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Mental Health in America: Where Are We Now?

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Linda Rosenberg

President and CEO, National Council for Behavioral Health

Mental Health in America: Where Are We Now?

April 28, 2016 | Uncategorized | Comments
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The following is the oral version of my testimony to the Senate Finance Committee  on April 28, 2016. You can also read the full written testimony I submitted here.


Good afternoon Chairman Hatch, Ranking Member Wyden and Members of the Committee. My name is Linda Rosenberg and I’m the President and CEO of the National Council for Behavioral Health. I’m honored to be here with my distinguished colleagues.


There is attention to mental illnesses and addictions … everywhere we look.

  • From the Presidential elections
  • …to this week’s New York Times feature … on the Portland Police
  • From the 600,000 Americans who’ve taken a Mental Health First Aid course
  • … to last week’s CDC data showing a 25% increase in suicides in the last 15 years

As the numbers tell us, … attention is not enough. It’s not enough … for the more than 28,000 … who died from an opioid overdose. It’s not enough … for the more than 41,000 … who completed suicide.  … And it’s not enough … for their families.

It’s not enough, … not because of stigma, … and not because we don’t know what works. It’s not enough … because of how rarely effective interventions are available.

The question before you … is not, “where are we now?” … but “where do we need to be?”

  • If we’re serious about moving from pockets of excellence … to the widespread availability of effective interventions, … we need to stop depending upon grants … and then wondering why good practices don’t spread.
  • When we have cancer or heart disease, getting access to chemotherapy or a stent … doesn’t depend on our local clinic having a grant. Why are mental illnesses and addictions different?
  • The answer … to where do we need to be … is the Excellence in Mental Health Act demonstration. A bipartisan initiative… led by Senators Stabenow and Blunt … the Act enables and sustains treatment systems … that increase access, deliver evidence based care, and integrate services.


Discussions of access often focus only on increasing beds. Beds can never be effective in a vacuum. Only community-based services prevent re-admissions. At a time of Accountable Care Organizations and Medical Homes … beds alone aren’t enough. Neither, for that matter is crisis care … just as with psychiatric hospitals … standing alone they aren’t enough.

  • The Excellence Act establishes criteria for Certified Community Behavioral Health Clinics – CCBHCs – that provide mental health … and substance use services … and primary care screening. CCBHCs create smooth care transitions … and deliver 24-hour crisis services … including mobile teams … coordinating … with law enforcement … criminal justice … and veterans’ organizations.

Science-based care:

But it’s not just access—we need uniformly high-quality services. Unfortunately, the adoption of research based practice is limited. An example is the successful NIMH RAISE study … that improved outcomes for youth experiencing a first psychotic episode.  Most communities will be unable to implement the program … block grant funding, and time limited philanthropic grants will not be enough … and thousands of young adults will be relegated to a life of disability.

  • CCBHCs can move the needle. They’re required to offer evidence-based services … and are paid a rate inclusive of these activities. Through outcome tracking … andquality bonus payments, … clinics will be held accountable for patients’ progress … a step in our nation’s move to value based purchasing.

A key challenge to delivering science based services … is our shortage of professionals. Clinics all over the country struggle to recruit and retain staff. The fundamental barrier  … is that most clinics can’t afford … skilled staff … or investments in technology to extend staff reach. Those of you who have ever run a business … know this is unsustainable.

  • The Excellence Act offers certified clinics … Medicaid payments … based on the costs of treating patients. They can hire critical staff … and leverage new technologies. And even those historically opposed to prospective payment, like the National Medicaid Directors, acknowledge there’s not a better solution.


The average age of death … for Americans with serious mental illness is 53, … the same as the U.S. life expectancy in 1917. The culprits are heart disease, lung disease, and cancer. And, people with chronic physical illnesses … often have co-morbid depression and anxiety. Integrated care improves outcomes for both groups.

  • CCBHCs represent a foundational opportunity to advance the way care is integrated and coordinated. … They will help reverse the trend of early mortality … and support primary care’s behavioral health efforts.


Shining a spotlight … into the shadows of mental illness and addictions … is not enough. 

The Excellence in Mental Health Act is where our behavioral health system needs to be.

Twenty-four states are now planning their participation in the demonstration. Yet, the law sets an 8-state limit.

Every state … that wishes to create and sustain quality service systems … should be able to do so. The National Council urges you … to allow all 24 states to participate … and to open the planning process to the remaining 26.

CCBHCs will transform services in this country—that’s what we can call reform.


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