john. well, you know, i was sitting here chomping at the bit listening to arthur and fran speak earlier. recovery, you would think you've got 25 million people in recovery out there, you would lean on those people, the experiences, okay, what worked? let's implement that. let's add value to what you people are doing. affordable care act, medicaid expansion-that's going to be a solution for a lot of our problems if these states would buy into it. but you drop back on virginia, for example. they spend $5, $6, $7 billion a year on the consequences of addiction. this past july, the governor signed several bills. one was to recognize recovery support services and reimburse, but they stripped the funding out of it, yet he signed a bill that probably added $100 million to the department of correction's budget, to, you know, further sentencing on, you know, pot dealers and what not. now i'm not saying public safety is, you know, that's very important. i get that part. but we need to shift that conversation. exactly. but the recovery community, i mean, i think that is going to be a major solution, that-that we need to invest more time, energy, money, and, furthermore, we need to respect and value those people, and faces & voices of recovery has done an excellent job elevating the value of the recovery community nationwide, trying to get these policymakers together, these politicians to go, look, let's listen to these folks, you know, they've got game. we want that game. so obviously national organizations such as faces & voices of recovery, and-and-and what other organizations? you know, i know that for the mental health community, there's nami, there's cadca. well there's the coalition for whole health, which is a really exciting national organization where people with mental illness and others are coming together to advocate jointly, so it's nami, mental health america, faces & voices of recovery, the legal action center working with advocates as part of the coalition nationally and then working in states, because we need to advocate at the state level to make sure that the recovery supports and other activities that we know need to be part of health reform are implemented at the state level. so advocating on the essential health benefit, for example, to make sure that the full continuum of care that people need to recover both from addiction and mental illness are available. and fran, these organizations, are they-how likely are they to really pick up the mantle, as pat was noting that they have to pick up? is there a federal role, state role in this process, and if so, what is it? i think there's both, and i'll let arthur speak for himself, but in the federal role, what we're doing, and we're doing very well by the way. we are bringing these federal-these national organizations together, and then we're asking in a local level, in a state and local level, to do the same thing. so-and we're bringing what we call not traditional partners. so the mental health organizations are meeting with the substance abuse organizations. the mental health and the substance abuse organizations are coming together and meeting with insurance companies. they're meeting with business companies. they're meeting with families. and why is it important for them to meet with the insurance sector? because if we're going to go together hand in hand into health reform and we want to change the message and we want to be able to have america be able to take those brand-new cards for insurance and be able to bring them to get services, so there is more accessible, affordable treatment for addictions, there are more prevention programs for people, especially around in schools and-and communities for kids that are being bullied and-and the lgbtq communities and-and all these areas that we've kind of left alone for a while. we're all working together, and that's the key-that prevention, treatment, and recovery services with the national and local organizations coming together will march, so to speak, to be able to send the same message. it's all about messaging, and it's all about supporting each other. arthur? well, what i would say is that i think government plays a large role in supporting these organizations, and it's really critical. so pat mentioned that in philadelphia we had 18,000 people at our recovery walk last-this past fall. that is significant. the first recovery walk in philadelphia, which is done by an organization called pro-act, a-a community of recovery, had maybe 150 people. but because of our partnership with them, bringing our providers to the table, and the emphasis that we've had in philadelphia on the fact that recovery is possible, we-we in our department do a variety of things from- during recovery month . well, throughout the year. for example, you know, one of the things that we think is really important, and pat's organization has been the leader in the country around this, is putting a face on recovery. we think that's really, really important. most people work next to, they worship next to people in recovery. most of the time they don't know it, and so people in recovery seem like the other. and so the idea of putting a face on recovery is something that we've really adopted in our-in our service system, and we've done a lot of things to support that, in addition to a number of other things that we've done. but that partnership has led to, now, a recovery walk, which i think is the largest in the country. it's 18,000 people. think of this-18,000 people walking in the streets of philadelphia saying recovery is possible. i mean, that was unimaginable even to us in the city even 5 or 6 years ago. so it really talks-it speaks to the power of the partnership and what can happen, and we fully expect that next year we're going to top 20,000 people, or hopefully larger, and every time we do that, it sends a very strong message to the community that recovery is possible, that people in recovery are your neighbors, and that we ought to work together to-to achieve this. and there are a lot of opportunity to garner that support and that strength in issues-other issues that are going to be coming up on with aca, so just electronic health records, for example, which is a whole new way of really communicating health information to the patients and between and among doctors. so is-is that an area that we can also look at where this particular force, you know, within-within the state and