Transcripts For CSPAN2 White House Mental Health Summit Part

Why is in crisis half of the description clicks because 11 million americans upwards of 4 million are receiving no treatment to their lives lost to psychosis untreated serious Mental Illness represents a huge and unnecessary loss of human potential. It also makes our more dire social mission such as random acts of violence and sheltered homelessness Substance Abuse, and the disturbing rise of the rate of suicide i want to emphasize these problems are exacerbated not by serious Mental Illness but exacerbated by serious Mental Illness. Todays historic conversation draws broadly on the expertise of people from many disciplines and experiences and perspectives our goal is to put on the table a robust set of reforms how we go about delivering treatment to persons with serious Mental Illness. The Trump Administration has already begun the process of rebuilding our treatment system this very week the president will sign fiscal year 2020 appropriations bill that makes important in the improvement of the treatment of those suffering from serious Mental Illness. It includes 120 milliondollar increase in the substance Health Administration provides 200 million for Certified Community Health Centers to provide comprehensive services to those suffering from Mental Illness and provides 125 million from project aware that help schools and Community Organizations and First Responders and others to identify Mental Health issues and help those affected get the treatment that they need 19 million from outpatient treatment from criminal and juvenile Justice Programs it with those mental ill individuals away from the criminal Justice System and into more appropriate treatment venues. And it includes 7 million for assertive evidencebased practice where multidisciplinary teams with Personalized Care these funds are just a down payment on what will hopefully be a much larger reform that we will identify and discuss today there is much more work that needs to be done. To start us off in our conversation we have with us this morning doctor drew pinsky i can think of no person better able to explain to us how we got into this situation we are currently in order to describe the price we pay as a society for failing to treat persons suffering from serious Mental Illness. You know doctor true one drew from his career in Radio Television including celebrity rehab on vh1 series chronicling celebrities struggle for sobriety also rehab that follow the experiences of everyday people battling addiction. Also the author of several books including putting broken lives back together again all the while pursuing this very successful media career he maintained an active medical practice belongs to both the board of internal medicine and the american board of addiction medicine and for many years assistant clinical professor of psychiatry at school of medicine and holds professorships with departments of medicine and pediatric and adolescent medicine. Plus doctor drew has served for over two decades as a medical director for Chemical Dependency Services and the hospital psychiatric facility in pasaden pasadena. But i think his greatest and most endearing characteristic is his habit of telling the truth just as he sees it so welcome doctor drew to the stage to kick us off in our conversation thank you. [applause] thank you very much. I am sure my directness makes people uncomfortable and nervous but well see if we can have at it it is such a privilege to be here you have no idea how excited i am. I am just one physician just one doctors perspective on the history over the last as an internist and then to take care of because it was a mess in there for 30 years with Brain Disorders the way that like you were treating heart conditions but it get sick like every other organ but then much to my chagrin the last ten years i have watched the entire system unravel and dk to the point i wake up every day upset immobilized concerned, freaked out and i want to share with you a little bit about the history of how we got here. Theres a lot yet to be said that if we dont pray this with an understanding of what mistakes we have made we will miss the big picture. Relying heavily on the text of doctor toris book he said very coyly a few minutes ago he said yes we made a couple of mistakes and yes mistakes were made so we become falsified in laws and practices between 50 and 60 years old so i will take you to this brief history. 1945 a young psychiatrist name to felix to have the Prestigious National government to redirect priorities non elected official and this one man and the initiative picks up from world war ii because of the Service System testified Mental Illness is the greatest cause of loss of manpower and it became clear in testimony that amongst the men rejected , 18 percent were rejected because of Mental Illness 14 because of mental retardation at that time other Neurological Disorders 30 percent due to mental disability and that was eyeopening at the time it was the first time a government had that data confronted with that data. Congress proposed a national Mental Health plan. With neuropsychiatric disorders and for other purposes this is doctor felix mean job he is a psychiatrist that showed up in 1945 and said champion in the bill i wanted and broad language but there is literally nothing i cant do a nonelected official