Mental Health in America: An Interview with Patrick Kennedy

As the second day of the Democratic National Convention unfolds inside the Wells Fargo Center in Philadelphia, a former U.S. congressman with one of the most recognizable names in politics will be a few blocks away outside City Hall, calling attention to a policy challenge he understands all too personally: America’s mental health and addiction crises.

Patrick J. Kennedy, a former representative from Rhode Island and the youngest son of the late Sen. Ted Kennedy, will be one of several speakers today at the Like-Minded Rally for Mental Health and Substance Use Reform at Dilworth Park. The purpose of the rally, which is presented by The Kennedy Forum, the Thomas Scattergood Behavioral Health Foundation, and the City of Philadelphia Department of Behavioral Health and Intellectual disAbility Services, is to demand more accountability and support from policymakers in addressing addiction and other mental health concerns.

For Kennedy, 49, this is no pet cause. His struggles with alcohol and drug addiction are well documented, perhaps most explicitly in his 2015 book A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction. In the book, Kennedy documents not only his own history of mental health challenges but those of other family members, including both parents’ battles with alcoholism.

Since leaving office in 2011, Kennedy has become one of the most outspoken mental health advocates in the country. He is the founder of The Kennedy Forum and co-founder of One Mind, nonprofit organizations dedicated in part to promoting mental and behavioral health awareness and research, and he has also led a bipartisan effort to address the growing opioid epidemic.

In an exclusive interview with GoodTherapy.org, Kennedy discussed the Mental Health Parity and Addiction Equity Act of 2008 (one of his signature pieces of legislation), what he sees as the biggest obstacles to effective mental health treatment, and what needs to change for mental health and addiction issues to become a public health priority in a deeply divided political climate.

What do you and your supporters hope to accomplish during today’s mental health rally in Philadelphia?

Simply put: be heard! These are ballot-box issues. I hope to see Democratic party delegates, candidates, and policymakers adopt a comprehensive approach to mental health and addiction that truly reforms the diagnosis and treatment of these conditions. If they do, we’ll be taking a big step toward dramatically improving the health and well-being of all Americans. The reality is that one in four Americans is affected by a mental health condition. Suicide rates are at an all-time high. Drug overdoses have replaced car accidents as the leading cause of accidental death. This is everyone’s issue, and today’s fractured environment and approach aren’t cutting it. Mental health conditions and addiction should be treated the same as any other physical health condition—we need coordinated care that’s available, affordable, and includes prevention and early intervention. We need to fully embrace the comorbidity of mental illness and addiction and acknowledge how discrimination prevents people from getting care and families from supporting care. We need an approach that increases access to evidence-based treatments.

You’ve been urging people to “hold our leaders accountable” for their policy positions on mental health, calling them “voting issues.” Why do you think so many public officials have hesitated to champion addiction and mental health as a national health crisis, and what specifically has to happen for that to change?

In a nutshell: misunderstanding, and a history of seeing mental health and addiction as somehow “different” than other diseases that get broad public and legislative attention and support. While there is tremendous need in America, there still hasn’t been a truly comprehensive piece of legislation that will address the major gaps that exist. Legislators need to see mental health and addiction as integral to overall health and not something that lives in a silo. They also need to understand that there are tremendous cost savings associated with practices like collaborative care, and health outcomes can be improved by investing in measurement-based care and new technologies. Most of all, they need a blueprint—and we have it in our national platform. The Like-Minded Rally at the Democratic National Convention is meant to outline the path to get us there.

“People with mental health conditions and addictions are just like you and me, but they’re managing what is essentially a chronic disease from which they can recover, get better, and live full, long, happy lives.”

In your book A Common Struggle, you describe your own struggles with addiction, alcoholism, untreated bipolar, even suicide ideation. For people who have never experienced a serious mental health issue, what’s the most important thing you want them to understand about people who do?

People with mental health conditions and addictions are just like you and me, but they’re managing what is essentially a chronic disease from which they can recover, get better, and live full, long, happy lives. I’m an example of that! Mental illness is really misunderstood on that score, and it is one of the last remaining “acceptable” forms of discrimination we have. We push people with mental illnesses into the shadows and forget about them. Even 50 years after my uncle signed the Community Mental Health Act of 1963, we are seeing these pervasive and dangerous prejudices and stigmas continue in many ways. In signing the bill, the president said, “The mentally ill need no longer be alien to our affections or beyond the help of our communities.” That rings true today and is what we need to believe as a nation, especially as our politics become more and more fractured.

On your website, you mention the Mental Health Parity and Addiction Equity Act was the signature achievement of your time in Congress. Since the law was implemented, what are some of the positive changes you’ve seen this piece of legislation have?

