And we look forward to him sharing perspectives on Law Enforcement. This is concerning our Mental Health treatment crisis. So let me just start by inviting lori to begin and share some thoughts with us. Good afternoon everyone. I appreciate the opportunity to be here and represent governor dewine, bold vision on helping ohio leaving with Mental Illness and Substance Abuse get will and stay well. And for Business Conditions who are at risk and having it developed those conditions. On the first night that he was sworn into office, he took a really unusual move and created in a policy loophole Advisory Office within his team called recovery ohio. Alicia nelson was the director of that initiative is here with us today. This work is different in ohio and i think probably in many states because it brought together a council of 30 private citizens that include people leaving with Mental Illness and addiction and people recovering from those illnesses and their Family Members and clergy Law Enforcement, judges, former governor, professionals in the Addiction Treatment field, Mental Health treatment field. In the prevention news local government, just a wide swap of ohioans, to create recommendations for the pathways that we would use moving forward in ohio over the next several years. As of this report here, was created in six weeks. And it was an aggressive timeline but the other think we know, is that we have this unique moment in time for that really is the common understanding of what is working and what has brought working. We have opportunities. We found consensus and 75 recommendations for the state of ohio to follow. These recommendations to be implemented at the state loophole but also at the local loophole. There is a lot in here for the National Conversation as well. So i hope you take a minute to google this report and search it and find it on our website recovery ohio website. There are eight areas that we are focused on. This includes stigma and parity, reduction in treatment and prevention, recovery and looking at special populations as well including criminal justice. In the very important aspect of data and how we can but is working and what has brought working. There will some organizing principles and values in this work for the government as well. He knows that we have to be looking at Mental Illness and Substance Abuse disorders across the lifespan. Severus in ohio, that means were thinking thinking about everything from prenatal care to older adults and how were initiating prevention treatment and recovery support. And that were doing that not just for the individuals experiencing those conditions but for their Family Members as well. And the Family Voices that vital part of the work that we are doing in ohio. When we are out traveling to other states and communities to see what is working. Not just going as state employees are public servants, we are taking with us and inviting alongside of us Family Members and people have lived experience. You can set yeses made sense to me, the student are this is something that we really could build on in our state. Also looking at erasing the partnerships that we have with local government. Its not just because we have a statutory relationship with them but because ohio has brought dismayed of of diverse people. Races and off it settings a religion but also diverse communities. We have vibrant urban areas and metropolitan suburban areas, also have lots of farmland and Rural Communities and appellation communities. They all have different characteristic geographically and politically to deal with. And then we also really embrace the partnerships with the private sector as well. Corporations, philanthropy, again local government and resources and what they can bring to the table and offered and solutions. Not just in resources but also in helping us shape policies that work for them is it too. Weve got some big work specifically with adults with serious and persistent Mental Illnesses is underway. We are really thinking, we talked a lot about multics system views and everybody understands that the kids, have severe needs and are kind of rotating through systems and not necessarily with a lot of success. We have significant work underway. This is across our state departments. In fact that its one of the points of recovery ohio is to have all of 26 departments within the administration look at what we are doing to best meet the needs of ohioans with Behavioral Health conditions. Also looking at multisystem adults bring those adults that are experience homelessness involved with courts and jails and prisons. Emergency rooms and those responses that arent meeting their Mental Health and Addiction Recovery needs. Looking at early identification and intervention. Thats been talked about a lot today. The really recognizing if we can see those first signs and symptoms of a serious emotional disorder or Mental Illness, intervene immediately, for that person and their family that we can continue actually stop significant damage to the brink that will continue over time and traumatic experiences that they will have in the course of time for those illnesses go untreated. Some are doing work in the space as well. And a focus on crisis. Connecting people to care and helping them stabilize but also really Thriving Community and is recognizing the crisis is it when his first learned about or experienced but throughout the course of a person news live. They will have acute aspirations of the Mental Illness in their Substance Abuse disorder we need to be responsive to that. That certainly means there is a brawl for everyone in the solution and we know that the environment created in our communities will either help people get well or keep them from getting well. So we are really looking at how we can create a flexible array of housing and residential support and making sure that we dont confuse independence with being alone. And recognize of recovery Community Organizations of how we can best help families and individuals leaving with these illnesses birds are excited about all thats going