running around our government changing the name to national Mental Health because he wanted to carefully steer this away from anything about Mental Illness because at the time the idea of Mental Illness was something that was stigmatized and growing consensus which was bizarre that institutions created Mental Illness and caused Mental Illness. Imagined that. Cosponsored by a young senator of john Kennedy Felix was aware his sister had Mental Illness and he began plotting and figuring out a way to use president kennedy for his and. In the history of rosemary is sad not entirely clear what she had whether a psychotic illness or Substance Abuse that she was behaving badly and the kennedys needed it to stop. Joe kennedy at the time consulted throughout the land for the greatest psychiatrist available and they suggested they pursue the breakthrough treatment at the time was a frontal lobotomy but of course the consequence change this woman permanently and i would say that i have heard the matriarch of the family felt worse about this that even the assassination of her sons killing the individual as we knew her because of bad behavior. The commissioners report was an ideological document when it came out and i hope the take away from a lecture today is that when clinicians and politicians and scientists develop a position that becomes more theological than scientifi scientific, run. It is always a disaster. In addition to the decay of the Mental Health Delivery System in the middle of the Opioid Epidemic i saw what happened when peak pain became the sign in pain controls whatever the patient says it is they declared themselves a white hat profession to save poor people from pain as somebody who was objecting being killed now that joint commission with the department of Mental Health and state medical societies were on board that i was threatened constantly with retribution from various administrative organizations not filling out the happy side signs in the middle of a call those vital signs they were always unhappy they were within drug withdrawal but if i didnt make it in that moment i was literally in danger of criminal prosecution for patient abuse for an adequate treatment of pain. If you dont think there were prosecutions did not send shockwaves through my profession thats why we send everybody to Pain Management it was no longer malpractice it was criminalized. Beware when clinicians and politicians and scientists develop theology and dont remain objective and scientific. So this is a theological document primarily the following statements and recommendations were beyond remedy this was a one or 200 year series of developments. The future services should be community Mental Health service centers. Do not get me wrong im not out dating those Community Health centers as interpreted it was mental Health Centers designed to prevent Mental Health problems but not use the word illness preventing Mental Health issues is something they had no idea what to do i would dare say we have little ability to do it today but almost no directive toward the treatment of psychiatric illness in the outpatient setting and the federal government would participate and i would share with you that is a massive departure a nonelected official a professional board shifting to the state and in previous years to be proposed to president pierce to deliver the Mental Health delivery a provision of the constitution the state should be managing this properly left to the state and counties. Much like president kennedy appointed Mental Health for this and along the same time which promised the medicalization of psychiatric illness. He was assisted with two psychiatrist one who would succeed felix as director of the nih. And one of those incarnations grew out of the opiate center and it was very interesting plate but there were accesses so we have from 1946 through 1970 the Mental Health policy was dominated by three physicians and those with custodial care one summer in a Colorado State hospital for the chronically mentally ill and then trained as a pediatrician and briefly visited a couple of State Hospitals in massachusetts he was at the federal Narcotics Treatment Center not a place for the chronically mentally elbow they could go as opposed to prison as an Opiate Addict and sent to the object and literally never set foot in a State Hospital and they were charged with resources to be maintained by the state for hundreds of years at the same time our culture had run amok published in 61 the illness did not exist dare i say felix adopted this as a philosophy arguing Mental Illness was the institutionalization one flew over the cuckoos nest 1962 came around robert the Us Interagency Council allowed me to use his rhetoric for one flew over the cuckoos nest they thought they were watching a documentary they were watching a fictionalized account a movie about an Imaginary Institution and then scenes like publication with the sane and insane places these are the boundary problems that were going all the time he took students and pretended to be patients to go into a hospital the whole thing maybe not the whole thing but there were narrative excesses and it is the equivalent of medical students to vomit blood and criticize the er staff light criticizing for having a g. I. Bleed. Literally thats what they did. Im moderately upset about all this. [laughter] president kennedy signed