Transcripts For CSPAN Mental Health Care System 20140420

Thank you for coming today. I am a resident scholar here at aei. Our discussion is on the role of and the role of the government and Mental Health policy. We typically think of Mental Health as a state responsibility. Extent it is. The federal government can have a very influential role in shaping services and policies for mentally ill patients. There are huge gaps there which fallen toll patients the street and into gel. It is heartbreaking situation. Have representative tim murphy. The Panel Discusses helping family and Mental Health crisis act. It addresses persistent problems in Mental Health care systems, among them the shortage of psychiatric beds. There are is just a hearing two days ago on that. Education ofe evidencebased treatment. Small problem of violence and mentally ill, outdated, involuntary commitment laws and the questionable priorities of the lead Agency Within hhs that is responsible for funding the services for the nations mentally ill. Everyone on the panel will respond to his comments are patiencedicated to the and to the families who love them. I will first introduce representative murphy. I will introduce everyone. Fuller byuch countries biographies at your desk. I will be brief. Then i will begin. Revisited murphy is currently and has six term in congress, representing the 18 district of pennsylvania. He is a former psychologist, i still au are psychologist, with three decades of experience. The chairman of the oversight subcommittee of the energy and commerce committee. The cochair of the Mental Health rockets and Founding Member of caucus. Res he authored the seniors access to Mental Health act which ended the practice of charging copayments to seniors on medicare antiintroduced and passed into law the Mental Health security act for americas families and education which was instrumental in Getting College students who are suffering from depression or psychosis the help they need before a tragedy strikes. Next will be dr. Jeffrey lieberman who was the chairman of psychiatry at Columbia University college of physicians and surgeons, also the dreck sure of the new york state psychiatric institute. His expertise has been in schizophrenia and psychopharmacology. Sure he is a president of the American Psychiatric association. Next is patrick j kennedy, the cofounder of one mind for research. He served 16 years in the house of representatives and was the author and lead sponsor of a and theealth parity, addiction equity act of 2008. Finally, the professor of psychiatry at the uniformed services. He is specializing in orizophrenia or policy Infectious Disease and schizophrenia which is a very interesting theory. He is the juncture of the family medical research institute. He has coauthored numerous papers and 20 books. Panel. Our distinguished we will start with mr. Murphy. In q3 much. Thank you very much. Is convenient. Thank you, sally. I didnt know how to get the slides working. It is anybody . Anybody know what we can do here . We will move into 21st Century Technology in just a moment here. Good morning. Thank you. It is an honor to be part of this distinguished panel. Credits for this. That would be nice. We will move forward. 3713. To talk about hr parentsmmitted to be from sandy hook elementary that we would have this bill introduced before the anniversary of that tragedy. Nation has been rocked by several of these tragedies. Although those with mental not of the vast majority likely to be violent, it is an area of grave concern. Some of these have been committed by someone with untreated Mental Illness and that we need to deal with these things. Lets see if i can make this work. Some is going to have to sit there and make it work. I have no idea how to do this. It does look fancy nonetheless. Ok. All right. Let me keep talking here. Let me give you some numbers. Without this, nothing else is going to make sense to you. Are about 60 million americans, about 20 of our population or so, with some degree of Mental Illness. From the mild, transient acute problem of anxiety or sadness to severe Mental Illness. About 9. 6 americans have a serious Mental Illness. About 3. 6 million are without treatment. It is extremely important to understand what happens when someone is without treatment. Without treatment they can be more likely to exhibit some violent aggressive tendencies. When they are in treatment, there is a 15 fold decrease in the likelihood that they may become involved in violence. Some with Mental Illness have about three to four times more likelihood that they will be victims of violence, rape, assault, robbery. Someone is imprisoned on the street or at home, independent, whatever that might be. Children who are mentally ill, three times more likely to be victims a sexual abuse. That should move us toward action. The problem is the actions that have been taken are very much wasteful, are mr. Did, and we and we mr. Wrecked it are not given the services we needed. The federal government arty spend about 125 billion to work until ms. Toward Mental Illness. Most of that is for disability, medicaid. Very little is for research. Very little is forgetting out in terms of early treatment and access. What seems to happen however is where these people go. About twitter Percent People in our prisons are mentally ill. If you look at the next life you will see that as we close the hospitals, particularly in the 550,000nd 1960s, with beds for a population of 150 million. As they close down we now have about 40,000 hospital beds but where have the patience gone . We have filled our systems. While state budgets are bursting at the seams and paying for growth and expansion and overpopulation and small residents, it is no wonder why it is not the crime that is expanding. It is that we have traded the hospital bed for a prison cell. With all weve also traded the hospital bed for a mattress in the flophouse, homeless shelter for a blanket over some subway grates in our cities. It is inhumane. It is immoral. If it is in a third world status. Even when we do take some action such as a typical situation when a seriously mental a person is having some acute rate down, aggressive, threatening, the police are called. An emergencym to department. What happens . And ill staff emergency room, which is not designed to do with a mentally ill patient is brought here. They tied them by their wrists in their legs to a gurney, too hallway orthem in a a room surrounded by a sheet for some visible cover. If the person get out of control they sedate them. What could be more inhumane than putting someone in jail, leaving them in the street or physically or chemically handcuffing them to the bed and calling that treatment. It is wrong. Its about time our nation woke faced at the turmoil of the family feels about facing this has to change. In pursuit of this over the last year i held a series of hearings. Heres what we learned. We learned there is inadequate inpatient treatment options. Simply not enough beds. There is inadequate outpatient treatment, too. Away from is far, far helping people get better to recover, to get jobs again, to get independent housing. We know this can happen. The treatment has been out there. There are a