within the local community can-can also help? sure. i think that the issue of electronic health records is really important. if we're going to have an integrated health care system, we have to have an integrated medical record system, and, right now, as you may know, that in the aca legislation, behavioral health care was left out. i think that was a huge mistake, mainly because of some of the-the issues we've talked about before, which-which is you really can't treat even most chronic health conditions without having a strategy around treating behavioral health conditions because it's so interrelated. and if you don't have an integrated record that includes the behavioral health conditions along with the physical health conditions, you're just not going to be effective, so i think you're absolutely right. we have to think about-and, you know, there are people in congress that are trying to change that. and when we come back, i want to go back to-because samhsa is really in the forefront of working toward really getting behavioral health integrated into aca, so i want to come back to that. we'll be right back. [music] before, addiction and depression kept me from living my life. and now every step i take in recovery benefits everyone. there are many options that make the road to recovery more accessible. it begins with the first step. join the voices for recovery. for information and treatment referral for you or someone you love, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] the national alliance on mental illness, also known as nami, has a mission to help improve the lives of people affected by mental illness. the bottom line is to save lives and to support recovery. our approach in support groups and education groups and what we do on the information helpline really has to do with recovery and the ability of each person to live in the community as much as possible to engage and to give people the idea that recovery is a possibility, that people with these illnesses from depression to schizophrenia live in the community and have lives and work, and none of this means that your life is going to come to an end. in my lifetime, people used to whisper about cancer. they wouldn't talk about it. it was not talked about. and it's the same with mental illness-that people don't want to talk about it because it can be debilitating. it's critical that we really do have a national dialogue on it and that the national dialogue frankly not focus on worst case scenario, but really focus on recovery. reaching out, speaking out, and changing attitudes usually involves personal contact. you have to meet people in the public sector where they are, because if you don't, you won't reach them. you won't get to them, and you can do that through flyers, through newsletters, all the websites, teleconferences, webinars. all these activities promote community awareness. that's where we depend very much on the in our own voice program. it's part of that broader person-to-person strategy. the in our own voice program has two people living with a mental illness that kind of walk through from their dark days, understanding their diagnosis, how they got help, what living in recovery looks like for them. and then we give the audience a chance to ask questions, and in many ways that's the most powerful part of it, because we say is there something you wanted to know, but were afraid to ask? ask us. we've lived this, and we can guarantee you that nothing you're going to ask us isn't things we haven't heard before, and we know you wonder. nami helpline. this is anne. may i help you? at the helpline where i work, we seek to get the word out about nami's community presence. on the helpline we speak to, really, the full gamut of people who have some connection to mental illness. we talk to people with mental illnesses. we talk to family members a lot, and we talk to professionals, and then everybody is some conglomeration of that, even our staff. so if we can get the word out to people that there's hope to say no, there are other people in your town who have the same problem and they thought they were the only ones, i think that's very powerful. [music] nami walks and nami bikes bring people together because they reach out to and draw in people who are not necessarily part of the mental health community. they are upbeat, creative, celebration events that draws people and helps get them involved in-in thinking about mental illness. you have to go on a walk in order to get the full feeling of a walk. it is the most camaraderie. i have been on almost every nami walk since the inception. we walk for nami. we are here to reduce stigma. that's the biggest tings for the walks and the bikes, to reduce the stigma surrounding mental wellness. the other impact is that people in the community see-the broad community-see who the people are in the mental health community. they realize that it's their neighbors and friends. that makes a difference. that's part-that's part of education. and fran, let's go back to what arthur was saying about what the aca is doing in terms of behavioral health. i know pam has been extremely active through cms, through other federal agencies, to attempt to position the issue of behavioral health. what does that entail? well, it entails a-a few things in all of the different levels of services that samhsa offers under behavioral health. in the prevention area, we're looking at what services are we going to fund, what is fundable. now we're looking-what is going to be funded are the interventions, and that's not going to cover all the prevention services, so this screening and brief intervention that was discussed earlier, that is an opportunity for us to get coverage across the country. prevention services at the community level, which we can talk about later, doesn't need to be covered, so we're gonna-we can talk about how they relate. the electronic health records. electronic health records across the country will help us out enormously, and we're spending a lot of time working with cms and working with insurance companies and helping them understand how being connected will help stopping people from going to different doctors across state lines and such like that. we're also looking at helping to bring the community together and getting them engaged, so that they know that they can go and ask for services for substance abuse and mental health-to be able to be covered