That law was the culmination of many years of bipartisan support to end the false distinction in insurance coverage between illnesses of the brain and the body, and we are seeing some progress but not enough. The Affordable Care Act took this foundation and went even further, but a top priority for present-day policymakers and candidates must be to enforce this law, which simply is not happening. We need disclosure on the part of insurance companies to ensure their medical management practices and utilization review requirements are truly the same for physical and mental health. We simply don’t know, so enforcement has been practically nonexistent. However, Attorney General Eric Schneiderman of New York has been a real champion in this area, and he has successfully prosecuted cases involving parity violations. But this needs to be a national priority. I look forward to seeing what the president’s task force on parity recommends in October. That will be a watershed moment for those of us who have been fighting this battle for the past decade. I will say this: parity for mental health and addiction has been a driving force for people to better understand their rights, and we all need to work together to keep that front and center.

A recent NPR story exploring mental health coverage says nearly half of therapists in California currently don’t take insurance. According to the story, insurance companies claim a shortage of therapists while therapists claim insurance company reimbursement rates are too low, compelling many therapists to remain outside of insurance networks and leaving low-income individuals with fewer treatment options. Based on your experience working on the Mental Health Parity and Addiction Equity Act, what are some ways insurance companies and therapists can work together to address this disparity?

First, we have to address the shortage crisis when it comes to therapists. We need to incentivize the entire system, from payers to providers, to prioritize mental health and addiction. That’s my primary concern. Next, we need better transparency and coordination of care. As you know, our specialty mental health care system, including therapists, doesn’t have the capacity to serve the huge population of Americans living with mental health conditions, and those with inadequately treated mental illnesses and addictions often live shorter and sicker lives because of co-occurring chronic illnesses. So, the cost burden of the status quo is enormous. By demanding mental health parity and requiring equal coverage and benefits for mental health and addiction treatment providers, and in turn ensuring that mental health and physical health care are coordinated, we can drive better outcomes, lower costs, and deal intelligently with the supply-and-demand issue when it comes to treatment.

According to the U.S. Department of Health and Human Services, 44 people in the United States die from overdose of prescription drugs every day, with opioids a leading cause. How do we reconcile the legitimate medical need for these drugs with the reality that they are overprescribed, abused, and in many cases highly addictive? What’s the answer?

We need reform across the board when it comes to addressing the nation’s opioid crisis. Obviously, there needs to be changes within the provider community, within the insurer community, and within the advocacy community. What’s the answer for the over 2 million people who are already addicted in this country? Every research study that’s been done has shown that opioid replacement therapy is the standard evidence-based treatment model, but too many people are being denied this treatment because there aren’t enough doctors who can prescribe medications like buprenorphine or naltrexone, and we have artificial treatment caps created by outdated policy that limit the number of patients these doctors can treat with these methods. We have obsolete policies in place that prevent doctors from treating patients suffering from opioid addiction according to clinical guidelines and best practices—you would never see that with any other disease, and it’s not acceptable with this one, either. Opioid replacement therapy, in conjunction with cognitive behavioral therapy and peer support, can and does help people achieve long-term recovery, and we must ensure all patients who need this comprehensive approach can access it.

The National Center for Health Statistics released a report earlier this year highlighting a sharp increase in the U.S. suicide rate—up 24% from 1999 to 2014. Thinking back to your time in Congress, what is some advice you would give legislators to address this issue?

Completed suicides are the outcome of a failed system, and that’s what we’re dealing with here in the U.S. right now. Period, full stop. Think about it this way—we wouldn’t dream of denying people cancer treatment until their disease reached stage 4, but that’s what we routinely do in mental health. We wait until it becomes a crisis instead of working to prevent it. Legislators need to follow through on their promises to strengthen the parity law by demanding greater disclosure on the part of health plans, and other payers, regarding their practices. We need systemic reimbursement of care by both public and private insurance, not just a series of grant programs like we’ve seen in the most recent legislation on Capitol Hill. We also need legislation that encourages data sharing while maintaining the privacy of the patient, and we need coordination of care, including integrating mental health and substance use health care records into electronic health records. I am a huge supporter of the Zero Suicide initiative, and I think it can be a model for how we address suicide in a more comprehensive way. In other words, when we strengthen all parts of the system, coordinate care, focus on prevention, and invest in models that work, we will see the epidemic of suicide begin to ease.

At GoodTherapy.org, we are constantly battling the forces of stigma, which many people consider one of the most significant barriers to seeking treatment. How would you convince someone reading this—someone in the depths of addiction, depression, or a similarly challenging issue—to set aside their fears and worries and reach out for help?

Don’t be alone with your illness and your struggle. Talk about it, even though it is hard. Don’t hide from it, and when you’re ready, speak openly to friends and family members. That worked for me. At the same time, don’t be afraid to demand the best diagnosis, the best care, the best coverage, and the best way of staying current with medicine and treatment. If you were living with diabetes or cancer, you wouldn’t hesitate to get the treatment you needed. I encourage those living with a mental health condition or addiction, which are themselves chronic diseases, to keep that truth front and center. I encourage their loved ones to take the same approach. Recognize that nobody chooses to have a mental illness or addiction. This isn’t something you can just “snap out of.” Recovery is a process, but I hope my experience can be a beacon of hope for others that, with the right treatment, you can and will get better and have a very meaningful life.

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