on looking forward to learning more. From the rest of the panel as well. Thank you very much. [applause]. Jane, thank you. Thank you. I am so grateful for the opportunity to be here. I am especially grateful for this administrations focus. Field been to the fort Worth Airport youve been in the heart of my Senate District in texas. Like so many communities across the country, we are very concerned about several trends that we are staying. A lot of it, most of it has been discussed today. Rethink homelessness, an increase in teen suicide, violence, veterans who are struggling. Is it too many people who are in need of treatment, who are ending up in our jail. I attended our health and Services Committees for 16 years in my dealings with the budgetary aspects, of health and Human Services and certainly Mental Health will seen through the eyes of how it affected us in healthcare. When it became finance chairman, all of a sudden it wasnt just the money that we are sending her spinning in our article two of our budget with a Health Component but i also as a finance chair, six years ago, how much are we spending across all state agencies. Nobody could give me the answered. As we probed, and it took over a month to find out that we will spending a toll of 8 billion across 23 state agencies. And there was no coordination or discussion of duplication. So one of my first things that i did as finance one of the first things i did as finance chairman was ask that we get that information together and we created a consortium and it was wonderfully successful and i would urge all of you to do that. We wanted to focus on duplication of efforts but is everybody talking to everybody. If you had a good experience in your agency are you talking to another agency about it . We did establish a coordinating council that has now been in effect for five years and very very successful. They developed a Strategic Plan and quite honestly if you have a budget request for many state agency that comes before me and is not part of the Strategic Plan it will not be funded so it has been very successful. They have come up with four Mission Statement goals they are focusing on first, most importantly as pertains to Mental Health and that is treatment before tragedy. We are maximizing our resources, were going to improve coordination of services, and very important, that we reduce the stigma that is attached to Mental Health. Those are the four goals the coordinating council sticks with and it has been very successful. Years ago we certainly became aware of the fact that so many of our Mental Illness cases were presenting themselves in our jails or hospitals and as you know it is absolutely the worst, the most expensive, ineffective place for our patients to end up and we integrated our physical and Mental Health in medicaid, ramped up services for the homeless, invested in jail divers and allowing lowlevel offenders to avoid jail time and complete treatment, very successful again. We also established programs for our veterans. We are committed to our veterans. I carried a bill number of years ago, we talked about peertopeer counseling. It works and is very ineffective and those who experienced are those who can help our ptsd, our veterans who have shared similar experiences, very successful program. As we look to the future, in texas we had the horrible santa fe shootings in our school. We immediately focused our attention to what is going on on our schools and legislating committees in the house and senate that have looked at the Mental Health component with this and learning a lot and last session i carried a bill and kind of fun when you make sure it is appropriately funded. We answered some of the questions that were asked earlier. A lot of challenges in dealing with i used to say adolescent Mental Health, i now say children because it shows itself earlier than adolescence but with our adolescents and our use, in texas, we are a growing state. We only have 600 child psychiatrists in the whole state and so what do you do when we have the student population boots growing by 60,000 students a year, 5 and half million students, 600 child psychologists, psychiatrists so we looked at another program proving itself to be very successful, we have 16 medical schools in texas with good psychiatry department, we are training them and we are making a significant investment in graduate medical education and so we put more money into that with specialty in psychiatry and particularly child psychiatry and we are going to use those residents and telemedicine and connect them up with especially the more rural parts of our state, 80 some counties dont have any psychiatrists but we can reach them through Mental Health and we can use both the resources the state is already paying for with those psychiatry residents and provide identification, pointing them in the right direction, very very helpful. We have found our teachers and clergy and child doctors are not trained to deal with some of these things. They spot them, 75 of our Mental Health problems identified by the pediatrician but they dont know what to do. They are not trained in this but we can point them to the consortium we established and if they are in a moral part of the state, have them point the youth and family to resources in their community that can help so weve got some exciting things going on. I go back to the one major issue we all have to address and thats why im so happy to see the summit, weve got to remove the stigma, make sure Mental Health is looked at as any other illness an individual may encounter. [applause] thanks very much. What is the view from georgia . This one works. I became a county commissioner in 2004 and as you all know, humane responsibilities, Public Safety as well as your budget. When i asked our then sheriff who was in our Detention Center that was a question i couldnt get a simple answer. It concerned me because as looking at my budget book before i came here our budget from 20192020, i want you to hold on to this number just over 50 , like 50. 