under their insurance companies from a state level, because although the federal government can fight and work for getting many of our services recognized at the level of federal government with insurance under aca, the real work is happening at the state and the communities. arthur, you were talking about some community efforts that need to take place. you want to expand on that? well, i think we've had what i call a black box approach to treatment and the issue of behavioral health conditions, which basically means we build a treatment black box in the community, we wait for people to recognize that they need help, and then passively, hopefully, people will come to treatment. that approach really doesn't work. well, i shouldn't say it doesn't work. it doesn't work as effectively as if we had a different paradigm, a paradigm that understood that what we have to do is to engage communities. we have to get out of sort of the treatment black box and look at how do we take a public health approach to this issue in the same way that we have with-with physical health conditions. most people know that if you wash your hands, you can save a lot of money just on health care costs because people don't get sick. well, there are things that we know from a behavioral health standpoint that if we do those things, people won't develop addictions or they won't develop mental health problems. and so, we have to put more emphasis on those kinds of things, and those things require us to have a different kind of relationship with the community. we need to be talking about the importance of addressing early childhood experiences in terms of trauma, for example. studies show that people who experience a lot of adverse childhood events are more likely to have a whole host of issues, including behavioral health conditions. and so if we can intervene early in those kinds of-in people's lives, it prevents people from developing problems later on. and john, you wanted to add some points related to- well, i was just thinking, you know, faces & voices of recovery has done a great job mobilizing the recovery community across the country, and what we're discovering, that things aren't equal across the country. granted, there's pockets of funding out there for treatment and nobody gets enough funding, but the recovery and support services, peer delivery recovery support services, they-they get hardly anything. and if you could throw a little bit of funds on those alone, remember, you've got 25 million americans in recovery. they're itching to get into the game. the 25 million americans that need recovery-it's almost as if there's an invisible barrier there to access these dollars to deliver these services to get this great outcome. so the recovery community has got to do a better job articulating their needs and how we're going to get there without offending everybody, and that's a delicate balancing act. it is a delicate balance, and that-that-that sort of public education, pat, i know you have some programs that promote, as john was saying, this-this particular perspective. right. all across the country people in recovery are engaged now as service providers, providing peer recovery support services, and one of the exciting opportunities with the implementation of the affordable care act is new roles in our health system for people in recovery. so, for example, if we want to encourage people to enroll in health reform to help people navigate this new system, there may be new-i think there will be new opportunities for people to be trained in these new roles. but also, that there's this growing network of innovative services that are helping people initiate the recovery, help people while they are receiving treatment to support their recovery, and then once they're back in the community, to connect with the other supports and resources that people need because, for recovery to happen in communities where it does happen, people also need access to housing, access to employment, access to other kinds of supports to help them sustain the recovery for the long haul. so our-our opportunity really as an organized recovery community is to advocate on behalf of an essential health benefit in the state of virginia that will reimburse for those peer recovery support services but also for a health system that connects individuals with other supports that they need in the community. which are much more cost effective than recidivism or relapse. absolutely. absolutely. you know, we're the best bang for the buck, but we can't even get a nickel, and-and sadly, we can't even get our own policymakers, our own bureaucrats. we can't even convince them to step up for us, so we've got some work to do in that area. i think john is right. i think that there are pockets. so in philadelphia, for example, my agency has spent a tremendous amount of resources in both helping to develop peer-based services and to deliver them, and in fact, in-in-in our case, i actually require that any new service that comes into our system build into its budget peers, because we know that people who have lived experience working in these programs are enormously effective at engaging people, keeping people connected to treatment, and, frankly, making treatment more effective. so i think that-i think that it is a-it is a varied kind of field now, but i think it needs to be more standardized and more acceptable across the board, but, you know, policymakers, i think if they're willing to be creative and willing to stretch out of the box, can do some things even within the current environment. it just takes a little political will to do it. and a good example of this is the growing network of recovery high schools and recovery programs in colleges, so thinking about the current situations in which young people find themselves who are in recovery from addiction, helping them recover at an early age. you know, pat, i must have been channeling to you because i just wanted to get to the youth part of this. i know most of what we've talked about in terms of peer recovery has been in the adult sector of-of the recovery community, and we really need to get, as we're talking about prevention and so on, talk about using young people in recovery, you know, for-for prevention purposes and-and to help educate the public. so indeed, you know, the recovery schools, the recovery programs, we've started, you know, with the young people in recovery, and-and