number of supportive that canfrom health help. There are Community Wraparound services. Unfortunately, there is not enough of it. There is a huge shortage of psychiatrists overall, particularly those who treat serious Mental Wellness. When you talk about 7000 child psychiatrist for 15 million children, and we need 30,000, that is a serious problem. People cannot get help here it when there is no help there is no hope. When there is no hope people feel the stigma of going from place to pays, emergency room to emergency room. It is no wonder they feel a stigma. We are part of the society that maltreat those with Mental Illness. Another problem we found is that the Health Insurance privacy act is also the right to privacy act are subject to a great deal of confusion. They are supposed to be there to protect confidentiality of records. I agree. People are notat Getting School records and other records that do not need to be out there. What they have become is another barrier. Of releasingar something often released nothing. We have testified where parents were in a hospital trying to convince someone else i need to tell you about the history of my people sayhter and we cannot talk to unless we have permission. You cannot give permission for someone who does not know where they are. It is so severely involved in paranoia and delusions. They do not know who they are. Were telling people until we get their information we cannot tell you anything. That is wrong. It is a misinterpretation of the law. If youre in an auto accident and you are unconscious or you have a stroke and you are incoherent, no one says we have to wait until you get better before we make a decision to treat you. We do not do that. Why do we do that with someone who is in the middle of deep depression, deep bipolar disorder or psychosis . It is wrong. You cannot get the history. If you cannot get the history for a psychiatric disorder you cannot diagnose or treat it. It is akin to telling an Orthopedic Surgeon we want you to diagnose if there are any fractures but we are not going to give you any xrays. We have to provide access to information. We start to follow all the ethical rules of every profession. We also found that it is an imminent standard that has person hast said the to be in imminent danger to themselves or someone else. Then you can, without their authority, put them in inpatient care against their will. Again, the standard is to this level of someone has to be basically slitting their wrists am overdosing, holding a gun or knife to so elses throat before we believe they need help. Do we do that with any other medical illness . Do we wait for someone to say i cannot treat you until your cancer has advanced to stage four . I cannot do it to cardiovascular problems until you have a stroke . No. Withow we have this psychiatric illnesses. We have to wait until the person is completely deteriorated before we do something. We need to step in and help them. Prognosis ofter the system. It is also important that we have evidencebased treatments that really work. There are treatment out there. Lot ofppens as we see a federal dollars in state dollars going to work programs. It is more along the lines of many elected officials saying and you go fund this away. It is americas big secret. We say lets just fund these programs and no one asks the question. Does it work . In some cases, they do not work. Some of the money is spent on silly things that will make your loved boil as a taxpayer. Why is that federal dollars go to pay for a conference where literally the topics are such things as interpretive dancing or making a collage or getting in touch with your inner animal. When we see millions of dollars going toward those things and telling people we do not have enough people to provide help for you, that is wrong. We are not going to put up with that anymore. It goes to this point of federal dollars. What does it do . We empower parents and caregivers with making it very clear definition of refining the definitions that hit the malls laws are soa. Amily members know what the standards to be clearly defined. We want them to have access to history when they need it. It fixes the shortage of inpatient beds. Right now there is a 60 bed rule. How we figure out were not going to address you if you have more than 16 . Most have a critical bed shortage. This has to change. We also want to make sure theyre are alternatives to islamization to institutionalization. Patient human has found to be extremely states. Very few states do appeared new york has found int incident putting people involuntary commitment, in new york were things work with the family members or the District Attorney or the judge and come up with an agreement on the patient to stay on medication and treatment. What they found that the costs fell 64 sonment overall. In many of the areas is as much higher. Some areas exceed 80 of those going into jail. Or homeless. It encouragese is states to adopt a need for treatment standard incident just waiting until someone is going to kill someone else or their cell. We look at the need for treatment as a statement standard. It reaches patients just be on the emergency room. The cms recently came up with the ruling that they were going to limit the type of medications available for someone with psychiatric illnesses. We had a rather emotional hearing a few days ago on this. From ems toldve us they would limit the type of drugs that were available. To read out loud a statement from the American Psychiatric association which clearly said the cms distorted the analysis. In that, one of the comment that was made was about ssris. I say can you tell me what it is . The response was i was not briefed on that. If you do not even know what youre talking about, it is clear that you will draw conclusions that have nothing to do with reality. I am understating my concern for the decision that was made. Havented out that they another standard with and that that says you are not perhaps if you are not rehospitalized it is ok to change it. They were limiting the type of drugs so severely that i thought it was going to greatly impaired physicians abilities to prescribe appropriate medication. 65 and you over age receive a diagnosis of chronic illness, you are twice as likely to face depression. You double your health care costs. Exacerbation of physical symptoms, less likelihood to comply with other treatments. When seniorsm that them douicide, 20 of it on the day of the doctor visit. 