4 of our annual operating budget is going to our sheriffs department, our jail and our courts. That does not include our policing. In our Detention Center, our jail, 20 25 of the inmates their suffer from a mental disorder and or Substance Abuse oh your numbers are starting to go up and the reality of this is very painful. Mental illness is a disease as unique and serious as others, alzheimers, cancer, diabetes but again is is already been mentioned today, nobody wants to talk about it, you dont see fund raisers for the Mental Health ball or a charity for Mental Health. It is a horrible disease. I cannot imagine waking up every day maybe not being able to navigate through life. It is a true disadvantage. I would encourage each of you all and obviously you care enough because you are here today and that means the world to all of us that you took the time to be here as well as this administration addressing a problem that should have been addressed years ago. Take a tour of your jail. Ask your sheriff to show you where inmates that suffer from Mental Illness are housed. It will change your perspective. I can see it right now, the first time i went out there, i asked my state representative, my congressman and one of our prominent judges who does our accountability courts to please show up and they did. What i saw i was not prepared to see is what sticks in my mind was a gentleman who walked up to a yellow line with tape, with weighted shoulders, he was clutching papers, and he saw us in the hall and the judge looked at me and said do you know what he is looking at . I said no. She says he thinks we are here to help them. He thinks we are here to get him out. It dawned on me, who was he, who was going to help him, did he have family, what was going to happen to him . At that point i decided that jail was not the place, was not the place for a person suffering from Mental Illness. About that time when we were getting ready to leave, the deputies in a wheelchair pushed a man by been in a straitjacket on 24 hour observation. Ladies and gentlemen, our sheriffs are not set up to run a Mental Health hospital. Its a terrible burden to them not to mention the fact that the individuals that work there are not trained Mental Health professionals. When someone comes in for an assessment they may not know what medication they are on, what medications they need to be on. They are shooting in the dark and sometimes it works and sometimes it doesnt. So we formed a group called breaking the cycle, this group is similar to the National Association of counties was doing and this is where we got the idea because i cant say enough about how wonderful they have been in addressing some of these issues and helping counties address these issues as they have a stepping up initiative called breaking the cycle and the reason for that, we had a Poverty Initiative called stepping up so we didnt want to use the same name. We meet about every two months and there are 6 basic questions we started with because we wanted to reach what we call the intercept 0 which was through crisis intervention training and a mobile unit to prevent people from going to jail and i will get into the reason why that was so important to begin with but the sixth question counties need to ask, number one, is our leadership committed. By forming this committee we were very committed. Number 2 do we conduct timely screenings and assessments. I dont know whether we were or were not. At the time we had one provider, Mental Health provider, psychiatrist, at our jail. Since then we have increased that number partly through a grant from the department of justice that we received a few months ago but we are going to increase that because it was impossible for one psychiatrist to handle the number of inmates that we had that were suffering from this problem. We needed to know do we have baseline data. This is where it gets really sticky. Data and data flow and information does not flow freely. All kinds of restraints on peoples private business was a real problem and it still is, we are still fighting that battle. Have we conducted a comprehensive process and inventory of our services, we are getting there, we are working on that. Do we practice policy in finding funding improvements . Funding, we need more money. Im just going to leave that right there. Do we track the progress, now we are starting to track it, we are getting real numbers and understanding better what our needs are but the two things, several things jumped out, but through the National Association of counties and their task force combined with the National Sheriffs association we are trying to call attention to the problem of the inmate medicaid exclusion. There are two bills currently in congress right now, senate bill 2628 and 2626 because here is the problem. If an inmate is booked into your jail they are suffering from Mental Illness and they are there over 2030 days they are going to lose their rights to medicaid, medicare, Veterans Benefits and ship. I want you to understand these are pretrial detainees. Why are their rights being stripped before they have been Proven Guilty . All it is is a cost shift measure from congress to the local governments. And it is not right. Heres the other problem. If they are about to be released and often times we do not get much notice when someone is going to be released and im mainly here talking about misdemeanors and they cant they get there 5 days of medication and cant get those services reinstated, what do you think is going to happen . They are coming right back. Our public defender has a client, 60 plus years old who has been in and out of jail over 100 times. The system has failed him. We have failed him. And think of what it is costing. That needs to be corrected. It really does. It is not fair to the individual. Its not fair to the taxpayer and it certainly is not fair to our sheriffs. So we had a problem and we worked with the state of georgia. Our Behavioral Service provider, gateway Behavioral Services in Chatham County and we came up with the funding for a divergent center. This Diversion Center