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Highlights of the 25th Carter Center Mental Health Symposium

December 15, 2009
by Ronald W. Manderscheid, PhD, Executive Director, NACBHDD
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The former first lady’s symposium identifies three key concerns for the future

On Nov. 5 and 6, I had the honor of participating in the 25th Anniversary Mental Health Symposium, hosted by former first lady Rosalynn Carter at the Carter Center in Atlanta. This anniversary was also a signal opportunity for the group to honor Mrs. Carter for more than 35 years of dedicated leadership to the mental health field. The festivities were highlighted by a letter from current first lady Michelle Obama, who thanked Mrs. Carter on behalf of all Americans and reviewed her most important accomplishments. More than 200 leaders from the field were in attendance, and, for the second year, an additional audience of more than 250 participated via a webinar program. Archived presentations can be viewed athttp://www.cartercenter.org/health/mental_health/symposium2009-archives1.html.

We all owe Mrs. Carter a tremendous debt for keeping the dream alive over an entire generation and ensuring that the cause has endured for improved mental healthcare. Thank you ever so much, Mrs. Carter! We all love you.

This quarter century landmark Symposium also served as an opportunity to look intensely into the future. The first keynote speaker, Ken Thorpe of Emory University, set the tone with a fundamental challenge: Chronic care costs 75 cents out of every healthcare dollar we spend in the United States, since more than half of all Americans suffer from one or more chronic illnesses. Mental health and substance use conditions are implicated in virtually all of these chronic diseases. Hence, we must be concerned that mental health and substance use conditions are addressed when other chronic illnesses are treated. At the same time, an urgent need exists to develop prevention tools to delay the onset of all of these diseases. National health reform must confront this urgent challenge.

The balance of the Symposium focused on how to achieve important advances in mental health and substance use care. Three current national concerns were each discussed by a speaker and a panel: the Health Home; Comparative Effectiveness; and Health IT. Each area requires urgent action by us as we enter the era of National Health Reform. The Health Home was described by Larry Green, a primary care physician and national leader from the University of Colorado. Simply put, the Health Home can help us overcome the fragmentation that currently exists between behavioral healthcare and primary care. It can also help consumers identify the right home: a behavioral health home for those with serious conditions and a primary health home for others.

Innovation will be required if the health home is also to have the capability to address disease prevention and health promotion. The national Comparative Effectiveness Research (CER) initiative was described by Carolyn Clancy, the Administrator of the Agency for Healthcare Research and Quality (AHRQ). (CER determines the relative effectiveness of particular interventions in light of their respective costs.) This initiative, promoted by President Obama himself, is needed to improve care quality while controlling cost. In the mental health and substance use fields, we will need consumer and family input on priorities and “practice based” evidence, and we will need to build appropriate infrastructure to undertake the research, translation, and implementation needed to take advantage of all that CER offers.

Rob Kolodner, the former Director of the HHS Office of the National Coordinator (ONC) described the promise of Health IT. Although it is not commonly recognized, Health IT is essential for both clinical work with individual consumers and broader interventions with populations. Currently, we are at the cusp, or tipping point, of broad based implementation of electronic health records, personal health records, and decision support tools. Behavioral healthcare must be part of this innovation.

Participants were organized into six breakout groups for more intensive discussion of the action steps necessary to realize the promise described by the speakers and panels. These breakouts addressed care for cultural and ethnic minorities; care for children and adolescents; workforce development; financing; population health and prevention; and research.

The final hour of the Symposium was devoted to an overview of these action steps. In a few short weeks, participants will receive a summary of the steps so that they can begin to implement them. In the future, we look forward to Mrs. Carter’s continued leadership of the field and to the very important work being undertaken by the Carter Center Mental Health Program. Finally, I have an important inside tip: Look for a significant new book on mental healthcare by Mrs. Carter early in 2010.

Photo Credit: Annemarie Poyo/The Carter Center

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