40 the week. 70 within a month of their last doctor visit. Recognizing that many of these antidepressant drugs take 26 weeks to become effective, to tie a physicians hand and say you cannot use this until you have tried other ones that have failed, it puts the patients life at risk. Im happy to say a couple of weeks after that hearing, cms refers to our decision. This bill would say we would not leave it up to the whims of whoever sitting in the chair but we will make it part of the law. Sameday billing issue is quite important. You cannot have to dr. Bills on the same day. Moreow that a family is likely to go to a pediatrician or internist when they are beginning to exhibit severe Mental Illness. We know the average is 112 weeks before a person has their first visit to treat mental ole miss. What happens is illness. What happens if a mother brings doctornage son i to a and the doctor says i am very concerned but we need him to see a psychiatrist now. That is right. You are on medicaid. Can he come back tomorrow . That is inhumane. Were not going to have it anymore. There needs to be allowance for sameday billing. More access to telepsychiatry. Physicians can access by calling a number or allow more telepsychiatrists. We know it is a very effective mechanism to do it. They can talk under a vehicle screen. It is in barriers to eliminate. Medical research is important. Incidentrized a brain to involve a lot of research on the brain, the last frontier of the human body. A very Effective Program for Early Intervention for these problems. We also want to integrate Mental Health and primary care. That is where the first appointment tend to take place. That hashis is a bill been put into the bill that was passed yesterday. I had also put in some funding in there which was approved yesterday and the house bill. I am sure the senate will do that too. To help with outpatient clinics. It is a cause for celebration. More Behavioral Health it, medical records are moving into the 21st century where they are electronic records. Not for behavioral medicine. Why would that be . We had to have an integrated care model where the brains functions are seen as part of the body and not distant from. Not something you put in jail or call the police for or kicked out of your office because you dont want to do it. Deal with it. Physicians can work as a team. Tother part of this bill is our Community Health centers, to care Mental Health professionals to volunteer. Heres another thing that is so absurd be federal government could come up with it. If you work in a Community Health center, marvelous places that provide Lowcost Services to underserved areas, you are covered by the federal tort claims act. Malpractice insurance is low. They can provide integrated care. They are all working together. Great. That is what you want. Of them arey, a lot understaffed. If you are employed there, you are covered by this. If you are at a free clinic and you volunteer there, you are covered by the act. If you are a Community Health center and you volunteer, youre covered. If you are the free clinic and paid you not covered. Wait a minute . People will give of their time a dayk at the centers, month, and afternoon a week in valuable. We will take away that barrier and allow people to be the good andritans, want to help out give up their time. Quite frankly, this will probably be about a billion dollars with free care in this country. Next is the department of justice reform. A lots of prisons is guesstimates. We still do not know a lot of what happened in the federal Justice System. We want to know what happens with serious Mental Wellness. It is a disjointed model. They may have some care. They may have a different kind of care in jail. We do not know if they have followup care. We want to make sure we are tracking that. Extremelywareness is important. I understand that serious Mental Wellness and what the symptoms are so they are not afraid of it. This is extremely important. Of all this money spent, there is nobody that looks after what happened to the department of defense, veterans affair, department of justice, department of health and human services, and maybe Even Department of labor transportation. Is spent iney prevention and Treatment Services for Mental Illness. A lot is not evidencebased care. Dod has done some marvelous things. Military they have done tremendous initiatives to try to create more care for our act to duty guardsman out there. 20 get appropriate help. 20 . Is not goods treatment. We want an assistant secretary and Mental Health specifically designed as a clinical psychologist. This persons job is to go through every neck and cranny of the federal government and find every dollar can say is it evidencebased care . If not, eliminate it. If it is duplicate it. If it is great, expanded. If it is duplicative, merge it. If it is great, expand it. This is what this bill does. It is very comprehensive. It is not something i can explain in a thumbnail sketch. There are three things i think have happened in the last 50 or 60 years in this nation to change Mental Health. Our changes president kennedy made with regard to how we need to close and stop warehousing people. They made sure we have Mental Health parity. These other reform still need to happen. The federal government finally stood up and made some reforms and change the barriers. None of us want to see any more headlines of another tragedy of a victimization of a person with Mental Illness or violent committed by a person with mental ole miss. Lets ring this issue out of the shadows. Thank you very much. [applause] thank you very much. Thank you very much. Thank you very much. In conclusion, i would like to thank. I have spent my career really being a scientist and a theratory doing research on psychology of schizophrenia and acting as a clinician and treating patients as well. Decade, i andy be the chair of the largest little help care provider in the metropolitan area. Ive gotten john into the legislative political dimension of things. It has been an interesting but sobering experience. When sally called me to participate in this event, i noted that it was smack in the middle of a vacation that i take every year to go and watch the sony tennis open. I said after thinking about it in nearing who is going to be and im going to come. I missed Roger Federer playing yesterday. Good reason. This is an opportunity at a time that can really be the Tipping Point or a turning point. We are here today, an issue that has been in front of us for decades. If not more. Many people have been talking about it, railing about it, even my good friend and colleague. Congressman murphy has stepped that isto assume a role really doing something important. Paul wellstone, gordon smith, john porter, patrick kennedy, his colleague and his father. Move onwent on, they and we are not sure who is going to follow in their ways. Congressman murphy has stepped forward to do so along with other individuals who are so gratefully working in this way such as senator stop the know and your stabenow and your cochairperson in colorado. And the neuroscience caucus. And so forth. They really have a chance to do some a now given the fact that an individual has the vision and courage and a platform to step forward to do so. I have some slides. As researcher, he cannot talk without having slides for too long. I thought i would pick those up so you could follow along. It is not going to be easy. Our systemis because of care, which is admittedly isgmented and expensive trying to adjust at least three to fine pulations defined by type of illness, severity, and venue of treatment. The one that we hear most amount about and the most urgent priority are the serious and persistently mental, schizophrenia, recurrent, sec hide it psychotic depression. And are treated largely Mental Health care facilities. There may have the people who are receiving medical and Surgical Services that have comorbid psychiatric illnesses. This portion of the health care