will be open 24 7 with 24 beds and tweet observation units as well. The 24 beds will house people up to 30 days. In that 30 days we believe we can combine the Services Necessary on the spot, the Wraparound Services that would be needed as that person gets ready to transition. It will open in may, certainly we are not creating the wheel here. This has been did and in other places and has been done successfully but that, combined with our accountability courts, Mental Health courts and drug courts which are two year programs we feel like we are going to try to help people not fall through the cracks as they have before and here is the other problem. Becomes a disparity issue. Of an individual is booked into jail, lowlevel offender, Mental Illness and they have no money to bond out they will lose the benefits i was just talking about. Those that have the money to bond out wont so this divergent center is critical for people that cannot afford to post a balance cannot afford to lose their benefits is a couple of the things we are working on. We are going to increase our cit training, we are looking at the city of savannah received a grant for a mobile crisis unit which does do some followup services. Our governor, brian kemp, of the state of georgia has an apps now for people that need assistance, to call into a number, especially for suicide and that is certainly a positive thing. Finally and at last, i think this issue is achieving the attention that it so greatly needs. It is a terrible thing to suffer from an illness that you cant help. With that i think i want everybody to urge their congressmen, their senators to please think about senate bill 2826 i said 26 wait a minute. It is 2626 and 2628. I apologize and i think that is it. [applause] thank you, commissioner stone, and sheriff ben. Thank you. It is going to work. I am from the rural part of idaho in the north. We are from boise, idaho which claims were to the county is. I have a unique perspective with work with the mentally. My wife is a coordinator in our county. I live it every day. Last february donald trump challenged leadership for the National Sheriffs association to come up with some plans to do not only with the opioid problem but also our Mental Health crisis. In june we had a meeting in washington dc sponsored by the bureau of justice assistance and the National Sheriffs and we sat down with 20 sheriffs, our federal partners and government organizations and padded this problem around and we had urban sheriffs with suburban sheriffs and rural sheriffs and we spanned the country, from massachusetts to california and idaho to florida. We really had a good representation. Out of that event came a report that went to william barr earlier this week with 7 primary recommendations and i would like to go through those. First, to establish a National Policy initiative to increase the education and awareness of the nations Mental Health crisis and its impact on Law Enforcement, jails, behavioral Health Systems and the safety of our communities. 2, to establish integrated crisis response, divergent and jail based Mental Health services. 3, develop and support cohesive and evidencebased reentry programs. 4, include opportunities and strategies for sheriffs, Mental Health leaders, the private sector and Community Stakeholders to contribute to federal and state policy development. For the ones executing it we need to be part of it. 5, fund enhanced training for correctional staff regarding Mental Health and Substance Abuse disorders. 6, increase resources for moral communities and 7, continue support for the department of justice jails, Technical Assistance and training support workgroup. I want to note a couple challenges and things we are doing. One of the first challenges we came up with was financing a programs crisis stabilization center. I applaud your center. I think it is fabulous. We have a 24 hour ctr. In my county, it is a Dropoff Center that is Law Enforcement friendly. We figured in the last quarter that we reported we saved the hospital 500,000 a quarter, people who would normally report to the emergency room went to the Crisis Center. That is real money. That is real money. Another challenge is to Fund Resources for medically assisted treatment in our jails both for opioid addictions and Mental Health issues. They are going to be there. We have to treat them but the financing just isnt available. 3, support changed the exclusion policy, thank you for talking about that because it is so important, they are not guilty, they are innocent, they are pretrial detainees. Why would they lose their benefits, medicare, medicaid, veterans and chip. It will cost in the long run. Next increased resources and Rural Communities. And idaho there are 44 counties, 36 jails. Two of those jails have a Mental Health professional 40 hours a week. Was that 5 . We need resources in our moral communities. And a couple ways to do that would be much like they did with rural doctors is forgiving Student Loans for rural Health Professionals who dedicate appear go of time into those Rural Communities. The other thing would be streamlined the grant process, the application and post grant reporting process. When you have a county Sheriffs Office that has maybe a sheriff and four deputies they dont have staff to manage cramps. Other duties are assigned from the sheriff. That will report on the nsa website is available for you to see. Its not long, it is about 10 pages and i encourage you to go back and read it. Mental health, dealing with the mentally ill in our communities has become a 10th of what we do. It is a huge, onerous responsibility we have had to take on because nobody else will do it. We are the ones on the front lines. And idaho, i sit on the council that oversees our academies and we approved the final curriculum to a queued include cit deputies because we felt they needed at the beginning of their career, not 2 or 3 or 5 years down the road. Lets start it now. We have got to get our hands around this problem. Thank you. [applause] since youve got the mike down there let