Transcripts For CSPAN Manhattan Institute - Mental Health 20171229

Institute. Welcome to todays symposium on the state of treatment of americas mentally ill. Were pleased and honored to have with us to distinguished authors. Their current books on Mental Illness are shaping public discussion. Also, the assistant secretary for Mental Health and Substance Abuse its. She is playing a key role in shaping public policy. The is worth pointing out that the question of the right role for government into supporting the care and treatment of the mentally ill is one that has long vexed us as a nation. Consider the case of the educator who in the 1930s began presenceresidents prisons. Sadly and tragically, the same can be said about the situation today. Even as the population of the Rikers Island jail here in new york city as declined, the percentage of the population that is mentally ill there has increased. Knowould be distressed to that the atlantic referred to Cook County Jail and chicago as largest Mental Health hospital. Americans who suffer from conditions such as schizophrenia have no access to help. Many can be found on sidewalks not far from the building in which we are meeting this morning. How did this situation come to be . What is it like for the families of the mentally ill when they seek help . What steps should government take . What policies should rethink . These questions will be at the heart of our discussion. Will hear first from authors dj earle theirter discussion will be moderated byy. Erin billups. She also hosts the weekly city help beat program. For those unfamiliar with new york one, it is the most serious news cast here. First, to introduce dj jaffe, billups. Ley, and erin i am here to introduce to authors whose own personal family circumstances have opened their eyes and their passion to advocate for those with Mental Health illnesses. Your book was a 2007 Pulitzer Prize finalist. He is currently a member of the National Alliance on Mental Illness. Jaffe is the executive director of a think tank. He has also served on the board and is a regular contributor to the huffington post. , i would, if you can love for you to share your personal experience that has propelled you into your advocacy work. Thank you so much. It is nice to see so many familiar faces. My story begins, my son was a College Student here in new york. I found out that he was having a psychotic breakdown. I raced to new york from fairfax county, virginia. I discovered that he had been wandering around for five days. He had barely slept and had hardly eaten. I took him to fairfax. On that for our ride, he would cry when minute, then left the next. I begged him to take medication. He had been diagnosed as bipolar one year earlier. He asked me how i would feel if he killed himself. I took him to the emergency room. We did not have a psychiatrist. We sat there for hours. He finally said he had enough. I literally grabbed a doctor, tracked him into the room, he came in with his hands up and said, im sorry i cannot help you. You have been in this room for four hours. Your son has told us that he does not want medication. Bring him back after he tries to kill you or somebody else. I took him home. He slipped out of my house. He broke into a strangers house to take a bubble bath. He was charged with two felonies , breaking and entering, and destruction of property. He became one of the thousands of people with serious mental onus that part sitting in our it jails and prisons. , i spent 10hat months in the miami jail following people with Mental Illnesses through the system. I went to miami because Rikers Island said no. Cook county said no. No,angeles twin towers said they would not let me in. The judge down there let me in. That is why i got involved in the system. I cannot get my son help. Wrote my book, five hospitalizations later, i called up the mental crisis team. I said come look at my son. They ask him is he dangerous . One night he became violent and i called. They asked, is he dangerous or violence violence . The police came and shot my son aice with eight taser taser. They hauled him away. And the 80s, my wife and i became guardian for her sister. We thought that if she came to new york and lived with us, that would solve all of her problems. Day, we, during the would sit around the dinner table and she would spew out this barrage of uncontrollable gibberish. Ive never heard Something Like that from someone i loved. We hear her screaming at night. They were voices only she could hear. Which right to get her into treatment, but she did not think she was sick. She thought she was the messiah. She thought everybody else had a problem. Eventually we were able to get her into treatment, but they would not tell us what was wrong with her, or what her next appointment was, because they wanted to protect her privacy. Toause the system wanted protect her privacy, we did not know when her next doctor appointment was. We didnt know what prescription she needed. We cannot assist in monitoring her treatment. We kept going through this cycle. That kind of led me to realize how horrific the system was. Ive been involved in a love nonprofits a lot of nonprofits. I came to learn that a lot of what we are told about Mental Health is simply not true. That is what i wrote a book on. Can you talk about what you to as a possible solution end this constant stream of those with serious Mental Illness and turned the criminal Justice System . Yes. First i want to say that the outcome is, my son is ok and doing well. When you are talking about Mental Health you have to divide the groups. Housing first, giving them a place to live is the first cornerstone. You cant get better if youre living under a bridge. The Community Treatment team kenexa person with people that care about them. We know from the left logic in los angeles that they have an 80 recovery rate. They did people jobs get people jobs. People with Mental Health what what we all want. They want a safe place to live, a purpose in their life, and somebody to love them. It is that simple. We create all these barriers to keep people from getting these services. Dj jaffe i think that supervised housing and not necessarily permanent housing first. My sister and a lot lived in a group home. Whatany years, that is taught her the skills to live independently. They put her in an dependent living one time, and she failed. The thesis of my book is that we have to understand that 100 of the population can have their wellness improved. There are 4 who are seriously and persistently mentally ill. We tend to focus the bulk of our resources on the least symptomatic. As a result, criminal justice is running a shadow Mental Health system for those who refuse services by the Mental Health system. Erin billups what are your feelings on the push for more. Mentors . Peer wouldfe the question is, someone two somebody providing support . What that same support provided by a professional, a Family Member, a member of the community, be as effective as