population is one of the biggest cost drivers. Group which is individuals who have mild reforms of Mental Illness or worried well or working addictions that are treated impact practice settings. Distincthree situations. We are all talking about slightly different emphases on these different populations or settings where people are receiving care. Opportunities. Inre is an obvious need addressing the needs of the population to several things. One of them has become the new buzzword, collaborative or integrated care. What that means simply is psychiatry needs to be embedded in the primary care system. There cannot be separate faces. They have to be embedded like journalists go to war. Psychiatrists do not pa take on general medical cares the responsibility. I marry care professionals need to be embedded in the clinics that are treating the spmi populations. That is a nobrainer. They have huge benefits. If we really want to get serious with this, and this is the next thing we will try to push congressman murphy on, is we need a Public Health initiative for Mental Health care. Like you have hypertension screenings, diabetes screening, tb screenings. It will not be as easy. There needs to be Mental Health oforts that moved out clinical settings into the Community Whether it is primary care, the educational system, the work lace. Thatbased organizations is where Mental Health care needs to move, also. It is a new frontier. This has historically been a stepchild for medicine. There are reasons for that. It isfrom those, something that the government has seen fit to need to step in and do something about. People with Mental Illness were not taking care of an ordinary ways in which people had their help taking care of. The government had to step in. It largely has fallen to the state or local government. Have a state health system. You have a Mental Health statement. The federal government as the book of american psychosis. It really only depicts the government effort to try to take on Mental Health care. Started with the Community Health act. Were struggling to recover from it. The recognition that Mental Health was somewhat different as some kind of special attention. That is still the case. Addition, our challenges are obvious. Everybody is well aware of the fragmentation. The tips of the iceberg of the neglect and the failed Mental Health policy are seen in numeral believe enumerable he. It is the jails that are 30 or 40 . That ise cost of care driving up the percentage of gdp that is spent on health care. That is driven by this. We have opportunities here. We have a convergence of things that is going on. The truth be told one of the reasons that people have stigmas is because stigma can be deconstruct it to discrimination on one hand or mistrust and suspicion on the other. Mistrust reasons to it. We did not have much to offer. Now we do. There are evidencebased treatment, the science of the brain is the new science. Health of a mental traction and never had before here at combined with this is the legislative initiatives that are really being pushed forward. Even though it does not perfect, the increase of social awareness. Opportunity that historically has not occurred. I think what will that will who are involved in Mental Health care on the provider side, the policy side and even the stakeholder side need to put aside their parochial interests and realize that this is not competing for market share. We are not competing until we get the largest portion and the other group does not. What is the optimal model of delivery here . What are the roles they should play in that . How do we configure it in the context of services that are just riveted into different venues or settings . How do we finance that. These are knowable things. We do not have to find a gene or do a great job to have a huge impact. This is the way it can be orchestrated. Not rosy, theme glasses kind of guy. Though theg even challenges are significant we have a historic opportunity. How much we think we can do it will only work if we can really orchestrate the logical process in an effective way. Thank you. Thank you so much for your leadership. Ive gotten a little wary of not having to turn on microphones for three years since i have been out of congress. Excuse me for being a little rusty here. I really am honored to be here with you. Are so thrilled that you amassing the kind of energy that needs to be placed in this area and to try to get the federal government to Pay Attention to how do we move forward effectively . Want to say to all of you, i am honored to be here with all of you. I am a liberal democrat. Mental healthpartisanship. The principalere sponsors. In 2008 george w. Bush signed into law and it could have been not and it cannot and do without many others. Arehis town today, we polarized by ideology. This is one area where we can put our ideology aside and understand there will still be those with ideology on either and that the large majority of us can Work Together to find common ground. I will use a metaphor to kind of explain what jeff has been trying to explain in his academic and medical lingo. He talked about the tip of the iceberg. We have the titanic. We are taking on water. Now we are trying to think how do we avoid hitting the iceberg again . Tocould build more like oats care of all the people who will be displaced because of this disaster system we had in place. Or we could steer clear of the iceberg. What a thought. Answer toords, the the persistently mental ill is not only to treat them but to from becoming severe and persistently mental ill. Liken it to diabetes. We are all about discussing how to conduct more amputations. As opposed to getting people the kind of primary care that will their being early candidates for diabetes and trading them aggressively early on so that they never have to develop the symptoms that necessitates such to crony and draconian responses. I appreciate the fact that so people after the lack of follow through on president kennedys correct vision, he talked about more research and come up with better therapies. He talked about communitybased care. At the end of the day, people want to live with their families and in their community, not in institutions. There, the money never went from the institutions to provide the needed care in the community. If you look at the most t connection, one makes it so successful is there are the funding mechanisms to sit or keep will in their community. Fite is no kind of quick here. Quick fix. We need a comprehensive approach. We need to tell the American People what we are talking about. Were not talking about Mental Health. We are talking about treating every american the way we would treat them if they had cancer, diabetes, cardiovascular disease, asthma, any other illness. If we truly change our mindset and think about this in the same way we would any other health care, a lot of these problems go away. Why . We will start paying for them. I am on lipitor. I have been on lipitor for 15 years. Why are they worried about me having a stroke in my 60s. I was in my 30s when i was first put on lipitor. Are we taking that same mentality in terms of Mental Health . You know imy face going to have skin cancer because iparty had it. When