me start with you. You have devoted your career, your profession, to Law Enforcement, we thank you for your service. The citizens of york county do. How have you seen the situation change with regard to serious Mental Illness over the time of your service . There is such a greater awareness now. Before, you just kind of put them away somewhere in a cell and didnt think about them again but they are people with the problem and they are not just criminals committing crimes just for crimes sake and we have finally come to that realization. It has taken 30 years to do that but that is the biggest change, we are recognizing now that these arent just criminals, these are people who have an illness. You raised lots of interesting issues. Is it, as part of your state strategy, are you looking to reconstruct the capacity for inpatient treatment . Is that a necessary part of ohio app strategy Going Forward . What we are looking at is how much capacity we need for the number of people that need that service and are people able to get in patient care when they needed and relatively close to where they are and that is something we know isnt true. Today. Part of that is based on the opportunity to expand private psychiatric capacity which would exist in more communities around the state than Hospital Capacity does come we have 6 State Hospitals, we help almost 11 patients daily, nearly 7000 annually. Our State Hospital system has largely become a place for competency restoration and those adults who are unable to be sentenced because of not guilty by reason of insanity or incompetent to stand trial and those are longerterm stays so we need some capacity for shortterm stays or adjusting acute crises or acute symptoms that may be related to missed appointments in Community Care or medications that are not working to the full benefit or medication noncompliance, those sorts of things where we can have a quick inpatient stay that will stabilize but remain connected to the communitybased care that people need in order to be in a homelike environment, not necessarily more longerterm institutions but a better use of the inpatient Psychiatric Care we have in helping people get the right kind of care close to where they are. I was going to ask as a result or function of york county administered structure are you seeing innovation coming out of your counties . In theory they are laboratories, right . Although in reality sometimes it doesnt live up to that open expectation. There is tremendous innovation at the local level and we are trying to help that grow. There are just amazing, strong practices with good outcomes happening in communities across the state of ohio. What we are finding is the need to help communities learn from one another and grow those practices across the state. Some of that is researchbased practices people have grabbed onto and they are really building up capacity in their workforce and local collaborations. Other things that may be based on a National Model but are also taking advantage of assets that exist in that communities so an example of that would be the coresponder model were not all communities have a high volume of people that would need a Crisis Center so cant necessarily have a placebased response and may not have a hospital available to their community in real time either but they can have First Responders accompanied by Mental Health. Support providers going into the community, into homes or restaurants, other locations, libraries, in real time to meet the needs of people in psychiatric crisis and get them into the right kind of care for them so we are seeing lots of great things. That is exciting. Jane, weve received a number of fascinating questions from our audience of participants, one actually comes to us from texas, it was directed at you and the question is this. What do you see as the biggest challenge texas faces related to Mental Health in the years coming and how can states that a coordinate with the federal government . That raises two good questions i would like to delve into. The appropriate relationship between federal government and localities and what your strategy is Going Forward . The first answer is the easier answer, funding and i dont think anybody is surprised, looking at things from the perspective of finance chairman, 1000 people a day are moving to texas, schools have 60,000 new students a year so just keeping up with the growth, funding is a huge huge challenge. We have critical shortages of Mental Health professionals, in 80 of our counties and that is a huge challenge. Funding is always a challenge when it comes to healthcare costs, medicaid was 20 of our budget, 35 and growing and so the answer to the second part of your question would also be more flexibility for the state and particularly the Larger Population of the state, texas is a very diverse state and the flexibility to do things in texas in a way that may not be applicable in georgia or ohio would be nice. Im very concerned about the effect the loss of district money would have on Behavioral Health especially. I dont know what we will do. Bottom line is you cut back on services or come up with creative ways to back it but that is going to hurt. Funding is always one aspect of the solution and the partnership is important, that is why it is so impressive to me that partnering and understanding the challenges we face at the local level, the state level and the communities come up with great answers and we need to enable them in any way, to handle the challenges they face in a way that works best at the local level. I will ask you a followup because so much interest was expressed by the audience and what has happened in terms of inpatient treatment. With the increase in inpatient capacity part of the plan . Absolutely. Funding and flexibility is important, the growing population especially. The exclusion as a negative impact on inpatient capacity and Residential Care as well but there are other considerations we have to build around that. Lifting that alone will not necessarily create what state and local communities