that provided be a. There has been zero research on that. On some cases it works really well. Within the leadership, there is an antimedication and antitreatment bias. The leaders of the peers support community and new york have worked to close more hospitals, oppose something we have called kendras law, they have supported making it easier for the seriously mentally ill to get guns. It has had a negative affect on the system. There is no doubt that being a peers supporter is very helpful. You have a sense of wellness. You are getting a paycheck. Peers support is clearly beneficial. That ng having someone who has been there is extremely helpful. Dualo found that it is a street. You have ap or that has social connectivity with someone. One of the biggest ways to help people get engaged in their own treatment is to have them help someone else. My son was really five hospitalizations. We get into this argument all the time where we say, if we just give People Services then they will get better. My son had a house, he had people who cared about him. It was not enough. You need all of this, in my opinion. The question is, how do you get that individual to want to engage in his own treatment . One of the things that encourages me is that the test comes from the addiction world. This is probably a much larger problem there than it is with Mental Health. I asked my son. The things that got him to want to change for fear change punishment, his brother said that he cannot see his niece. Of being acceptance sick. That is very hard and our society for somebody to admit that they have a Mental Illness. I believe you need all of these tools. There is just no one single answer. Agree withs do you the direction that mr. Jaffe says . That all of the resources are being taken away from the mentally ill . Pete earley when you go down to miami, youll discover that pete earley went to a clinic today. One person could have 52 records. There is no continuity. There is no personal relationship. You are already isolated. We focus on the frequent utilizers. ,hey eat up all of the services they are stuck in the revolving door. Sure. J is a saying is we have broadened Mental Health. These people are easier to help. We tend to go, lets have this program, and this program, and that program. Nobody wants to help these people, and that is why they are in jail. It is obvious we are not helping people. If you look at the numbers, community programs, they only accept voluntary patients. There is a chart in my book where i document the number of hospitals circa 1960. I forgot what the number was, 500,000. And then the number incarcerated, and then i compare that number two today. The totals are the exact same. We just moved the mentally ill out of the institutions and into the jails. In the Mental Health system, we tend to the reports on, how are the people in the Mental Health system doing . Majority of the most seriously mentally ill are not in that system. They are in the corrections system. The statistics are undeniable, that we not focusing on the most seriously ill. Pete earley what shocked me was knew thee People Programs better than i did. They knew what to say. They knew all of that stuff, but we still were not engaging them. Youve got to get them engaged in their own treatment. Of people with schizophrenia cannot be helped no matter what we do. What do you do with those folks . Where do they end up . They end up in jails and prisons. Erin billups there is also the issue of the shortage of Mental Health professionals to support this community. There is a need for a. Workforce there is a need for a peer workforce. People would say that there are support. For peer it is clear that ,hose who are providing everyone who provides peer support gives the statistics showing how great the programs are working. I reviewed all the literature. There is no literature that compares the delivery of peer support with the delivery of service with something else. Erin billups what needs to be done to create more support within Mental Health professionals to address the needs of the seriously mentally ill . All of my working out is focused on criminal justice. There somebody from the Citys Department of Public Safety here. It is because the Mental Health system has offloaded the most seriously ill to the criminal Justice System, it is the criminal Justice System that is running a shadow Mental Health system. They are the ones interested in solving this problem. If you ask somebody in corrections what do we need to solve the problem . Morewill instantly say hospitals, we have to keep the people in a longer until they are stabilized, we need to be able to put them into mandated and monitored treatment in the community. Asked that same question to somebody in the Mental Health industry. They will say that we have to educate the public, and the stigma. They are going to propose things that are totally irrelevant to the elephant in the room. There are 90,000 seriously mentally people in new york city who received zero treatment and the past year in the past year. This is who we are not focusing on and that is the issue. Pete earley if you want to improve the delivery of Psychiatric Services to people who are seriously mentally ill, then you need to start paying for those services. Parity has been turned into almost a joke, when it comes to actually had seven son psychiatrists. Only two bothered to learn more than his name and symptoms. Treating the mind also requires treating the heart. You cannot do it that way. It is also important to understand that throwing more money at Mental Health is not the same as treating the seriously ill. Dj jaffe when i was growing yingblinged was not bull was not a part of Mental Health. Every social Service Problem is been wrapped in a Mental Health narrative. Mental health funds are diverted to it. Until we focus on the most seriously mentally ill, more money is not necessarily the answer. It certainly has not been so far. Pete earley i will agree with you on that. The funds are not being focused on those who can deliver those services. Erin billups i would love to hear from you guys about the. Urrent Opioid Crisis people with bipolar disorder have drug and alcohol problems, some of them. Im not an expert on the open your crisis. I know that 99 of the people in problems. Ail had that does not necessarily address the Opioid Crisis. Jumping on that one. We have finally figured out that addictionsth menta and are combined. Bothffe people with disorders are the least likely. O get into care if somebody needs marriage counseling and the other is a mentally ill, opioid user, the person with marriage counseling is going to go in. Erin billups wed like to take a few questions from the audience. The thesis that is put out there is only someone compared to the addition of the same Services Provided by anyone and then i want to see, does it improve a meaningful metric. Everything in the world that makes you smile. Show somebody a picture of a cat and theyll smile so that is now