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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

What Now?

November 9, 2016 | Advocacy | Healthcare | Comments
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I love this quote from Hillel the Elder, one of the most important figures in Jewish history, because I often find myself asking, “If not us, who? If not now, when?” as I think about the National Council’s role in ensuring access to effective care for people with addictions and mental illnesses and in supporting the people in their lives who love them.

The outcome of the presidential election doesn’t change the National Council’s answers to the two questions that Hillel the Elder asked.

Easily available, effective services is still our true north.

And the National Council will continue to speak openly, offering paths to progress that reflect an understanding of the political, health care and business environments.

Two weeks ago I was reminded of how far we’ve come when an event I attended began with the retelling of the story of Mental Health America’s bell. In the early 1950s, MHA issued a call to asylums across the country to send them their chains and shackles – and on April 13, 1953, those inhumane bindings were melted down and recast into a sign of hope: the Mental Health Bell.

We remember that painful history. A description of a state hospital in the 1940s describes conditions like this … “they lived caged in small cells with a peep-hole slit in the door, groveling naked on a cold stone floor.”

Even into the 1970s when I worked in a state hospital as a new college graduate, patients were marched into a communal bathroom to be counted at the change of every shift and restrained if they dared to question staff. Patients and families were afraid to complain for fear of retribution.

And less than five years ago, most Americans believed an addiction was a moral failing. The response to that failing was incarceration. Acute treatment and belief in a higher power were the primary interventions to what science has taught us are chronic disorders.

But over the years together we pushed for change. Because you – the on-the-ground providers of mental health and addiction services in communities across America – believed in a new direction. You applied science to treatment. You created outpatient and rehabilitation programs, incorporating case management, peer and recovery supports, and housing. You worked long and hard to bring behavioral health disorders into health care to integrate the mind and body.

And, it led to change not only on the ground but in Washington.

In 2008, the Mental Health Parity and Addiction Equity Act became federal law. Insurance could no longer legally discriminate against people with behavioral health disorders.

In 2012, the Affordable Care Act expanded insurance coverage and underscored that addictions and mental illnesses were to be treated like all health conditions.

In 2014, the passage of the Excellence in Mental Health Act offered a pathway to equality in the safety net, the promise of standardizing effective mental health and addiction care, and the resources to retool organizations and staff to deliver that care.

700,000 Americans have taken a Mental Health First Aid course. The National Council is proud to have introduced Mental Health First Aid to an American public hungry to learn how to recognize the signs of mental illness, to be able to respond in an emergency and to know where you can get help.

The outcome of the presidential election doesn’t change the progress we’ve made, it doesn’t change our goal of effective, accessible care and it won’t change or limit the passion and intelligence that our community brings to work with a new administration and Congress.

But it can mean being prepared to change strategy and tactics and the National Council community is ready to do that. Next week our Board and Public Policy committee meets in Washington, DC. I expect we will continue to be bold and, yes, perhaps at times controversial.

Our new president in a recent stop in New Hampshire addressed the opioid epidemic. He will want to find a path to recovery for all Americans, and the National Council will continue to speak openly, offering paths to progress that reflect an understanding of the political, healthcare and business environments.

Bills may be passed that use the “new” language – reform, value based, population health – but offer no expansion of service capacity nor invest in quality. We may see proposals that limit entitlements, and that continue to build the gulf between the haves and have nots. We’ve seen it all before and we are prepared to say no loudly and strongly.

We also understand that delivering health care is not building planes or cars—building planes and cars is complicated, delivering health care is complex. Improving complex processes is not easy and requires knowledge, creativity and flexibility, and the National Council and its members will bring those assets to regulation, policy and legislative processes.

When we ask the questions “If not us, who? If not now, when?” the answers are clear. The National Council stands with all of our sister and brother stakeholders committed to easily available, effective services as the true north.

The election doesn’t change that goal and doesn’t delay our efforts to achieve it.