need to make sure people get the kind of care they need when they need it and part of that is related to housing as well. The earlier panel talked about that, but having collectible operating capacities, we have the opportunity to build Housing Developments and use scattered housing but often in policy we confuse independence with alone and it doesnt create the best environment for people to have the level of support they need to thrive in their community when they are in an environment with the case manager that is able to visit periodically, it might even be daily but that might not be enough support. I know i personally have always lived with the family or roommates or someone, i rely on that sharing of economic burden and household chairs and the company and encouragement and a person with Mental Illness needs to be well. What any of us needs and community is what a person with Mental Illness needs and community and we dont necessarily think that way when designing services and support and resources and policies. We need to do better on the housing front and need to make sure theres opportunities in all communities and flexible resources in all communities that allow landlords to participate in a way that they can feel confident that they are going to be able to uphold their responsibilities and independence as well. In your divers and facility, providing Court Ordered treatment, is that right . It is starting out as a dropoff point for assessment and especially for those that might be transitioning into the Mental Health court, they will do the assessments there and we are now switched over to a competency docket for the Mental Health of superior court judge so that the assessments can be done quicker but the divergence center hopefully will be a resource for where all the services that an individual will need will be there. In other words, they dont have to wait for this person from this department or this person from that department because just a for instance, before someone can go through our Mental Health court they have to have housing just like it was mentioned and according to our public defend her that is one of the biggest obstacles for someone to go to Mental Health court, they dont have a place to live so that to me the difference between a Diversion Center and the jail is we try to combine all those services they are going to need at that location where is in the jail it cant happen that way so that is why this Diversion Center is going to be so terribly important. I have to give kudos to our sheriff because im going to read this title. He was one of the first jails credited for Mental Health standards for the National Commission on correctional healthcare. That is a long title but he achieved that but every time he sees me he says when you going to finish that Diversion Center, please hurry up, we dont really want a lowlevel offender coming to our jail being booked into our jail, possibly losing their services and benefits when they could go to the Diversion Center and get the help they need because they are going to assimilate back into the community and if we can help them assimilate with the resources they need, the likelihood of them recidivate and becomes much lower not to mention a life that can become productive again and that is really the feelgood part of this so i am hoping, i hope not to put too many expectations on the Diversion Center but that is what we are looking at and one other neat thing you mentioned, we do, across the country have a shortage of psychiatrists and psychiatric providers for people that need these services so this Diversion Center will be a training center, and i believe it is through Mercer University to train psychiatrists and psychiatric help there which is a big plus so the only problem i see with our Diversion Center, i can already you right now it would not be big enough. But im very excited and i would invite each and every one of you to come and tore it when it is complete. We would be proud to show it to you. The support from the state of georgia was just, we got it done. I really am very thrilled with that because as i sit here today, we have to live in a world where we have to worry about shootings, mass shootings, it is time we look the straight in the eye and say we are going to help people, we are not going to lets look through the cracks anymore so thank you. You touched on the workforce issue, it was of keen interest to a number of our participants so let me throw out a question for several panelists to weigh in. It comes to us from ohio. The metro Health System in cleveland is a safety net Health System for our region. Weve been outstanding our Behavioral Health workforce for integrated care to combat a suicide epidemic. To best meet the needs of our community we need to recruit and retain more Behavioral Health providers, lowpaying Student Loan Debt remain barriers but we have begun to tackle this issue through increased reimbursement rates. Director chris and others, talk more about what you are doing to tackle workforce issues, including any thoughts you may have about a way forward there and because of the need that is so urgent can you address what we do in the nearterm. My friends at metrohealth, happy youre here today. The workforce has been a challenge for several years, decades really, in Behavioral Health. A lot of it does have to do with pay and what is available to recruits and attracting people into jobs that can be very difficult and very personally taxing. We have worked on some of the reimbursement rates that are available to providers, parity certainly plays a big issue and that was talked about earlier on another panel, what providers get paid for Psychiatric Services compared with physical Healthcare Reimbursement is is not equitable necessary in all cases so that is something we Pay Attention to. We know that there are opportunities with the workforce that exists in ohio and in other states too, to not just attract new people but to retain the workforce we already have, so really making an emphasis on how we can help build career