evidence baseed to improve Mental Health it made you smile but what we should look at is what programs are improving meaningful metrics. Metrics are homelessness, arrest and incarceration and victimization. I would like to see research on all programs that do that. I can tell you this. The 21st century security act created an interdepartment mental agency and were drafting a report right now and everything is about this. Creating sidewalks and studies of what separates the chatter from what really is working so hopefully that will report. The problem here is that with some things. Whether its Global Warming or als. You know nothing is going to happen until theres greater acknowledgement or understanding. People talk about access or capacity. Theres not providers. But the how do we get traction to influence whole policy wholesale vamping not just to provide it but to actually then ensure quality. Irs i want to stymie this flood. We look at outcomes for those within the system and were youre talking about as the Bush Commission forward assist tell thats not much of a system if you take your kid to the emergency room they can wait todays before they see anything. We dont. Our system is broken even if you want help trying to get into it is nearly impossible that goes back to one of my pet peeves thats civil commitment that has to do with dangerousness and waiting for someone. We have to implement a system to help people before they get to stage four that leads them to jails or prisons. We do have time for one more questio question. Police chief. Retired 40 years of Law Enforcement and current chairman of the committee on severe Mental Illness for new york city. I have a daughter so heres the peer support as Law Enforcement and Police Officer we are seeing the same people come in and us responded to ten times a month for the same person in and out if there is not time to stabilize them theyre never going to get the housing or to any of that. Until we do something with that small percentage cycling in and out and it takes an aggressive approach to have something to break that cycle but its not going to happen with a 72hour commitment. It takes more time than that for the medication to become effective. The problem is first and goes backwards and its Pretty Simple to identify that problem. Thank you so much and we have one more. Hi corporation for supportive housing. Im wondering you can speak to the effectiveness of Mental Health court . I have been in Mental Health court matthew is here and he runs the brooklyn Mental Health court and i get a little choked up because i went to his court and he let me sent in the witness box if someone is arrested and they have to a certain level of crime in the d. A. They can take them to his court and he can order them to stay in treatment for x amount of time and if they do that the charges are dropped and he brings them in every week and gets report from brilliant social workers. And he graduates and gives them a thing that says they graduate and its terrific. Heres the problem. He does after a crime is committed what we should be doing before the crime is committed so for instance we have a law in new york that is identical to mental ending around the country called assisted lauras law. Bakers act in florida allowing judges to order a person with his try of violence and incarceration duing to not stay on treatment to stay on treatment while they live in the community. Its brilliant. This one of the things that the Peer Community is Work Together see we dont get more of yet they will have demonstrations saying well we got to train the police to do better. We have to recognize violence. Psychiatric unit are locked and nurses were buttons and were training officers to go on Mental Illness calls. These for people that go to mental ill court that dont have to. I want to jump real quick. What happen is a tragedy and we say we have to train the police and we have crisis intervention and then problemsolving courts everywhere but virginia. We think were giving everybody a break and theyre fantastic and we have sequential inter set model thats identifying people in jails and prisons and corporation that is pews program thats a great getting people out of jail. The problem goes back to what d. J. Is saying you have to energy thor the criminal Justice System. I was in alabama and theyre saying best thing to happen is you get arrested. Thats wrong. What i disagree partly with my good friend is all these things are great but the judge will tell you if you dont have any place to send anybody it doesnt work. You have to have housing and you have to have treatment and services otherwise youre just churning through the system. We have to end the conversation there. Thank you gentlemen and thank you all for listening. Thank you to d. J. And erin billups and the book insane consequences how the Mental Illness industry fails the mentally ill. Pick it up on amazon. Really important book. Now we do have an expert on opioid addiction and somebody in a position to move the system who has traction who is in a position to influence and improve some of the terrible stories that we just heard. Doctor or the eleanor is the first and shes the first person over in the hold a position of the assistant secretary for Mental Health and Substance Abuse and leads the Services Administration in the department of health and human services. Most Mental Health services are administered at the state and local level but the acronym for the agency she leads defines programs to find out what really does work and guidance for systems around the country. Its the leading edge of improving our national Mental Illness treatment regimen. Shes a graduate of the unity of connecticut and is a distinguished fellow of the academy of addiction and 25 years as a clinitian and Clinical Researcher and most recently the Rhode Island State Department of Behavioral Healthcare and her own work focuses on opioid addiction thats so much of our National Conversation right now. Join me in welcoming doctor eleanor mccancekatz. Perhaps this is a set issue. President trump said opioid addition National Public health emergency. Tell me how that came to be and why particular ly opioid addiction and Substance Abuse is housed under the same umbrella as Mental Illness . Well, last part first. The Substance Abuse and Mental Health Services Administration addresses issues related to Behavioral Health. Mental illnesses including Substance Use disorders and those are Mental Illnesses effect behavior and so thats how that came to be housed in one agency. The president yesterday recognized through the declaration of Public Health emergency signed into effect by our acting secretary, the gravity of the situation with the widespread tragedy of the Opioid Epidemic however i think its really important to say our administration has been working very hard on the Opioid Epidemic since the election and since the president got into office and i mean by that a couple of things came to be known. It was our