have you been to the dermatologist recently. Youve got me. You got me. Jeff was talking about screening. I call it a checkup from the neck up. Why dont we have every contain as visit check up from the neck up . Mental health is not something you have to go down the hall to drink from the colored water fountain. One wants that separate but not so equal system of care. That is what Mental Health is today. Separate and unequal system. We want Mental Health as part of Overall Health care. The last thing i will say is i think the way for us to achieve this in trying to do together the bill is to monitor federal governments implementation of the Mental Health parity act so that centers of medicare and medicaid than othersre say ever will on where the dollars a Mental Health will go. I would like to see them follow the federal law. Imagine the federal government having to follow their own law. Department of labor is going to oversee the plan because over half the health care is being delivered in the private sector or, why not have clarity anditoring that they treat the thevisible wounds of war same way we would treat their visible wounds. Both are killing them. Why frankly, the invisible wounds are costing more soldiers the visible ones. My view is this is all about framing the issue. I appreciate the work that everyone is doing in this still to try to do that. Time ina very important the history of this movement to get it right. There is a lock on the line, not the least of which is our returning heroes who will not only use the public system but they will be employees and our fortune 100, 500, and Small Business companies all across this country. We better get it right. Not only for those of us who have a Mental Illness like myself or an addiction like myself, but for our returning heroes. And look to be here forward to the discussion. Thank you very much. Thank you to aei for sponsoring this it is an honor to be here and to support representative murphy on his bill. Ive been following this for over 40 years. The problems have gotten progressively worse. It is an equal opportunity disaster. We have had the passage of the cmhc bill. We have had the five democrat president s. No president has understood the problem. These are brain diseases we are talking about. Nothing has been done. We had two president ial commissions. Members of 1525 congress that had severely mentally ill people in their family. We have had things like the insurance parity. Parity did a lot for a lot of people but it did very little for people with severe Mental Illness. Provisions and murphy is the first member of congress to take on serious Mental Illness and try to propose Serious Solutions to this. I think were all obligated for that. Is that a difficult problem . You bet it will be. There are 3. 59 people with untreated illness today. That is the same of the population of San Francisco and oakland put together. These are not just numbers. There is an acute shortage of psychiatric that. No one is saying we need to go back to where we were in 1958. We have effectively closed one million public psychiatric bed state hospitals. Ev project on the same number of people for population. There is one million will who a would have been in psychiatric hospitals. Where are they now . Tuesday we will be releasing a new read more from the center of the number of mentally ill will on state prisons and jails. The numbers about 350,000. What we have left in the state hospitals as we have 35,000. We have 10 times 10 times more people in our jails and we have in the mental hospitals. We have at least 200,000 homeless. That is a conservative number. Have 350 thousand people who are in jails and prisons. They were prisons and murphy had hearings on wednesday asking where have all these people gone. Them are in0,000 of here. That is where they have gone. These are not just numbers. These are people. Have are people who mothers and fathers and brothers and sisters. I get a print out every day of the reports from around the United States and what is going on. Was on. K seth boyer homeless. He refused to take his medicine. He is probably unaware of his illness. He told his parents that he sometimes slept in trash bins. He was found dead, compacted in the trash bin where he had been picked up. These are tragedies that happen every day. About 10 of our 13,000 homicides a year that are committed by people with severe, untreated Mental Illness. About 50 of the mass killings are committed by people with severe Mental Wellness who are untreated. Our Emergency Rooms are now overrun in terms of where it the 400,000 people are. Huge problem in the Emergency Rooms. It is getting worse. Maner and South Carolina a with severe Mental Illness was stuck in the emergency room for 36 days waiting for a bed. Until recently we thought 36 hours was a long time to wait. We are now at 236 days. Every going to go to 36 months . At what part we start to turn this around . Police and sheriffs are overwhelmed with the number of severely mental ill, increase in justifiable homicides. Is just the data, about half of the people who are killed by sheriffs and police are severely mental ill. Summer suicide by cop. This is getting worse. Individuals have taken over many of the public spaces, parks, playgrounds, bus stations, etc. We did a survey of librarians. A staff member have been assaulted by a mentally ill patron. Many of the Public Libraries have become day programs. The other thing that has amazed me over the years, because i follow the politics of this town, and this is a hugely expensive problem that i do not always expect the democrats to pay too much attention to. Almost nobody has picked it up. Andfederal medicaid medicare are among the most rapidly growing segment of the federal budget. Medicaid, people with Mental Illness are 11 of the beneficiaries that rep resents ssd i tripledt between 1980 and 2010. One to eight percent had a diagnosis. They are the largest and fastestgrowing group of beneficiaries. The problem is huge. Ofs is costly in terms dollar. What he has proposed is a very good start. He has many different areas on it. You can live in the community for as long as you take your medicine. You do not know that you are sick. We know you have been dangerous. Let me stress only a small number people need to be here. Those who do need to be on it really need to be on it. It is a marvelous functioning. Five states have shown that studies in new york and North Carolina have shown that it increases the incarceration. Increases episodes of violence. It decreases costs. That is coming out this month show that when you keep people on medication you decrease the cost. This is demonstration projects. I think it is going to become very clear how important this has been on it. Sat is probably the least there. Ive been around for 40 years. Im constantly amazed at how dysfunctional some of the agencies are. Is in a class all by itself. This bill attempts to bring them into the 21st century. What it will work or not i am not sure. It is worth a try. T increases the role it is one of the few people in washington who really understands this problem is that the best leadership we have had today. Anything we can do to get him more involved in this problem. Let