pathways, how we can help support the workforce really promoting support of their excellence in the field. How are we helping with Practice Development . How are we helping employers train the workforce for the skill set they need for todays issues and advancing best practices and researchbased practices and not making it so difficult to connect 2 or so expensive to connect to that only a handful of providers are able to approach those levels of excellence so we are working on that workforce capacity as well from loan repayment to Tuition Reimbursement, some people cant even afford to get a loan or dont qualify for a loan so Tuition Reimbursement becomes important. Also supporting people in pursuing higher degrees and credentials, we are doing to support and encourage supervision within the Behavioral Health workplace so that other employees can advance their licensure to independent practices. A number of Different Things. We noticed it is not just clinical practice but Business Practices well, we need to attract and retain people who understand Risk Management and quality and financing and create the future trajectory for organizations and patients that yield the best outcomes, making sure we are supporting that part of the workforce is important to us here. May i add from a budgetary perspective because we have tried just about everything, attracting people to Behavioral Health professions, weve done student loan repayment, weve done things to try to attract them to rural areas, created new residency slots but looking just purely at the budget perspective of this, weve got to make sure decisions of lawmakers in the legislature understand that by investing in those programs that will help the problems you are facing in making sure that we can invest in your divergent programs, that will save enough money to pay for those Student Loans and other programs we want weve got to spend smart and weve got to make sure we are investing in programs that dont just recycle people in and out of our Emergency Rooms and in and out of our jails, if we can invest in programs that are smart it will give us money to attract and retain the individuals we are seeking for our Behavioral Health areas, we also, i go back to the stigma. I want people who are going into, getting a doctorate in something, be a doctor in a Mental Health area. That stigma is still carried through the medical profession and that has got to stop. I want as many people interested in psychiatry as they are in any other healthrelated area so i will keep harping on the stigma affect. I will add the Behavioral Health workforce isnt just limited to those professionals that work in Behavioral Health settings. Our friends at metrohealth really have a program where they are doing a lot around integrating the best practices of Behavioral Healthcare and physical healthcare since the entire workforce understand how to help a person in psychiatric disgrace, not a specialist in those areas, thats an excellent example of what we do. The conversation earlier on how to engage with our based Faithbased Community members because they are on the front lines also looking at Health Outreach workers who may be privileged information about a family the Healthcare System or Behavioral Healthcare system might never get to. Teachers, Law Enforcement, Mental Health, first aid, these are investments we are making in ohio so everyone understands the signs of someone in psychiatric distress, the same we do when we see someone having signs of a stroke or heart attack and we know what to do. I know it is not my job to do heart surgery but it is my job to call 911 and support the person until the medical professional gets there. We are making efforts to engage. Judges too. I had a juvenile justice judge in my office who said i know when some of these children come before me that this is a Mental Health problem. You do not want to send them to lock them up but even our judges dont know. That was a part of our solution, making sure our judges are trained and nowhere to go. We need to show all the entities you just mentioned where to go. Not just random good but where to go if they cant deal with it. Any final words for us . With this divers and center we will offer training through Mercer University and i think that is going to be phenomenal because not only will they have a place to be trained through local hospitals but they will be right there on site with individuals brought to the Diversion Center so they will get firsthand experience before they are even out into the field. I have high hopes. If you invite me back in a year i will post you up on where we are. Thats a deal. Sheriffs in america have been dealing with for a long time and i think we have come to the realization we cant fix this alone and we need everybodys help, county commissioners and Mental Health professionals and it is going to take a team effort. We didnt get here overnight and we wont fix it overnight but we have to keep moving in the right direction. Very good. Please join me in thanking our excellent panel. [applause] we are going to move to our next speaker so if panelists feel free to walk this way down the stage, thank you so much. Our next speaker is doctor Richard Stone, doctor Richard Stone is executive in charge of the veterans Health Administration sometimes referred to as the vha which has the authority to perform the functions and duties of the undersecretary for health at the va, the largest integrated Health System in the United States so without further a do doctor Richard Stone. [applause] ladies and gentlemen, good afternoon and thank you so much for inviting me. I have the privilege of leading the veterans Health Administration. There are 18 million veterans in america. 