There is no time like now to begin the work of this committee. We are badly in need of a fresh examination of how we treat serious mental illness in America.
As Prepared for Delivery
Thank you for that introduction, Assistant Secretary [Elinore McCance-Katz].
Good morning, and thank you all for joining us here today.
Thank you to Secretary [Ben] Carson for coming to this meeting—a wonderful demonstration of President Trump and this administration’s commitment to the challenge of serious mental illness in America.
It’s always nice to have another surgeon in the room, too.
Thank you to all the members of the committee, from both inside and outside the federal government, for making a significant commitment to this important effort.
We also want to thank Kana Enomoto for her work as acting administrator of SAMHSA, and everyone at SAMHSA who has helped select and convene this committee.
There is no time like now to begin the work of this committee. We are badly in need of a fresh examination of how we treat serious mental illness in America.
It is well-timed because we have already identified serious mental illness as one of the Department’s top three clinical priorities, alongside childhood obesity and the opioid crisis.
Each of our priorities presents a complicated challenge, one where our policies are coming up short, and one where real progress would be a truly meaningful victory for the health and well-being of Americans.
In thinking about why we are here, and why we have made serious mental illness a top priority, there are three numbers I want you to keep in your mind: 10 million, 10 years, 10 times. Ten, ten, ten.
10 million:
According to the latest data from SAMHSA, 10 million Americans in a given year live with a serious mental illness.
As you know, that is defined as a diagnosable mental illness of sufficient duration, resulting in serious functional impairment that interferes with or limits one or more major life activities.
This term most often means schizophrenia, bipolar disorder and/or severe depression.
So many of these 10 million Americans are, quite simply, being failed by the system and policies we have today: One-third of them received no mental health care at all in the last year.
This is like letting one-third of Americans with cancer or diabetes go without treatment.
Those who get treatment too often receive it inconsistently or incompletely— far from the standard of care we would demand for other serious diseases.
The consequences are simply devastating, to those 10 million, and to the families who love them and the communities they enrich.
Here is the second number I want you to keep in mind: 10 years.
What does 10 years mean? SAMHSA estimates that Americans with serious mental illness are estimated to live lives that are eight to 10 years shorter than the broader population.
By some estimates—including by Joe Parks, whom we have here on this committee—that number, depending on how you measure it, may be higher, as much as 25 years.
That is a tremendous amount of suffering—suffering that we know how to prevent.
The diseases we are discussing today are, for now, incurable. But they are treatable, and with the knowledge we have today, recovery is the expectation.
As a physician, it is just so incredibly frustrating to see a health condition that we know how to treat go untreated.
Letting a serious mental illness go untreated has devastating consequences: not just shorter life spans, but lives often stricken with the inability to hold down a job, to maintain friendships, to display the affection we all feel for our loved ones.
Here’s the third number to keep in mind: 10 times.
According to one report, 10 times more Americans with serious mental illness are in prison than in psychiatric hospitals—about 350,000, by one count. What a striking depiction of how we have deprived so many Americans of the treatment they need, and the tragic consequences it has had.
We replaced an imperfect and sometimes cruel system of institutionalization with a system that is in many cases even more cruel—and failed to equip families and healthcare providers with what they need to fix it.
We could run through a raft of other statistics: the rates of terrible mental and physical comorbidities Americans with serious mental illness have, the share of Americans with serious mental illness who face homelessness.
But you know the situation. One of the major problems is that not enough of the rest of America does.
In too many places, this is truly a silent epidemic. For a while, people have referred to another one of the Department’s clinical priorities, America’s crisis of opioid addiction as a “silent epidemic.”
Thanks to the hard work of many, including many members of America’s behavioral health community, that is less true today than it was a few years ago—the suffering caused by opioid addiction is better and better known, although we have so far to go in our battle against it.
Americans with serious mental illness, however, have struggled in relative silence for decades now.
But it’s not for lack of trying by those who have suffered themselves or faced the challenge within their families.
So many of you here today have done so much work to raise awareness about the challenges of serious mental illness.
One of them is Pete Earley, whose book, entitled “Crazy”, helped educate me about this issue.
Pete, thank you for being here today, for representing the perspective of a parent who has helped a child through the struggles of schizophrenia.
You never look at the issue of mental health and how we run our mental health system the same way again after you read a book like Pete’s.
And you never look at it the same way after you’ve had a personal brush with the issue.
Dear friends of ours years ago had a son, Charles, who, like Pete’s son, struggled with schizophrenia.
Despite herculean efforts by this young man’s parents, he didn’t receive the treatment he needed, and his condition worsened and worsened, spending long periods of time homeless.
One morning, he decided that he was going to set out and kill his father. And he did.
Our system failed Charles and his family. Our society failed Charles and his family.
We are deeply committed to understanding how and why we have failed people like Charles and Pete’s family.
That is going to require not just raising awareness, but defeating the prejudice and apathy that weaken the way we treat this issue.
It also means understanding why our policies and practices have been failing, and replacing them with better ones.
An important player in that process is going to be Dr. Elinore McCance-Katz.
Introducing Dr. McCance-Katz
The old line in Washington goes that personnel is policy.
