Reflecting on 15 Years Well Spent
You’re gonna miss this
You’re gonna want this back
You’re gonna wish these days hadn’t gone by so fast
These are some good times
So take a good look around
You may not know it now
But you’re gonna miss this
- Trace Adkins
There was a jukebox in my room at the Gaylord Opryland and Convention Center in Nashville where I was attending NatCon19 in March. I didn’t know the Trace Adkins song, “You’re Gonna Miss This,” but once I heard it, I played it over and over. As I step down after 15 years as president and CEO of the National Council, I am going to miss this.
I’m going to miss the National Council members from all across this country who made me feel so welcomed. From Texas to Arkansas, from Vermont to Michigan – I’ve been treated like a queen. You’ve made me feel cherished and blessed, surprised and delighted, honored and humbled. I even traveled with some of you to Cuba and to Europe, where we saw how warm and welcoming the behavioral health communities are and how we share the same battles to get effective care to those who are struggling.
I’m going to miss hearing your success stories. Every day, you transform lives and communities. You find practical solutions to complex problems and you improve practice where it counts – in the continuous healing relationships that support recovery.
I’m going to miss the opportunities you’ve given me – to testify before Congress, to dine with First Ladies, to work with Lady Gaga and her mother to spread kindness around the globe.
Most of all I’m going to miss the challenging and rewarding work we’ve done together. In the past 15 years, we have done some amazing things.
We wanted to decrease stigma and we have, training 1.7 million people in Mental Health First Aid.
We made recovery the expectation, not the exception.
We moved integration from concept to reality.
We stopped asking, “What’s wrong with you?” and started asking, “What happened to you?”
We fought for parity and we continue to fight for implementation.
We demanded full inclusion of mental illnesses and addictions in the Affordable Care Act and we got it.
We chipped away at the discriminatory IMD.
And, committed to improving care, we championed Certified Community Behavioral Health Clinics (CCBHCs). Like Federally Qualified Health Centers, CCBHCs get cost-based reimbursement that goes up as more patients are welcomed, staff is added and technology adopted. CCBHCs integrate treatment, deliver medication-assisted therapies and provide 24/7 availability, becoming high touch-high tech treatment hubs.
We’ve come far in 15 years. Now, we have to ask ourselves, where do we go from here?
Startling figures show that average life expectancy in the United State dropped for the third straight year, driven by increases in overdose deaths and suicides. You are now more likely in this country to die from an opioid overdose than a car accident.
We’ve come to understand that race, class and privilege are at the heart of health disparities. We’ve learned that poverty and being viewed as less than equal exact lifelong consequences – chronic health conditions, mental illnesses, addictions, suicide and mass incarceration.
We must advocate for policies that address social determinants of health and we can, and must, make improvements in care.
We must create single points of accountability for the sickest, and often the poorest, among us – entities responsible for navigating the layers of programs we’ve created and matching the most intensive services for those being jailed or hospitalized and those who are homeless.
We must deliver clinically competent care. “Trauma competent,” “culturally competent” and “military competent” are all are important, but if we want better outcomes, we need to be teaching the basic skills of making connections, establishing relationships and delivering effective, evidence-based interventions.
We must adopt measurement-based care, using standardized instruments like the PHQ-9 and the DLA-20, to monitor progress, prompt treatment change and answer the call for value-based services.
We must stop hiding behind HIPAA and 42 CFR and engage the most important people in a patient’s life – their family – because when we do rehospitalizations go down.
We must eliminate patient wait times. We can watch a movie, call for a ride or order groceries at the touch of a button; we can institute same-day access.
And we must be savvy businesspeople, understanding that as health care becomes a retail market, with demand for mental health and addiction services exceeding supply, behavioral health has moved beyond the sole purview of government and not-for-profits into the worlds of private equity and venture capital.
Fifteen years goes by in the blink of an eye. The National Council has grown from a $2 million organization with a staff of 12 to a $54 million organization with a staff of 140. Along the way, we’ve become a force to be reckoned with. We’ve passed legislation. We’ve changed practice. We’ve saved lives. And our good work continues under the very capable leadership of our new president and CEO, Chuck Ingoglia.
Trace Adkins is right, I’m going to miss this, but I look forward to continuing to fight alongside you for effective, respectful care for all people with mental illnesses and addictions. As I step down from the National Council, I’m not setting down my mantle. This work is too important to me, to the people we serve and to the nation. I’ll be continuing my board and advisory work with government, philanthropic and business sectors, and I’m especially honored to be joining the Columbia University Department of Psychiatry as professor of mental health policy and director of external relationships.
You can still contact me at LindaR@TheNationalCouncil.org. I always look forward to hearing from you.