legislation of the state Mental Hospital onto the course of extinction that was the purpose however no plan on what to do with the discharge patients no plan for dealing with the resistant care patients we told you that legislation was focused on prevention and the evidence at that time showed that it made things worse so we have the imd exclusion a continued massive effect of custodial care needs i call on this administratio administration, please there is something there to make a massive difference so because there was no resources and no plan the patients were pouring out of the State Hospital by the hundreds of thousands going to nursing homes, prisons, the streets and death those with a four potential outcomes. And at the same time the grounds for the treatment of the mentally ill the need for treatment prior the need for care the group of physicians there were accesses as a result im not defending the need for care but overnight from need for care to harm self or other for the justification to bring somebody with a serious illness into the hospital overnight there is a giant distance we can close a little bit. Seventytwo the only justification the aclus should be nothing less than the abolition of involuntary hospitalization thats like saying when my patients become in distress the oxygen saturation levels are below 80 we cannot involuntarily do anything with that patient because they didnt tell me they want it. And of course fiscally conservative state governments are not so happy with this civil rights are very happy no clinical judgment represented this group and we talk about millions of people and finally because of Community Mental Health Centers that were inadequately funded i would say the entire structure and philosophy was flawed finally close the centers and block grant the money back to the states as an abject failure. And quoting from doctor toris book appropriately summarized with the knowledge 100 years to achieve maximum size precipitous attempt to move into settings that did not exist must be seen as incompetent at best and criminal at worst. Know what we are up against in addition to this history which was ill advised is now a series of laws put in place like in california the act which affords no consistency in treatment this is a task force that suggested untreated Mental Illness is a leader to the system and city streets are the open air asylum with people with Mental Illness are brutally victimized and i. The act maintains the silent genocide on our streets if you are so severely mentally ill that you can be held against your will and that requires only the most severe states of psychosis and say i will kill myself or somebody else and and up in the er and on the 72 hour hold then say four hours later i thought better of you can answer the new non the next two questions do you have food give a place to live than thats it youre out no treatment. No assessment no ability to determine probabilities of future success you can just go. The idea is that these are so right to outweigh the evident need for treatment and families are left desperate i work with state senators in california who have gone up with family please let us help our homeless loved one we have doctors in bed and money and places to live and sleep and eat help us get them home so we can treat them and we are told by sacramento to take a hike. Who do you think you are . . There is resources for these people and they are dying of three a day in the l. A. County area. To my friends and colleagues and representatives in california what does the body count need to be before you give up crazy ideas like building for walls to treat Mental Illness this is the current policy we are pursuing in california if we just have housing it will and 60 through 85 percent of the patients are resistant a vast majority have serious Mental Illness and drug addiction and for walls will not do anything you they even go when i was working with the board of supervisor touting he put out a bag of showers i said how did that work out he said on average it took 14 contacts to get one person into one shower. Its a Mental Illness its a serious condition. At its core it is the symptom we are managing that is a deficit of selfawareness the person with a disability is unaware having it first named by the famous astrologist the babinski sign which you are doing is a narrow exam that the very first thing you are taught about. To characterize the term these clinicians eat all the time in a stroke somebody has a right cortical stroke the left side goes out and the patient doesnt know it literally you can show the patient your hand it flops over the same develops in dementia we rush and we would be considered inhuman not to rush in they dont have insight into whats happening encephalopathy stay with stay away from you dont want help but if that evolves in the psychiatric illness to get them from dying and manic psychosis it is the same biology and other brain conditions but people are dying what does the body count need to be before we will try something a little different yes there were accesses for the need for care they were maniacs they were taking it out of their shirtsleeves and doing lobotomies i took care of those patients 30 years later trust me it was a mess it is not a good form of treatment. They were underfunded and understaffed and to allow them to happen some better understanding o