administration that put those resources into play. We have expanded the treatment of opioid use disorders across this country through funding that is, we call the state targeted response and we work closely with the states to help them to provide medication assisted treatment and psychosocial treatment standard care for the use disorder as well as Prevention Services particularly around widespread distribution of antidote to opioid overdose and training of first responders. We have a big investment in that area and have had for some time prior to the announcement yesterday. And we also are focusing on Recovery Services including peer Recovery Services to assist people recovering from these very serious opioid addictions. Yesterday in making that announcement, we will continue to expand what were doing and it allows us the administration to work collaboratively with congress to bring more resources to bear and so thats the direction that the president has taken. Let me ask you a slightly more blunt question. That draws on your own experience in psychiatry. Can people recover from opioid addiction and how does it happen . Definitely people can recover from opioid addiction. Ive been treated it since 1990 and ive seen many hundreds probably thousands of people recover. One of the things that can be difficult is that people often see the worse part of the disease before its treated and what they dont see is the kinds of evidence based practices that are available to help people get their lives back and we have three fda approved medications all of which have been shown to be quite useful in helping people to get into what we call recovery and get on with Productive Lives so injectable meds. Methadone and there products have all been shown to in the context of getting appropriate Psychosocial Services help people to stop to break the cycle of addiction and move on with their lives. Having seen this for so many years youre not pessimistic. Well, i will say this. This is a very, very serious problem which is why the president took the action he took yesterday. We fully recognize this. We see the heroin supply contaminated frequently with fentanyl and it can be hard to revive somebody that has taken a heroin product thats contaminateed with those high doses of opioids so it will take a while before this problem gets better which is why its so important to continue the work that weve already started and been working so hard on. The issue though is if we can expand treatment and evidence based treatment, too often people in our country get to and this is what we were talking about. They get to services that dont provide all of the evidence based interventions that we know work and when that happens they dont get the recovery that they could otherwise, so the work of my administration of the Substance Abuse and Mental Health Services Administration that work of our agency will be to help to better establish nationally these evidence based practices because we to think that people can recover if these get these services and thats how you reduce demand. Get people in recovery and help them to get on with their lives and that will take time but we know how to do it. Let me pivot then to the questions about the treatment of the seriously mentally ill who can of course include opioid addicts and thats the nature of your discussion. As i said previously within a few blocks of where we are in midtown manhattan you can find lots of people literally living on the streets with all of their belongings. Let me ask another nieve question. How the heck did that happen . So i think that unfortunately for many years, there has been an emphasis on reducing State Hospital beds and resources that previously were available to the very seriously mentally ill. And that was concurrent with the advent of new medications and im talking now back to the 60s and 50s when we first started seeing the development of antipsychotic medications that i presume, i was very young back then but i presume looks like miracle drugs. And so coincident with the development of those types of medications and the acknowledgement that State Hospitals had really deteriorated in quality to the point that they were not places that anyone should be there was a push to put people into communities, unfortunately the treatment didnt follow the release of all these folks into communities and thats continued. We havent made the kinds of investments that need to be made in community Mental Health services to help people get the care and treatment they need and to be able to live in their communities. So what would a system former Police Commissioner referenced earlier saying we need places to take people. What would that system look like if we were able to go out on the street here and invite somebody, if you will into a world of engaged treatment. What would that system look like thats absent now . Yeah. So theres a lot of work to be done and ill try to cover as much as i can. So the way things work right now. Some of this was just discussed in terms of the criminalization of the seriously mentally ill. There is a need to really reshape how we provider is vices in the Community Related to the treatment of mental disorders and what i mean by that is, right now, as d. J. Said its very easy to treat the people who are not as seriously ill in favor of knowing and in fairness to Community Providers these folks often present problems of such gravity they dont have resources in their Community Health centers to provide the care needed and they know once a person entered the Legal Systems theres compulsory treatment that will be done. Thats the retail of the system we live in so how do we think about that differently . We need to develop models that can accommodate people and with serious Mental Illness and focus on the most seriously ill. We have a model that has just been funded, Substance Abuse administration that we call the certified behavioral community center. What these do is they bringing to all of the types of Psychosocial Services and medication that people with serious Mental Illness will need to get their own recoverys in place and those, they also include Addiction Services and i also think that we should have physical Health Services available there as well and well be trying to work on that as we move those models forward but the idea would be that a person could come to one place. We have a very fragmented system. If you have an addiction model you go to one part of town and you have a Mental Health problem you go to another part of town and maybe you dont know where to go because you cant figure it out when your brain is not working correctly. These places would have act teams and mobile outreach. Forensic sort of Community Treatments. Associated with them as well as onsite providers. And the other thing that needs to happen and ive actually talked to mr. Rosenthal about this the other thing that i think doesnt happen that i hope we can get to happen is that theres a false dichotomy between the medical