me just thank representative murphy for taking this on. We are obligated to him. What he is doing is very important and deserves our support. Thank you. [applause] we have a good amount of time for q a. Two folks going around microphones. One thing i will mention. Mr. Murphy just went through a Tour De Force of his bill. One of the many important elements ive seen is the provision that would work with the criminal Justice System, to andate Law Enforcement sheriffs about Mental Illness on how to manage these folks into the treatment system and not into the criminal Justice System. Too often these are frontline professionals. In the case of the Washington Navy yard shooting, in retrospect everything is 2020. And may have made the fatal difference in his case. They visited him in the hotel room and may not have management that diminishes as much as they might have. It is a very important aspect. Im sorry. There were hands . Gentleman in the red tie. I share your illness. I too am a democrat. I am with Mental Wellness policy. I am a hardcore democrat. Issues ofnd on the the serious mentally ill that the Republican Party is a lot , mr. Murphy in particular. My own party is willing to throw money at Mental Health unwilling to admit the politically incorrect things that need to be done to help the most seriously ill. Talked about prevention. Theres no way to prevent schizophrenia or bipolar. We do not know how to do it. About Early Intervention. We do not know how to identify someone with schizophrenia before they come up with the systems. We do not know how. You talked about arisa i can talk about the number people with schizophrenia who have not insisted in nonsubsidized schizophrenia. What is it that my own party will not address . Not to get polarizing here, the one thing we cannot work to to not workeld is together we have more in common than we have separates us here . I think we absolutely need to do more. That has what ive been talking to tim on this legislation. I think identifying the role how the real health in the room, there is a problem of alization inn rosace our Emergency Rooms and prisons. Us to retreat from the program that the program, which i salute tim for we can dotion that Early Intervention, and if you intervene on the first instance of psychosis, you could dramatically reduce the pathology of that illness if you intervene early. Everybody knows that. To say we are not going to put in place a system of care that responds to you the same way we would with diabetes, the way we treat Mental Illness today is we wait until you have to treat the amputation. We say if you have cancer, we would not say come back if you have stage four cancer. Time asn a historic they say of a reincentivizing the payment. Thesestop paying for primary and secondary level of care, youre not going to have as many tertiary levels of care. Thati want to say about politically as i dont think we are irreconcilable here. To deal with the mentally ill but we also have to do it so we dont create so many of them. In this day and age, we are at a moment in time to change the system so that while we are treating those people who are so sick, we are preventing others from ending up in that situation. You. Ee with is there a vacuum of leadership . You bet. But thats what we are here to discuss is what to do about putting that Leadership Back in washington dc on these issues. Inc. You so much for this support of this bill. Ronald reagan, im not sure what he was referring to at the time said this isnt an issue of left or right, but issue of whether we move forward or back. Divisiont seen any among my colleagues on either side of the aisle on dealing with these issues. Is a divide on a couple of issues here. Back in the 60s, when reagan was the governor of california in the 70s, there was a movement at that time to close hospitals in california. Yet one group saying that would be like the russian gulags where we put the people we dont have to talk to, that was coming from one of friends. Another was saying we are putting people there against their will and they are not allowed to have their rights will stop so you have this him perfect storm to move to shut the Hospital System down. People have a right to get well. This is where this gets grossly misinterpreted from people who will say this person should have the ability to refuse treatment. I understand sometimes people are there with late stage cancer and they say its time, but when someone is not even well and they cant even make a decision and they dont know what planet they are on, how do we suddenly say theyre going to make a decision . Have them die with their rights on. Impassionedlly comments and they said most of the homeless he deals with have no idea that they have a Mental Illness. So lets give the people the right to get better and the right to treatment instead of they can refuse treatment if they want. Let them have this incredible option to feel healthy because the stigma that comes with Mental Illnesses this idea that it cant the treated. Themthink that we show inc. Blots and give them drugs and then sit them on the calcium talk about their relationship with their mother. On the couch and talk about their relationship with her mother. Then we can have a talk about the right to go back to work, the right to live independently, the right to say hello to a policeman instead of hearing the policeman say youre under arrest. Says is we can do this early. A point. St you dont have to use this much thatation, for the thing people are consumers really unnerves them. The level of side effects, you treat this early, you are not going to have the same levels. You wont have the same levels to apologize. Then there might be greater compliance so you wont have to tell them to rate court order that theyre going to have to take it. They will be able to live and understand its well within their ability to integrate. Side, wee them on our will have much better results than if we are trying to have this government micromanage people with Mental Illness. This gentleman. Im with the counsel for politics and ethics. Officer, withical our armed forces, including massive numbers of guard and reserve units after 13 years of continuous redeployment, would you address the necessity for more varied and outofthebox effective treatments, but also a cultural imperative to eliminate stigma that can be attached to posttraumatic stress disorder as we have these units coming back home and as they are going to need to decompress to do exactly what your colleague thomas congressman kennedy was saying. Folks dont wind up going fullblown into the system. Thank you. Putting my navy hat on. Im not authorized to make statements on the on behalf of the department of defense, with ptsd see here and hermetic brain injury been as is there has movement against seeking members with treatment, that it would lead to loss of rank or opportunities. Sometimes discharges, etc. They thought the noncommissioned officers would give them bad writeups. With ptsd andound postherpetic stress and other anxiety related, you can diagnose and treat it. But we have to remove the internal stigma. Many generals and admirals have done a lot of work but a lot of this needs to go to the level of noncommissioned