I think it’s safe to say we are all heartened by what that portends for President Trump’s decision to name Dr. McCance-Katz America’s first Assistant Secretary for Mental Health and Substance Use.
Can we give Dr. McCance-Katz a warm welcome to her new position?
The assistant secretary position was created by the same legislation that spawned this committee, the 21st Century Cures Act.
This is not the first commission ever convened by a president to consider the problem of serious mental illness in America: You remember President Jimmy Carter’s Commission on Mental Health, the New Freedom Commission under President George W. Bush.
But it is the first standing committee created to address this topic, required to report to Congress on the federal government’s handling of serious mental illness.
And it will have the chance to work hand-in-hand with Dr. McCance-Katz, who will bring a new level of authority to this issue, along with her own deep level of experience and expertise.
She brings experience at the federal level, serving as chief medical officer of SAMHSA; at the state level, serving as the Chief Medical Officer for the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals; and in the world of academia and psychiatry, most recently as a professor of psychiatry and human behavior at Brown University.
In fact, she is the first psychiatrist to be appointed to run SAMHSA.
She will be charged with working across our Department, and across the federal government, so that Americans with serious mental illness receive the highest standard of care we can offer them, care that is deeply informed by our knowledge of science and medicine.
Charge to ISMICC: We need a better sense of why we are failing to treat Americans with serious mental illness
We are big fans of Dr. McCance-Katz, but she cannot do this all on her own. That is where the rest of you come in.
You bring a wonderful range of expertise to the challenge before us—some from your personal lives, some from your professional experience, and some from both.
You have an understanding of the myriad issues that intersect with serious mental illness: the unique ways these diseases interact with physical health, the special risk they represent for America’s veterans, the ways they can interfere with holding down a steady job, the challenges these illnesses can present for law enforcement.
Your charge is threefold:
- Reporting on the advances we are making in treatment, recovery and prevention for serious mental illnesses. There has been steady progress in our understanding of these diseases over the past several decades, but much remains unknown, and we must let the very best science be our guide.
- Providing a rigorous assessment of where we are in this fight. Are Americans who struggle with these diseases living longer, healthier, more productive lives? Are they receiving the treatment they need, rather than ending up on the streets or behind bars?
- Making specific recommendations about policy reforms that can produce better treatment outcomes for Americans with these diseases. If our policies and practices need improving—and I think we can all agree they do—how can we fix them?
Dr. McCance-Katz is going to talk more in a little bit about specific questions we hope this committee will take up.
Your work product will be an invaluable resource to our department as we pursue three particular goals for the challenge of serious mental illness:
- Expanding evidence-based prevention, detection, and intervention, including more effective early treatment of psychosis, as well as aggressive work on suicide prevention.
- Improving the quality of care in all settings, both in-patient and community-based, by supporting the integration of mental and physical health and expanding our capacity to offer treatment.
- Improving outcomes for all Americans struggling with these diseases, by helping them find rewarding work and a stable place in their community.
All of these efforts have to go well beyond the parts of this Department that have traditionally dealt with mental illness.
The direct funding for mental health programming from SAMHSA, while crucial to connecting many Americans to treatment they need, pales in comparison to the scale of behavioral health services already paid for through CMS and private insurers.
Yet, mental healthcare—in particular for serious mental illness—still does not receive the emphasis and the resources it needs.
In part, that will come not just through provision of more healthcare services, but also more holistic treatment, a true continuum of care that makes sense for each patient.
That will involve a rigorous assessment of what we can do in in-patient and out-patient settings—where can we best serve Americans suffering from serious mental illness, at a sustainable cost, in a way that recognizes their dignity? What can we do to support families who provide day-to-day care?
Part of these inquiries will involve listening to people on the front lines: families, local government officials, healthcare providers. All of you here today bring not just your own valuable perspectives, but broad networks built over a lifetime of dedication to this cause.
Conclusion: We are optimistic about what we can do about this problem
We have set forth some tough questions for you—you have quite a challenge.
I’m an eternal optimist, and I suspect most of you are, too. It takes one to do the work you do.
We are joined by a number of staff members from SAMHSA today. Judging by their vision statement, they are optimists too.
Here’s their vision: “Behavioral health is essential to health. Prevention works. Treatment is effective. People recover.”
We here in this room all agree on that vision.
A lack of attention to serious mental illness has done grievous damage to America’s health, to millions of Americans’ lives.
But treatment is effective. People recover.
Optimists like to dream, and I want you all to dream a bit: Dream of a country where we treat serious mental illness with the same expertise and commitment that we treat cancer or heart disease. Where individuals and families facing serious mental illness feel no shame in their struggle, but receive the sympathy, support and love they need.
Love is going to be the motivating force in making that dream a reality.
Love of neighbor is what drives doctors to care for their patients; love of kin is what drives family members to do anything to get a child, a sibling or a spouse the care they need.
If our policies, and the work of this committee, can contain one-tenth of the love, compassion and commitment that I have seen in the work you have already done, the stories you have told, this endeavor will be a success.
Thanks for your service and commitment. Thanks also to Dr. McCance-Katz for her compassionate, clear-eyed approach she brings to this work. She will chair the rest of the meeting.