treatment of serious Mental Illness and the recovery. These are not separate things. This is a continuum and an individual who gets all of these resources will do best. Now what, so where im going with the cchbcs is the payment for services there is bundled. We know that works for our Community Health centers so the who dell on the physical health side is to have a bundled payment. Thats the money that comes from washington that pays for service . Correct and by that, its a per person and then any service they need. You kind of get paid for making People Better as opposed getting the different funds. Exactly. So were using this model and were going to follow it for a few years and we hope that we actually hope well be able to establish this kind of a model permanently because we know from the Community Health center side this has worked nicely. The models and the key were thats what your agency does is set up a model we hope will eventually change the situation around the country. Should that model include. It used to be we had a large system of locked mental asylums across the country. Families that were at their wits end because they had relatives living with them they considered dangerous and to have them committed. That whole system is wiped away. Should we in part reinvent that to have asylum to be part of our possible services . Yes, so what im trying to talk about here is the spectrum of services needed starting with the heart of services which i think i see as communitybased services and i believe that people have the right to live in communities. I believe that communitys can best meet the needs of their people and that we need to build around that to make it, to remake our current Mental Health system. We should not be relying on jails and prisons to provide what is minimal if any treatment to the seriously mentally ill so to answer your question. I see this as a whole spectrum of services. So do we need State Hospital beds . Absolutely. There is a minority but a definite significant number of people who simply have such severe illness that they cannot live independently. I ran the State Hospital system in rhode island for two years before coming to my present position and i can tell you that there are people that regardless of our current approaches cannot benefit and they need to be cared for and they need to be protected. So i see the State Hospital system as that kind of respite and we need more Crisis Intervention Services. I dont think hospital emergency room departments are places for the mentally ill. Theyre not equipped to take care of these. When we talk about people not agreeing to treatment or having ability to verbalize consent for treatment part of that has to do with what we were talking about with the lack of engagement. If you see a patient in the Emergency Department you will know what i mean. Its not a place for someone having problems with thinking and is frightened to be able to get the help they need where as we have models for Crisis Intervention Service wheres we can bring people that are experiencing exacerbations of symptoms and people that know how to work with folks that are experiencing that. Thats what they do for a living. Where we can have peers and other types of healthcare supporters that can often help people to avoid hospitalization. There will be people that need hospitalization and we need adequate number of acute care bed but we also need from those to, case wheres we cannot get People Better, we need to be able to make use of State Hospital beds. Right now in many states, m maybe all state as Care Hospitals are often compelled to keep people that theyre no longer being paid for and insurance has stopped because we have these odd definitions of what constitutes need for hospitalization and thats usually based on acute danger or suicide or homicide and as soon as that end this want to stop paying for services when the standard needs to be what has been that persons history and what services do they need and that we must have time to get into place before we release them. People that dont get beter are stuck often in acute Care Hospitals with those not Getting Compensation because we dont have enough. They cant make room for more people that do need services from which they can benefit. And so in the State Hospitals, we have people i can tell you in my own hospital in rhode island we have people who were ready to go back to communities and the only reason they were in the hospital was because we couldnt find a Community Bed for them. Place for them to be because as pete said, you have to have housing. You cant put people on the street. Its inhumane. So we had people that the only reason they were there was because we couldnt find a group home bed for them so im talking about Crisis Service and Community Behavioral health centers. Acute care beds and then you also have to have other levels of care so step down units. Group homes. Super viced apartments so that people can fully recover and get on with their life. Great to see that federal administrator can spit out an organizational chart just like that. You said we need to protect the serious mentally ill some of whom would have to be in State Hospital beds. Do we need to be protected from them . People who get treatment for their serious Mental Illness can recover. They can go on and be productive citizens and they hold jobs. You might not even know who has a serious Mental Illness if theyre getting treatment. No we dont need to be protected from them. We need to be protected if someone has an out of control Mental Illness thats not treated that can be dangerous absolutely. But if people get access to the care and treatment and Recovery Service they need. Absolutely not. To the untreated, do they pose a threat to themselves and others. Would the dialogue that ensues after the horrible Mass Shootings that weve seen far too many of in the United States is follows. Gun control on one hand. Mental Health Services on the other. Without asking you to wade into the swamp of gun control. Thank you. Is it appropriate to think about some of those who have been engaged in those situations as indicators of our failure to provide Mental Health services . Of course. Of course as a failure because the vast majority of folks we can treat and get back into healthy lives in community and its a failure and we need to do better. Just to put a clear spin on it. Its possible Virginia Tech could have been prevented. You believe that . I believe that its possible to have a supported set of communities. Will be ever able to intervene 100 of the time before theres a tragedy, of course not but i do think without speaking to a specific case, i do think that we know how to identify the symptoms of a developing serious Mental Illness. We have studies going on that nih and others are involved with looking at the symptoms and we know some of the genetic vulnerabilities looking at family history. So we could know how to focus on and thats what we need to do. We need to focus on people