officers, sergeants and chiefs will stop the best thing i heard from a patient i was seeing at Walter Reed Hospital was i was asking a marine about some of the symptoms. Dealing with some of the mental aspect of this, he said his gunny sergeant had told them almost every day if you have a twisted ankle and you are going outside the wire, you slow us down, youre going to get somebody killed. So speak up. If you have a twisted brain that day, speak up. We will get both of them fixed and will get you back in the saddle moving forward. Its the kind of attitude we need. Dont think there are enough providers within the department of defense and i dont think we have enough providers who have more experience. Medicale folks out of schools and their great providers. These are incredibly dedicated , but theres not enough years of experience. One navy seal said he liked work that would make him have more gray hair. Is what it comes down to making sure theres the transition between when they leave the service and get into is a hugeem or there gap between reservists and guardsmen. And go back to their fort back to the continental United States. They have groups they can work with, but when they go back to the reserve bases, their unit is dispersed. Here will be a lot more work but i will tell you one thing i tell them. People have a choice. I think its important for people to understand they have a choice. A person who has experienced severe combat i cant imagine. They have a choice. They can be a victim the rest of their life because they will always be underneath this older that holds them back from doing anything. Its sad to see them living in their mothers basement, playing video games and subduing themselves with vodka or whiskey. Can be ad choices they survivor. Despite what happened, i am moving forward. I will have these thoughts sometimes, but i will get moving forward and do what i can. The third choice is they can become a driver. A sourceturn this into of strength because they have been through what they have been through. They are stronger, faster, better and stronger and can teach other people how to handle it. They can say this is a source to make me a better person. There have been millions of people in our wars who have been traumatized by shell shock or whatever that is. But its only in the last decade we have begun to address that. Part of what i fear, the dod does not have to reinvent the wheel, though v. A. Can get up to snuff and rogue rooms in hhs can do what they are supposed to. To have everybody doing it on their own, but just like everything else, every branch of the service doesnt treat diabetes different am a they dont deliver babies differently, so why dont we do the same thing with Mental Health . I want to make to followup comments. And tjsck to patrick question about prevention the it has taken the civil war, world war i, world war ii, korea, vietnam, iraq, afghanistan, it has taken a few wars to realize their psychological consequences and not just physical consequences. Candid. Eed to be our understanding of ptsd and how it affects the brain, how can somebody be relatively normal and then in the span of whether its an ied explosion or repeated tors duty be irrevocably changed . That is what happens. But we do not know the underlying pathology or the vulnerabilities are. Truth be told, our treatments are effect of, but they are far from optimal. A lot more has to go into understanding this. Something peter caroli, who nothing about Mental Health and result asof his a result of overseeing the work in iraq was saying i want to see a way of diagnosing this. There is a suspicion that people do melling are. Thats an unkind thing to say but it is a reality. There needs to be a better understanding. Thatnk the point is prevention comes in many forms. It must just its not just primary prevention. We know someone is at risk for Heart Disease and we treat you and it never becomes anything. The mentally ill, its like tuberculosis, we stupid people in sanitariums. We had iron lung that there are no iron lungs anymore. The other side of that coin is interdicting people with respect to the checkup from the neck up when theyre getting their primary care or nonpsychiatric care. For that, we need the integrated care model. Next friday, by happenstance, we at theding a Forum National press club on integrated care where a very comprehensive report on the model care and economic consequences and expected if acted outcomes would occur. As i was saying before, there are different populations that need Mental Health care and they are seen at clinical venues. Be having approaches to dealing with them and the military is another one which is a specialized venue and population with the same body of knowledge that requires slightly adapted set of services. Thank you. Other questions . A showman in the corner. I am with the safe foundation. A question for the congressman. Those who have run through the Justice System, when the judge orders a checkup and when they that cano the test, turn them crazy also. As a doctor, you may know the procedure, it seems our Justice System is turning a lot of people crazy. Can addressway you that . Lenny talk about a couple of things there. By the time of person is involved with a major crime such as a felony assault or murder, it is too late to do something. Some states is the Justice System changes what they do. The sheriff who runs the Cook County Jail comments the second largest psychiatric facility in the nation. Largest is a jail in the Third Largest is a gel and it goes on down the line. Lets say someone is picked up for shoplifting at a local Big Box Store will stop somebody still 29 worth of sheets. This is a severely schizophrenic and who did not even know where he was. A prosecuted him. He sat in jail running up a total cost of 16,000 before it came before a judge who said time served, case dismissed. Hes back on the street and nobody provided care for him. The case of aaron alexis, the navy yard shooter, several times he came before the police. In accidental washarge of his weapon, harassing someone and shooting tires, but his microwave was talking to him. Switched from three hotel rooms in the same night. I dont know this, but i guess those policemen did not know what to do. Aybe they thought it was just guy talking to his microwave. Twice to the va hospital complaining they could not sleep and all they did was give him sleeping pills. I dont know if he ever saw a i thinkrist will stop that probably wasnt the case. But i see a long list of failures as a system and i was disappointed when the only thing the department of defense concluded was it could have been prevented if they had done a better security background check. Wrong. They should have done a better job identifying he had a problem and had it and needed treatment. Lets not give him an honorable discharge. Lets treat these issues. So where they are clear what to do, they will give the person treatment. We heard from the chief of police and we dont want these able to go to jail. The case original and found standing in a womans lover of living room. It took a lot of convincing for her to say he needed treatment and to get medication. Much utter often putting him in l will where he will