Dear Member:

In my last letter, I shared my thoughts about the April 16, 2007 tragedy at Virginia Tech. I lamented our patchwork approach to public mental health services and the resulting fragmentation. And I suggested that we consider moving toward a cohesive national service system.

Some of you shared your views -- and we began a dialogue about the vacuum of leadership and what our potential role could be in assuring that those who are troubled get the care and help they need.

Since I wrote that letter, the government has released its report about Virginia Tech, making clear that government will not provide the leadership needed to solve the problems of our care systems. And so perhaps National Council members should, as one member wrote in response to my letter, "be working together (not to preserve our current world) but to redesign the system from a national perspective. Organizations like the National Council for Community Behavioral Healthcare could/should be the leader in this movement."

And perhaps incrementally and modestly we are. And so in my letter this month, I want to update you on National Council activities and initiatives that support member's leadership in four critical areas:

* Services to veterans
* Improving access to and retention in treatment
* Coordination of behavioral and primary healthcare
* Addictions and chronic medical conditions

Our efforts in these areas are designed to demonstrate to policy makers in Washington and across the nation that mental health and addictions community-based service organizations -- state, county, not-for-profit public or private -- not only play a vital role in our nation's healthcare, economy, and society but that we are leading the way. We are navigating change with a moral compass that reflects the guiding principle that unites all of our members regardless of auspice, a fierce commitment to improving the lives of our most vulnerable citizens.

Services to veterans

A June 2007 report from the Department of Defense Mental Health Task Force highlights the growing psychological problems that troops returning from Iraq and Afghanistan are experiencing. The report points out that nearly 50 percent of National Guard members and reservists report symptoms of mental disorders -- and many find it difficult to access military-provided clinical care and support groups. The Washington Post published a poignant series on veterans' mental health issues, that ran June 17 and 18, and highlighted the growing unmet need as more soldiers return from Iraq with severe psychological wounds.

Recent developments in our response to this growing crisis include:

*The National Council, in collaboration with Mental Health America is working tirelessly in Congress to shape and secure a $100 million appropriation to fund a mental health organization/VA partnership targeting mental health services for returning Operation Iraqi Freedom and Operation Enduring Freedom veterans.

* On May 16, 2007, I testified before the House Committee on Veterans Affairs, highlighting National Council members who are collaborating with local VA clinics. Read my full testimony.

* Senators Pete Domenici (R-NM), and Barack Obama (D-IL) introduced S. 38, the Veterans' Mental Health Outreach and Access Act of 2007. On June 12, Representatives Ciro Rodriguez (D-TX), Patrick Kennedy (D-RI), Steve Pearce (R-NM), and Albio Sires (D-NJ) introduced a companion bill in the House. The bills include all of the elements of the appropriations request the National Council and Mental Health America have been pursuing in Congress in recent months, including a provision requiring the Department of Veterans Affairs to fund service partnerships with community mental health and addictions agencies to expand access to mental health services for National Guard members and reservists living in rural America. We urge you to contact your Representatives and ask them to become co-sponsors of the Veterans Mental Health Outreach and Access Act (HR 2689).

*On May 25, 2007 President Bush signed a war supplemental spending bill. Included was an additional $100 million dollars for the Department of Veterans Affairs to expand mental health capacity through contracts. And the VA recently sent a memo to all of its Integrated Service Networks specifying that where VA medical centers and clinics don't have the capacity to meet the needs of veterans, they have the authority to use Mental Health Initiative Funding to support contracting.

*National Council members have already stepped up to the plate. Successful models of VA-community provider collaborations can be found in Montana, South Dakota, and Washington State. See the National Council's press release highlighting members' contributions at www.nccbh.org/WHO/Newsroom/6-25-07.htm. And don't miss the Mental Health Weekly (May 28, 2007) front page coverage on the work of the National Council and its members on veterans issues (www.nccbh.org/galleries/default-file/MHWeeklyMay25.pdf).

*The Sunday, May 27, San Antonio Express op-ed, "Form networks to assist military families" (www.mysanantonio.com/opinion/stories/
MYSA052707.04H.timboe.22e966f.html) is another successful example of National Council efforts to draw national media attention to the potential of our members to meet the mental health needs of veterans.

The time for you to help meet this urgent need is now. There is increased pressure on the VA to provide care expeditiously and owing largely to the efforts of the National Council there is an infusion of additional resources directed toward partnerships with community mental health and addictions service organizations. If you haven't already done so, the National Council urges you to pursue partnerships with the Veterans Administration medical centers in your region, offering to supplement their capacity to provide much-needed services to our returning veterans. And look for more information about the National Council member call on contracting with the VA, scheduled for July 19 at 1:00 pm.

Improving access and retention

National Council members are mission driven organizations that hold themselves to extremely high standards. We are committed to helping consumers get clinically needed treatment and all of our public policy efforts are directed toward increasing access to effective services.

We believe that change and recovery are possible and take place through healing relationships. But we know that beyond the primary barrier -- fiscal constraints -- improving treatment access, retention, and adherence are complex issues. This month's issue of Psychiatric Services reports that treatment adherence is vastly overstated by both practitioners and consumers. And we know that the potential of the healing relationship is affected by scheduling and multiple screenings; the skills of practitioners; and the organization's capacity to collect and use data to drive practice change.

In support of member organizations and the consumers they serve, the National Council is launching an Access and Retention Improvement Initiative, a year-long learning collaborative -- led by National Council consultants, David Lloyd, Scott Lloyd, and Randy Love of MTM Services, and Bill Schmelter -- that will involve four member organizations chosen through a competitive application process.