who we can identify as high risk. So its interesting to hear how optimistic that the services are provided that things can get better . I absolutely believe that. But i will tell you one other thing and i wanted to be able to speak about this before we end our discussion and that is, while we can discuss the now way of providing care we cant do it without provideds and we have severe share contagiouses. Psychiatry is one of the oldest. Unfortunately were getting older and we only turnout about 1200 psychiatrists from residencies every year. One of the things i want the talk about is how to bring more Health Professionals into the field. More residency slots and more for addiction and we also need other Behavioral Health providers so i see Nurse Practitioners and physician assistance and advance practice clinicians as extremely important to getting people the care and treatment that they need. I think that psychologys are extraordinarily important to being able to help to focus the appropriate therapies and Psychosocial Services. Social workers. Peers and i do think we should develop appear professional workforce and i hope that will happen during my time and i hope that we can bring those peers and other who is are provideing Community Support closer. So theres Better Community and seamless sets of services. But our system again is so fragmented and you have had this argument about medical treatment verses recovery. Recovery includes medical treatment. Most people with severe Mental Illnesses cant get to recovery without medical treatment. On the other hand they cant be successful if they dont get the other services. Ill call that a call to arms for young people watching to consider the field of psychology and psychiatry and social work and related. I really hope we can bring more young people in because i think theyre the key. One last question. We heard pete talk about the difficulty he had and dj mentioned the difficulty in tracking the needs. Penetrating the veil of appointments of privacy laws, not being able to shepherd your son or daughter or Family Member through the system because youre not supposed to be involved. Does that privacy veil need to be changed . Amended. Adjusted . Yeah, so this is something that the president spoke about before he was elected and has been an issue for his Administration Since the time he became president so ive only started a couple of months ago but one of the first things i became involved in was this whole exploration were doing in the administration of current privacy laws both hippa. Health insurance excellent. Just repeat so it people can hear it. Health privacy and patient affordability act. Yeah. So look it up on google. So basically hippa is our privacy laws and we have tighter confidentiality for people in Substance Abuse treatment we call that 4 2cfr. I wont ask you what that stands for. Thank you. The administration has been looking at this and there will be guidance coming out soon. I think theres some misunderstanding of the current laws. There is the ability under hippa to communicate with families when a person is judged incapacitated theyre done so by their Mental Illness theres ability to speak with families a thats not wellknown at all. Families ill say my own view of the world is that families are maybe the most important part of a persons recovery. Theyre who the person grew up with and would be with Going Forward. Those for people that love and care for these folks. Thank you. And most, so what the federal government does drop in the bucket really. Its important we put as much dollars into these but the fact is families provide the care and that is the value of that is not calculatedly approached. So family have to be involved in these loved ones and there waist to do this under hipa. Similarly were looking at issues around the confidentiality statutes for Substance Abuse disorders but this is a high priority to make it possible for families to be able to tell clinitians whats going on and to get information back. When you think about it if you have someone who comes into an acute care setting and they have been suicidal and their Treatment Team has provided treatment and theyre ready to discharge them from the hospital and you cant talk to a family about what are the treatments that are being given. What are the continuing risks and how they should address those risks . Should they observe them . This makes no sense so we have to do things differently and as i said this has been a priority for this Administration Since the time the president came into office. Well i guess from that applause that you just received this is an audience thats very engaged and may have some questions so lets turn to the audience. Wow. Please look in the microphone and tell us who you are and ill start with this gentlemen at the right at the front table. Thank you and my name is javier and Leap Institute university of new york. Quick question. Access is not enough. Engagement i think is vital and i heard you say that in so many words and i heard pete say that so i want to get to my question about engagement but i also want to just thank you for your comment about the peier peer movement. Thats my experience as a Clinical Research sore heres my question. You talked about the need to reshape how we provider is vices to the seriously mentally ill and reshape the models of how we provider is vices and im wondering would that include models that educate all Service Providers and i think based on our discussion Family Members. Peers, people in the Justice System and Law Enforcement, educate them both about the very common problem, beat you said some people dont understand the ill but the research is clear about 50 of all patients with by polar and schizophrenia not even understand that they are ill. Top predictor of nonadherence. Do we educate family about that problem and most importantly evidence based models that help those providers engage people like d. J. s sisterinlaw. Petes son. My brother. I have a son who i cant get his medical records and hes 17 and i cant get his medical records. If i can interpret that meaning anybody that might interact with somebody thats mentally ill should have some sense of what that Mental Illness is perhaps expanding familiarity in medical schools and Police Academys is that practical and does it make sense in i think it is practical and i certainly think it makes sense. You know we do have to prioritize what we do in terms of education and training for everyone from School Children to Health Professionals to Law Enforcement and to anyone, so you will always see that there will be a conflict between how much time can you spend on the various requirement but when we look at the prevalence of Substance Use and mental disorders i dont see how anyone can say that we should not prioritize providing education and information to all of these groups that will interact with folks. Go into the health stop maybe we want to make sure those doctors know enough to say you shouldnt be here, you