what happens in some jails is some of these patients are victims of assault from other prisoners and they can be combative and aggressive and a deal with that by giving them more sedation or putting them in isolation. They have not committed a crime worthy of being in solitary confinement. We are trying to address these by ramping up awareness and getting into early treatment. Chairman joe pitts of the Health Subcommittee has announced they are going to do a hearing on this bill, 3717. This coming thursday at 10 30 in the morning. I hope america is watching and writing their congressman. A long list of democrats and republicans, its a partisan bill. Bill. Ve a hearing on a perfecting a bill is part of the process. Where this is going. We have time for one last question. Peter carson with powell tate. About how the increase in medicaid coverage on individuals will have treatment for the severely mentally ill. I will pass. Let me describe that. Will there be parity in the states because are there people to see someone. If theres no psychologist or psychiatrist, if the hospital can you see beds, someone in the hospital for 100 50 days question mark weve heard of children tied to a bed for several days. Arend to make sure there treatments and a lot of support services available. Health system in pittsburgh, im amazed at the number of volunteers they have to work with with people. Many places found it effective using a recovery model of peer support and people who have actually recovered from their Mental Illness and are doing quite well can get great support for someone. Those are the fundamental changes we need to make. We have to tear down these other barriers as well. Comment. D echo that its a stub, but its far from adequate. Reimbursement is at the lower level of the reimbursement spectrum in terms of thirdparty payment. Medicaid is managed through the states and each that is determining medicaid had been largely a fee for service, but its now being converted to managed care process. Each state is going through a way as they try to deal with how they are going to control their own medicaid cost him a how they are going to administer programs and health care. Congressmaning as murphy said, even if you have a pavement cities payment adequateat provides levels of reimbursement, whether its inpatient, ambulatory, emergency, it depends on the services being in place and the number of beds and providers. It has been a road it systematically over the last two or three decades. So the infrastructure is not really adequate. Financing process. Reconfiguration of the health care system. I want to thank all the people out there providing help. Often times they are underpaid and undervalued in what they do. Is the people in the military who are phenomenal in what they its as providers will stop the many volunteers out there. What still stands out is the many people suffering as family members and patients themselves who are looking for a way out of this and looking for hope. Its going to take united courage from all of us. Im for the expansion of the exclusion in the legislation going back to where we can find common ground. Heres the thing. Its a violation of parity. Medicaid and medicare do not have parity. I would like to find the nexus point to take this whole issue to the next level. I think it becomes like common law. Common law and what constitutes Mental Health. We need to have an iterative process that can share best practices amongst the states and like tim serves to set up in his legislation so that people will pay for something that can be demonstrated to be effective. Hes wondering why republicans dont get this. This is a deliverable will stop we need to make sure those become standardized forms of care and that you dont have to have a million conferences before you nail down what is the sweet spot in terms of therapy. We can accelerate this through cms which will have a plansversight as well as overseen by the department of labor. The private sector has shunted off everything on the medicaid system. Figure out a way to provide the services earlier, you get much more cuss much more costsharing and savings sharing which i like. Thank you all for coming and for an excellent panel. All the passion in this group and the growing interest that things may get better for the mentally ill. Thank you very much. [applause] [captioning performed by national captioning institute] [captions Copyright National cable satellite corp. 2013] on the next washington journal, Michael Green from the center for International Studies previews president obama asia. Then j hancock looks at how the Health Insurance industry is responding to the Affordable Care act. Then the National Journal reporter talks about possible Senate Action on expired tax credit for energy producers, particularly those involved in were noble fuels. As always, we will take your calls and you can join the conversation on facebook and footer. Washington journal live at 7 00 eastern on cspan. Looking ahead to monday, here is some of our live coverage on the cspan networks. Outgoing chair of the National Transportation safety board, deborah hirschman, will talk at the National Press club. She will finish her term on april 25 to become president and ceo of the National Safety council. We will bring you her remarks. Ive on cspan2 we will look at russian politics and their influence around the world. That conversation at the Heritage Foundation will happen live at 10 00 a. M. Eastern here on cspan. I love duke and i didnt do that to hurt duke. I did this to figure out what had happened in a dispassionate way. Even to this day, all one has to do is go on to amazon and see i have amassed 25 one star reviews and the book hasnt been out a week. Its a 600 page book, so im guessing not many of those one star review writers have read the book. My last book was about goldman sachs, but this is in another realm altogether. Silence theice of author looks at the duke lacrosse scandal tonight on cspans q and a. Over 35 years, cspan brings Public Affairs events from washington directly to you, putting you in the rim of congressional hearings, white house events, briefings and conferences and offering complete gaveltogavel coverage all as a service of private industry. By yourught to you local cable and satellite provider. Like us on facebook and twitter. Next, discussion about empowering the this advantage in society and enacting social change. Shriver,include maria David Robinson and others. Summitel was part of a working the 50th anniversary of at Civil Rights Act of 1964 the lbj president ial library in austin, texas. [applause] thank you and welcome everyone. We are delighted to be here and have our guests join us to talk century, social justice in the 21st century. Hear some of the work you are doing in a community where you work and that causes you can start in any direction, but i think we will start with david who is to my left. Andould like you to open up talked about what brings you to this place at this time. You accept the invitation . Number one, it was close. [applause] living in san antonio, right beenthe street, ive trying to be supportive of everything texas does. Its a wonderful institution and im glad i could be a part of it all stop