The collaborative -- based in part on the successes of IHI and NIATx -- gives participating organizations the performance improvement technology to improve access to care and reduce the poor outcomes associated with non-adherence to treatment while reducing revenue losses due to cancellations and no-show appointments.

All project costs, including conference calls, travel, and consultation time, are free to participants. Additionally, the National Council will provide participating sites with $5,000 to cover incidental expenses.

Member response to this initiative has been very positive and demand is very strong. It is our hope that the expected positive outcomes will enable us to offer a second phase of the initiative. I encourage you to learn more about the Access and Retention learning collaborative at www.nccbh.org/who/industry/access-retention.htm.

Access, adherence and retention are pivotal treatment issues. There are financial costs -- use of high-cost emergency and inpatient services. And more important, there are human costs -- family chaos, involuntary treatments, and even life and death.

A summary of the National Council's system recommendations to bridge tragic and costly gaps in care for people with serious mental illnesses transitioning from inpatient to community-based care are available at www.nccbh.org/WHO/Newsroom/COT-press_release.htm. We continue to work with other healthcare groups and the media to disseminate these guidelines and implement initiatives like our Access and Retention Learning Collaborative that improve continuity of care.

And most recently, the National Council released (see our press release at www.nccbh.org/WHO/Newsroom/Barriers-%20Press-Release.htm), the results of our survey that explored barriers interfering with treatment and the therapeutic alliance -- and found an additional barrier, alarmist advertising by attorneys soliciting cases related to anti-psychotic medications.

The survey and the results were featured on nearly 20 national and regional radio stations as well as by the Associated Press.

Behavioral and primary healthcare

The National Council continues to promote public understanding that freedom from mental illnesses and addictions is essential to general health. We provide leadership to public policy and practice efforts that focus on the whole health of individuals with mental illnesses and addictions. And we are a primary source of information, expertise, and lessons from the field on coordinating behavioral and primary healthcare.

Given this commitment, I am pleased to announce that the following eight National Council member organizations have been selected, through a competitive application process, to participate in Phase II of the National Council's Primary Care-Mental Health Collaborative Project. Under the National Council's guidance, these member sites will work with their local community health centers (listed in parens) to provide coordinated care of the highest quality.

* Austin Travis County Mental Health & Mental Retardation, TX
   (Community Care Services Department)
* Colorado West Regional Mental Health Inc., CO
   (Summit Community Care Clinic)
* Community Counseling Services, SD
   (Horizon Health Care, Inc.)
* Heritage Behavioral Health Center, IL
   (Community Health Improvement Center)
* Highline West Seattle Mental Health Center, WA
   (High Point Medical and Dental Clinic/Puget Sound Neighborhood Health Centers)
* LifeStream Behavioral Center, Inc., FL
   (Project Health, Inc., d/b/a Thomas E. Langley Medical Center)
* North Range Behavioral Health, CO
   (Sunrise Community Health, Inc.)
* Porter-Starke Services, Inc. IN
   (Hilltop Community Health Center, Inc)

The Primary Care-Mental Health Collaborative Project Phase II participants have access to over 50 hours of expert consultation time from National Council consultants, Jurgen Unutzer, Barbara Mauer, and Steven Vannoy; and participate in a national learning collaborative that utilizes rapid cycle quality improvement strategies. The National Council will disseminate the learnings from this project to all members.

Also note that in response to member demand for information about improving the health of consumers, we are hosting a Meet Me call on July 10th, "Making the Most of Health Screenings." More information is available at www.nccbh.org/SERVICE/meetmecall.htm.

Attention to addictions

The current issue of National Council Magazine is devoted to addictions services. You should receive your mailed copy in July and a PDF will soon be available on our website at http://www.nccbh.org/. This issue of the magazine reflects the National Council's increasing attention to addictions services and to our member organizations that provide those services; our view that freedom from addictions and mental illnesses is integral to overall health; and our belief that we can win the fight for parity only if the addictions and mental health advocacy communities fight together.

Addictions has come a long way from the days when it was perceived as a moral failure and lack of willpower. Today, there is growing public awareness and acceptance of addiction as a treatable disease. But there is a long way to go.

According to a June 7 analysis published by Health Affairs, employer-sponsored coverage for substance abuse treatment continues to have annual limits and lifetime caps on treatment visits and inpatient days and also requires higher cost sharing than coverage for general medical care. You can read more about this and other critical issues impacting addictions services in the National Council Magazine.

The National Council is spending increasing amounts of time on appropriations and legislation in the areas of addictions and criminal justice. We are partnering with advocacy organizations like SAAS; we are planning to recruit additional policy staff with addictions policy and practice expertise; and in 2008 we will be launching an e-newsletter focused on addictions. We believe that as we gain expertise and credibility, the National Council can help to bridge what at times feels like a divide between national mental health and addictions advocates. In truth mental health and addictions share many issues and have much to learn from each other.

National Council member organizations are on the front lines in their communities and the National Council is committed to helping members offer services that enable people to live, learn and thrive. We do that best when you share with us your challenges and successes, your thoughts on issues of importance to you and your feedback on National Council policy activities and practice initiatives. Do share. And I urge you to make the most of your National Council member benefits -- take a few minutes to read our emails, newsletters and magazine, participate in our monthly Meet Me Calls, and visit our website at http://www.nccbh.org/ for the latest news and resources.

I can be reached at LindaR@nccbh.org or at 301.984.6200, ext. 227.

Best Regards,
Linda Rosenberg, MSW
President and CEO
National Council for Community Behavioral Healthcare