June 10, 2013

Although mental and substance use disorders (SUDs) are usually mentioned in the same breath in the federal government, mental health took on a heightened meaning after last year’s shootings at Sandy Hook Elementary School in Connecticut. The result was a White House document, “Now Is the Time: The President’s plan to protect our children and our communities by reducing gun violence.” That document, released in January, included budget increases for some mental health initiatives, among other things (see ADAW, February 18). And it led to the six-hour National Conference on Mental Health, held at the White House June 3.

However, the only person at the meeting who spoke about Newtown was Vice President Joe Biden, said Bob Weiner, former press officer for the Office of National Drug Control Policy and a media analyst who was at the meeting. “Nobody talked about ‘Now Is the Time,’” Weiner told ADAW. “The president didn’t mention it, [Secretary of the Department of Health Kathleen] Sebelius didn’t mention it,” he said. “It’s frustrating that nothing else got done after Newtown.”

“What I did sense was that everyone was glad to have the opportunity for the conference, regardless of the reason for it,” said Weiner. “Speaker after speaker talked about coming out of the shadows and ending stigma, and many people said the same applies to substance abuse.”

One focus of the meeting was the announcement of a National Dialogue on Mental Health, which many organizations have agreed to support, said Pamela Greenberg, president and CEO of the Association for Behavioral Health and Wellness, who participated in the conference on June 3. “Some will only stay focused on mental health, like the National Association of Broadcasters,” she said. “But other organizations, in whatever way they participate, will bring up substance use disorders.”

In fact, the national dialogue is “not really about the people who already have an illness and have talked openly about it,” said Greenberg. “It’s about the people who are afraid to seek help and are afraid to talk about it.” The same concept applies to substance use disorders, said Greenberg.

The meeting was mainly about mental health, but “the important issue of addiction was added to the conversation, particularly co-occurring conditions,” said Paolo del Vecchio, director of the Center for Mental Health Services at the Substance Abuse and Mental Health Services Administration. Jeffrey Lieberman, M.D., president of the American Psychiatric Association, spoke at length about the importance of including substance use screening at mental health visits, added del Vecchio.

Parity

There was a lot of grumbling about the lack of a final rule on parity, but former Congressman Patrick Kennedy pressed the issue the hardest. When Sebelius said the federal government wanted to wait so parity would match the timing and implementation of the Affordable Care Act, Kennedy’s response was that this delay would just give the insurance companies a chance to delay on their own.

“I always feel as if substance abuse is a poor stepchild,” said Weiner. Neither parity nor SUDs would have received much consideration at this meeting “if it wasn’t for Patrick Kennedy, and the fact that Biden and Obama paid enormous attention to him,” he said.

Connecting gun violence and Newtown to mental illness has been a delicate public relations problem for mental health groups. On the one hand, they are glad for the attention and new funding. On the other, they are distressed that the public wants to link mental illness with violence, saying that the mentally ill are no more likely to be violent than the rest of the population (and there is no evidence that the shooter in Newtown was mentally ill). The background check issue — the comment period on a proposed rule on background checks closed last week — is particularly troubling to advocates for patients. That, in addition to the administration’s failure to get Congress to do anything this spring about guns, may be why the meeting did not pick up on the main theme from “Now Is the Time.”

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