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Sebelius: Time for a national dialogue about mental health

April 10, 2013
by Shannon Brys, Associate Editor
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Recognizing that 2013 marks this 50th anniversary of JFK signing the Mental Health Act, Kathleen Sebelius, Secretary of Health and Human Services (HHS), reminisced about the progress that has been made in the behavioral healthcare field over the past 50 years, as well as the challenges yet to come. Sebelius, who spoke at the plenary session this morning at the National Council conference, says that over the past 50 years, slowly but surely attitudes toward mental illness and addiction have begun to change.

Despite great progress, Sebelius said that today 60% of people with mental health conditions and nearly 90% of people with substance use disorders still don’t get the care they need.  

She spoke about two ways the nation can move forward to change the landscape of mental health: Reforming the healthcare system and spurring national dialogue about mental health.

Reforming the healthcare system

Sebelius recognized that for many years the healthcare system left many Americans with behavioral health problems uninsured and underinsured. In the past, nearly one in five individuals purchasing insurance didn’t have access to mental health services and nearly a third had no coverage at all for substance abuse disorder services, she explained.

“Before the federal parity laws, it was totally permissible for insurance plans to treat these disorders differently, offering less treatment or more critical oversight for those conditions compared to medical and surgical benefits,” Sebelius explained. “So we had an egregious double standard that allowed insurance plans to cover a sprained ankle, while ignoring a serious illness such as schizophrenia.”

But now, with the implementation of two historic laws—the Mental Health Parity and Addiction Equity Act—she says “we’re closing the gaps in mental health coverage.”

The Mental Health Parity and Addiction Equity Act ensures that mental health is covered on par with physical health. She said that President Obama is committed to issuing the final rule on the law this year and also that they are working on that currently. This federal law is now combined with the Affordable Care Act and ensures that Americans have access to mental health coverage and that their behavioral health benefits and the federal parity will be joined together in the new insurance policy.

“Those two acts together changed the landscape of mental health and substance abuse disorders forever,” she expressed.

Spurring national dialogue on mental health

Regarding this expansion, the first big expansion in access to coverage since Medicare and Medicaid were passed in 1965, a key message of the speech and challenge to providers: “Just because people have access to new coverage, doesn’t mean they know about it or they’ll get signed up, and that’s especially true for young adults,” she explained.

Sebelius stressed the importance of creating a culture in America where individuals can talk openly about any mental illness or addiction they might suffer from, so they can get the proper care they need. If we can’t create such a culture, “all of the health reform will do no good,” she said.

She illustrated an example of a person walking down the sidewalk and encountering a person having a heart attack. The instinct in this case, she says, would be to rush in to help.  However, if that same person is walking down the sidewalk and is confronted with someone in the midst of a psychotic or major depressive disorder, the reaction is to not make eye contact, and/or turn the other way.

She says many Americans often fail to recognize mental illness and substance abuse disorders as serious health conditions. Instead, the conditions are seen as social problems such as homelessness, juvenile justice issues or social welfare concerns.

“Now this is true not just for strangers, but often for our own loved ones. Too often we fail to offer support and we blame the person with the illness,” Sebelius stated.

“We can’t just change laws and policies, we need to change hearts and minds,” she added.

Investments in mental health

Sebelius also talked about President Obama’s new budget that will be unveiled tomorrow. Part of this budget, she said, makes a critical $160 million investment in HHS for programs that will be used to make a difference in this field. Among the investments she discussed were the following:

·        A critical addition to the mental health workforce.  She said funds will be invested to train more than 5,000 mental health professionals who will work to serve young people and advance new state based strategies to prevent young people “at the critical transition age of 16-24 with mental health problems, from falling through the cracks when they leave home.”

·        Project AWARE. This project seeks to train teachers and other adults to detect and respond to signs of mental illness. That could reach an additional 750,000 people throughout the country, she said. Project AWARE also includes investments for Mental Health First Aid.

·        CDC’s (US Centers for Disease Control and Prevention) proposed research on causes of gun violence and effective strategies to prevent future tragedies. The research would also aim to help students dealing with trauma and the anxieties that are the result of school-based violence and violence throughout their communities. “Research is such a critical part of this puzzle,” Sebelius stated.

She believes that in order to keep moving forward, the conversation that began after Newtown needs to be expanded. President Obama and Vice President Biden have asked Secretary of Education, Arne Duncan, and Sebelius to take the initiative and launch a national dialogue on mental health.