should be here. Correct. And one of the other big initiatives of samsa and other federal agencies integration of care so bringing Behavioral Healthcare into primary Healthcare Organizations and primary care into Behavioral Health programs and cross training. So if a guy on the street goes in for a flu shot maybe theyll be able to offer him more services. I dont know. I should have, pretty quick inter action. Lets make this a real lightning round. Hard stop at 10 30 because shes part of a the cabinet to announce the approach to the administration taking on opioid addiction. Yes, the, thats you. Thank you for calling me young. For ten years ive run a Child Welfare organization in new york city and ive been looking for addiction models are for a biological parents whos kids have been removed. I recently met with nyu and the college of nursing because im looking at Nurse Practitioners and they said that the most effective recovery is for people who are using opioids because there is the medication and its much harder to treat alcoholism, et cetera. How do you deal with the stigma of going back to someone saying, well theres a substitute drug when as a society we think people should be off everything because ive been in encountering that. So this is a matter of again making people aware that giving people medications youre talking about medications for op opioid addiction and those like methadone and so people need to understand that taking an opioid therapy for additionc not addiction. Heres what addiction is. When you get physically dependant on a short acting opioid your life is controlled by getting it, using it and being intoxicated briefly and starting to feel with withdraw and then going out and getting that next dose and whatever you have to do to prevent you from going into painful withdraw. When you give a medication like methadone thats a once a day drug that helps to stabilize you so you can get on with your life and then you can take care of your family and have a job and i challenge anyone to identify those folks thereat well stabilizeed so this is one of those big issues that we need to really educate the public about. Yes. The woman in white there in the back. Hi im from new jersey a large social Service Organization and i was wondering how you propose were going to pay for the increase in psychiatrists and social workers and all the Additional Services needed when medicaid is cut and insurance reimbursement is lacking to say the least and most people arent even covered . Well what i would say is those negotiations go on between congress and the president. We dont know what thats going to look like but i would advocate and do advocate for putting resources we need into insurance resources that will provide care and treatment for Behavioral Health and i dont mean just medical treatment but the sigh, Psychosocial Services. I hope thats going to be addressed when i was going through the process of confirmation i was able to meet with lots of senators and i can tell you that they are very committed to this and very interested in this, in a way that ive never heard of in my times an an adult in working in the field so this is a different kind of time and we do have all the tools we need because we have a president and administration that also supports Behavioral Healthcare so im hoping that will be addressed in a positive way. We also have party laws. Tell people what that means . It means if you have insurance that provides for Services Related to Substance Abuse and Mental Illness disorders they need to be on par with physical Healthcare Services so thats been in place with for a number of years. And our administration is focusing on trying to get attention to the enforcement of party laws and so we have a website where consumers who have had problems can be shepherded to the appropriate agency but we will look to enforce those laws. Let me make that question even harder if you dont mind. Are there things we should stop doing so to divert resources to the acute need we talked about this morning we need to take a hard look what is being funded right now and if they are not evidence based practices i would argue theres a question of why we should be paying for them. We know what works for example for opioid addiction. We know how to treat serious Mental Illness and thats inclusive of services that arent paid for so its going to go both ways and i dont know what the Additional Resources are that are needed but i do think we need to take a look at whats being paid for now and if we can become more efficient and make sure that people get these services that we know are effective how many more folks could we provide care and treatment to . Sounds like you will take a hard look at your own administration. Absolutely are. Great. Yes . Over here on the right . Tell us who you are and wait for the mic but you got it already. Im an to inand i am with an organization focused on Mental Health for black gay men and so the question i want to ask, congratulations on your appointment, its a three part question if you dont mind. Make it a quick three. One is, what is the federal government doing to address Mental Health for lgbt and people of color by extension. Second. We know that in medical schools around the country about 4 curriculum is spend on cultural competency including psychiatrists and psychologists. Whats the federal government going to do to increase quality cultural competency in medical institutions and the hold over from the Previous Panel the third kwae is what can the federal government do to ensure that Police Departments around the country are culturally sensitizeed to respond to calls for Mental Health crisis. Especially when it affects people of color . Thank you. So the issue of sensitivity to cultural differences is one that is important. At my agency we have the office of Behavorial Health equity and that office works across agencies to make sure to try to better make sure that individuals and organizations have access to the kinds of tools that are needed to in still cultural competency and thats an ongoing role at our agency. As far as care and treatment of people of color with mental and Substance Use disorder, this is part of every Funding Initiative that we have. We actually ask for plans from our grantees on how to ensure culturally sensitive care is provided and we review that so we are aware and we try to be sensitive to it and our office of Behavioral Health equity will continue to work on those issues Going Forward and as i say fanning out across other agencies to assist them as needed. Who would be a grantee such as that and what might they need to do that theyre not doing to reach people of color in communities and lgbt or people on the sidewalks that theyre not doing now to be culturally competent as you put it . So, we have training that we provide around issues of being sensitive. Really its more sensitive to be differences. Who would be in training . So our agency is a Services Agency and we award discretionary