they've done extremely, extremely well to create a presence. oh, and we have these videos on our website of young people in recovery. there's nothing more exciting than seeing a 20-year-old in recovery for 3 years, you know, who talks about their new life, and that's really what health reform's all about, that's really what talking about addiction and mental illness as a health condition is all about: helping people get help early and staying out of our criminal justice system. that's a great example right there. the recovery community has no barriers against youth. however, our systems are designed to have different protocols for different age limits, and that's just crazy. they've got to get wise in that area. well, the thing about this whole issue, and let's get back to-to the-the subject matter, which is really getting the message out, and i'm going to give each one of you, because we're almost running out of time, an opportunity to tell me who your top audience is and what would you tell them in terms of improving the communication about the aca, about our issues. you get one shot at this, and i'm going to start with fran. from samhsa's point of view, our audience is america. we don't have subsets of america to look to, so i-i will collect them-bring them all together. collaboration is the key. if you hear about messaging that will-everything we've been talking about is about messaging. and we-if you could see-this is not a sprint. this a marathon. this is going to take us years to do. but we have to get ready, and to get ready, we need to begin to help collaborate from the federal government where our role can be to help the states and the communities collaborate together. youth, peers, young people that are-are in our recovery and are going to be peers, they-they're far better and their reach is much more when connected with a prevention program. that prevention program can fair far better when connected with a treatment program or the families of treatment that are supporting someone in long-term-in treatment before they get into long-term recovery. and then, lastly, we need to be having a collaborative relationship with insurance companies, with health care companies, with all different programs that we've already mentioned because we-we need to begin to have america talk about addictions and mental health issues around the thanksgiving table just like they do about cancer and heart disease and diabetes. arthur? and i want to take off on-on the last point because i-i think that that is a great analogy for what we have to do. if you think about breast cancer, for example, 30, 40 years ago people whispered the-the words, right? people didn't talk about it. today, people, you know, wear pink. i think many, probably thousands of people have been saved. their lives have been saved because of the awareness about that. we have a-a lot of resources that are going into-to both prevention and treatment and so forth. i think-our-my goal is to have the same thing happen in-in terms of behavioral health conditions. when one out of five, one out of four people are affected by a condition, that is a lot of people, and if you're talking about mental illness, for example, that's what the numbers are. if you look at addiction, again, you have a large segment of the population that are affected by these conditions. if we can get the broader community to understand both the impact and the importance in the same way that we have with cancer, i think we can make a huge amount of difference, and that's what our goal is. that's why the recovery walk is so important to us. it's raising people's awareness-why we're doing things like online screening and so forth, because it's raising people's awareness in a way that-that mobilizes the community around this issue. very good. thank you, pat? our target audience is the recovery community, people in recovery and family members, and the message is that recovery is a reality, and, following up on what arthur said, it's to educate the public and others that people can and do recover, so that's our first message. our second message is to come together and organize and mobilize to influence public policy, because that's really where the rubber hits the road in terms of making sure, for example, that essential health benefits include peer recovery support services. so that's our message. john? you know, the authentic recovery community has got to take responsibility for their future. you cannot keep relying on other organization, groups, agencies to find in our lives our recovery and our future. so our responsibility is step up, be heard, be accurate in our description of what we need, how we want to do it. collaboration is important, but we have got to have our rightful place and funding for this. you know, we have got to stop being scared, fearful, shameful, get out of those basements, get up, get on the first floor, and be part of this thing. and, indeed, we want to remind our audience that recovery month , this is a particularly good time to take all these messages that we've heard in this show and to really bring them home to policymakers, elected officials, and everyone who needs to be engaged in our field of mental and substance use disorder recovery. and for that, we encourage you to go recoverymonth.gov and get engaged, get involved, not only in september, but throughout the year. thank you. it's been a great show. for a copy of this program or other programs in the road to recovery series, call samhsa at 1-800-662-help, or order online at recoverymonth.gov and click on the video radio web tab. every september, national recovery month provides an opportunity for communities like yours to raise awareness of substance use and mental health problems to highlight the effectiveness of treatment and that people can and do recover. in order to help you plan events and activities, in commemoration of this year's recovery month observance, the free online recovery month kit offers ideas, materials, and tools for planning, organizing, and realizing an event or outreach campaign that matches your goals and resources. to obtain an electronic copy of this year's recovery month kit and gain access to other free publications and materials related to recovery issues, visit the recovery month website at www.recoverymonth.gov or call 1-800-662-help. [music] >> thank you for your patience. i m leader pelosi's district >> thank you for your patience.