91 2 million of them seek care from the 172 hospitals, 1200 ambulatory clinics that i have the privilege to run on behalf of the secretary and the president. My goal this afternoon is to spend just a few minutes with you talking about what a federal Delivery System looks like that has approached this comprehensive problem of chronic Mental Illness resulting in homelessness and Substance Abuse and what i want to talk to you about and let me take a step back from this. I grew up in the upper midwest intergenerational home. I was the Third Generation in a home that, when mom kicked me out the front door in the morning she never had to worry about where i was because every other home in that neighborhood was generational. I had 30 moms on that couple blocks and there was no getting away with anything because they all were empowered to take action to keep my behavior in line. Down the street from us was the county hospital and a half mile away was the State Hospital for Mental Illness and then the transitions you have heard about this afternoon occurred and the State Hospital closed and the county hospital closed and most of those patients ended up either homeless or in the criminal Justice System. Now i want to fast forward. My last assignment on activeduty, just south of here, before the moving company left, before the moving company left, we had a house full of food from every neighbor, invitations for the next 6 weeks from every neighbor, we knew everyone in the neighborhood. I retired from activeduty a few years ago. Today i live in a neighborhood that i have lived in just under a year, i know a single neighbor. That single neighbor happens to be the spouse of a retired 2 star general who knew who i was and he had trouble and needed some help and that is the only reason we met. Think about what has happened to American Society and what each of you face in your local communities each day. The va has taken a comprehensive approach under this president and this administration to approach this problem and what do i mean by that . We have a Wraparound Service to American Veterans in the criminal Justice System. There are 181,000 veterans in the criminal Justice System, 77 of them have serious Mental Illness. 71 of them have Substance Abuse disorder. The vast majority of them have both. We therefore wrap them in multiple workers that coming to the jails and prisons, we are covering a little over 45 of the prisons and jails in the nation to ensure that when they are released from incarceration that we provide an environment for them that the defined as a domiciliary system. As i stand here today there are 8000 veterans which provides chronic living until we can be assured that they have their Substance Abuse disorder and are under treatment that is appropriate. We cannot guarantee that we are going to be successful but it looks like as we approach one year post discharge from our domiciliary system our recidivism rate is 4 . [applause] thank you. What i want to submit to you is that this system is what you should be thinking about as you think about where you want to be in your communities. Let me also say to you and 172 Medical Centers we have sameday access to Mental Illness care from our psychiatrists and we provide over 600,000 Mental Health visits and video connect visits in rural areas of the nation including our indian reservations since we have such a large number of veterans, a large number of american natives who are veterans. With those comments, i would hope since i am getting the sign in the back that i need to bring this to a end that if you have a Va Medical Center in your community, call up the Medical Center director and ask to meet with them and ask to talk about our domiciliary system, our Wraparound Services and the success we are having in chronic Mental Illness and this is exactly why under this president we have been able to reduce veteran homelessness by 75 . Thank you very much. [applause] sunday night on q a, wall street trader turned photojournalist on his book dignity, about the plight of those living on the margins of society in america. Sunday morning or saturday it was empty because all the semis were gone and immediately the intelligence came right through and we spoke about an hour, half an hour or so and she told me her life. It was the cliche of everything wrong that can happen to somebody. Eventually i asked what i ask everybody i photograph which is what is one sentence, how do you want me to describe you . Shot back it is what i am, a prostitute, mother of 6 and child of god. Sunday night at 8 00 eastern on cspans q a. Our cspan campaign 2020 bus team is traveling across the country asking what issues should president ial candidates address. What is important to me is any environmental issue. I would like to see more protection of our beaches, the keys. The videos going on on social media are stating that conversation but i want to see action on it and i hope it is something they do. Issue i would like to see the upcoming president ial candidates address is the current injustices in our country, video being placed on instagram or the white house or by people in the current office, those issues need to be addressed. The issue important to be is Climate Change because i want to be able to visit coral reefs in my lifetime and not have them be bleached. Something for candidates to think about is funding, the lack of actual issues in our government and this is important as universities in america. The most important issues are healthcare, Campaign Finance and ethics in government. Healthcare we should move towards improving we are not seeing the vision of universal healthcare, making it simple and affordable, and medicare for all system. And to address the issues, too much money in politics influencing things. Voices from the road on cspan. The house will be in order. For 40 years cspan has provided america unfiltered coverage of congress, the white house, the Supreme Court and Public Policy events from washington dc and around the country so you can make up your own mind, created by cable in 1979, cspan is brought to you by your local cable or satellite provider, cspan, your unfiltered view of government. And career through a collection of her essays and notable quotes. You can find a full schedule online at booktv. Org or by consulting your program guide. Now we kick off the weekend with wired magazines Andy Greenberg on sandworm, aup