grants that provider is vices and those services will will involve individuals that provider is vices. Peers and others so we have training available to help people. Its really a major issue of being aware of differences and how to acknowledge, how to acknowledge were different from each other. So how can i best help you. One more and two if youre quick. The woman right there . Hi im jody and i direct an agency called collaborative support of new jersey and Elana Kravitz is part of your community so we appreciate the opportunity. So my agency we, like many colleagues of mine focus on the 4 of people coming directly out of State Hospitals that nobody wants to serve along with people coming out of jails and prisons and i really appreciate what you said about the whole continue yum of all of the supports from every aspect that you took and outlined but the question i have that we havent focus and lot on is the whole poverty and homelessness. Its hard to get to recover from Substance Abuse and Mental Health issues and all the things were talking about if you dont have a roof over your head. And ability to get out of poverty. I was wondering what your plans are or how youre focused on that . So returning to a life of poverty. That hits everybody. Whats the best way to help . So i think we all agree that housing is absolutely essential and secretary carson has actually talked about his review of what goes on inhousing and urban development and trying to make changes that will make it easier to provide housing for people in need and people with Behavorial Health issues. One of the roles that i have as a new assistant secretary is to work across agencies and so this will require us to really do an inventor of whats being done at a federal level right now and what can we do better. In fact the 21st century cure act requires that we put together something that a crow anymore means the partnership of individuals from the communities nationally and many stakeholders and federal partners and were in the process right now of under taking a review of federal programs and getting recommendations about how we can better serve americans with serious Mental Illness and looking at the kinds of issues. Not just treatment issues but also what are the other kinds of resources that are needed and what could we do better a the a federave a full answer but i can tell you that were working on it. That the people that are helping us nationally are very dedicated and they take this to the stakeholder groups so were getting volumes of feedback and we hope to bring that together and be able to then focus that on federal services and improve them. That sounds like an important body. What about housing . Do they get their own apartments or a ranch house somewhere . You said group home . Supportive housing with service . And that can take a number of forms but we dont have that many of them in this country right now. Its very difficult to get people. We need group homes that focus for example on certain types of disorders. Where you can bring people into Community Setting and there are people available that have Behavioral Health skills that focus on particular types of issues. We need group homes that can aid our transitional age youth. One thing that concerns me greatly is transitional age youth 18 to 25 aging out of the foster care system with Mental Health problems with substance problems and we dont have the resources in place, i can tell you this i have personal experience we dont have resources in place to make sure that these young people get the care and treatment they need and were seeing it on the national serve survey and increases and in 1825yearolds with serious depression and suicidal tendencies and increase in alcohol and drug use so this, these types of group homes and other types of communities Living Services need to be a focus and we need to expand access. Well be working on that and one of the things ive done is ive put together a special emphasis on transitional age youth so we can look what the needs are and start to address them. Im also very concerned about what i term a triple diagnosis of serious Mental Illness and Substance Use disorder and intellectual disability. We have so many people that have these very serious cooccurring conditions and we do not have services in place to help to maintain them into their communities. Sometimes they get into a State Hospital and its not the place for them but theres no other place and we need to do better. Thats another focus ill have with my agency and well be trying to bring in experts so we can start to get a handle on this. This is not been a traditional focus of the Substance Abuse and Mental Health Services Administration but its going to be. [applause] ill follow up. Well let her go to spread the word about the emergency of health. Thank you for your service. Thank you. [applause] cspans washington journal live every day with news and policy issues that impact you. Coming up this morning. Scholar, diplomat and author discusses social media and encountering violent extremism with his book Digital World war. Be sure to watch cspans washington journal live at 7 00 this morning. Join the discussion. Sunday a conversation with former director of National Intelligence. James clapper at the George Washington university. Here is a look. Yeah, there are times you do have to be tough with people. But byandlarge what i found in my 50 plus years in the intel business is people want to do the right thing. They want to do the mission and they want to do it well and they want to excel in it and you have to create an environment where that can happen. Leadership and intelligence ultimately is about motivating others to use their intellected and thats whats one of the great things about this. I sort of consider that kind of a leadership laboratory. Itll be in the book. But i thought i would mention it because in the context of leadership. Looking back i think one factor thats changed Intelligence Community. The thing thats changed it more than anything else looking back historically is technology. Its not, you know when we had traumas like 9 11 yes that had an impact. Reorganizations that i think are highly over rated. Yeah, but what is really historically changed business of intelligence is technology and i say that in the context of adversary technology. What are the adversaries doing and our own to cope with it . On sunday former director of National Intelligence James Clapper talks about his life and career in the Intelligence Community well show you that conversation from the George Washington university. Sunday at 6 30 eastern here on cspa cspan. Next a debate about the First Amendment and hate speech on College Campuses and online. The National Constitution center cohosted in chicago with the federal society and the american constitution society. This is an hour and 45 minutes. Ladies and gentlemen, welcome to the National Constitution center. I am Jeffery Rosen the president of the Constitution Center in philadelphia