Mental Health Stigma: An Interview with Patrick Kennedy (Part Two)

In this two-part series, I speak with former Congressman Patrick Kennedy, D-RI, about mental health stigma and the work he and others are doing, not only to combat stigma, but to bring research into brain disorders and illnesses to the forefront. Kennedy is a co-founder of One Mind for Research, a group dedicated to brain disorder research. In this interview, Kennedy speaks about mental health stigma; the role his uncle, President John F. Kennedy played in bringing about treatment to local communities, and the role of post-tramatic stress in the "astronomical" suicide rate of today's veterans.

I wanted to ask you a question about research, because I used to work with people with mental illnesses and I noticed that there wasn't a lot of research out there on mental illnesses as there (is) for other illnesses, and I was wondering if you a. agreed with that, and b. what would you think would be the reason behind the fact that there's not as much research for brain disorders?

One, I agree. Not only do I agree, it's backed up by reality. There is not the same amount of effort and dollars going into brain research like there is other physical health research. And yet, that is beginning to change.

The reason that is the case is because of stigma. Frankly, the way Congress works is that we listen to our constituents tell us and then we respond. But people with brain illnesses often don't vote, and clearly many do not feel like putting their hand up and saying that they are consumers of mental health. So advocacy is a real challenge.

When you don't have the advocacy, frankly no matter even if it makes sense and it's meritorious, if you don't have the advocacy, it's not going to happen.

And so we really need to ramp up our advocacy, and part of why I'm speaking to you is that at Psychiatry.org/mentalhealth, we're trying to get the word out that advocacy is going to be crucial to mental health becoming part of overall health care.

As you know, I have the honor in Congress of authoring the Mental Health Parity and Addiction Equity Act. What that law says, now in concert with the Affordable Care Act, is that insurance can no longer treat mental health any different than the rest of physical health.

Because, lest we say the obvious; the brain is part of the body, and for too long insurance has played off that stigma and denied coverage for the organ of the brain, where they would not be able to deny that same coverage if you had diabetes or cancer or cardiovascular disease.

So, we're in the midst of a revolution in bringing mental health treatment to parity, meaning equality, with the rest of physical health care. And frankly, when we pay for mental health care, you'll begin to see greater research dollars go into mental health care too, because there will be a pipeline essentially, where the research will be necessitated because we want better treatments, just like we do for cancer.

We want better treatments, and we will demand more, provided we're covered for this thing called mental health.

And, you know, one of the things you had mentioned about the veterans' suicide rate, and I'm sure you're aware that September is National Suicide Prevention Month, and I know from personal experience; I'm in recovery from anorexia and that has a very high suicide rate also and very low treatment, I might add; we won't go there.

So what would you want to say to people; you yourself have struggled with a brain disorder, bipolar disorder; what would you want to say to people in terms of the stigma and how to break that in society?

We have a two-pronged approach. We obviously have the cultural attitudes that are a big problem, because less than 38 percent of adults with a diagnosable mental illness ever get treatment, and less than 20 percent of children also ever receive treatment for a diagnosable mental illness.

I might add that's because one, they don't have the coverage, but two, even if they do have the coverage; of those who do have coverage, two-thirds of those with coverage never avail themselves of that coverage because of the fear and the shame and the stigma that they often feel with getting mental health "care."

I do think that attitudes are our biggest culprit. Treatment does work, but we need to get it to people. We need to have people willing to seek it, and part of that means they can't be denied when they do seek it. That's why I am fighting to see that we get the White House to release a final rule implementing the Mental Health Parity and Addiction Equity Act.

What the rule will do is to define what we mean by mental health care. So when you look at a person with an eating disorder, you often find that insurance companies do not reimburse for recognized standards of care in clinical practice guidelines.

Now, if this were diabetes or if this was cancer, if you had leukemia, or a stroke, there is no way an insurance company could ever get away with denying life-saving treatment the way they routinely deny treatment for a diagnosable mental illness like an eating disorder.

What I want to see in this rule is I want to see the White House define an adequate scope of services, which means that if leukemia is covered, if cardiovascular disease and heart attack and stroke are covered, both inpatient and outpatient, in-network and out-of-network, both for pharmacy and emergency room care, then guess what?

The same level of care needs to be provided for a mental illness as is being currently provided for the rest of physical health care.

That rule will be coming out shortly from the administration, and it'll be imperative amongst those of us who are advocates to see that rule is both enforced and is applied. So I appreciate you doing this story, because we need to make people aware of the fact that they have a tool in their toolkit now, they have a law that's on their side, they're going to hopefully have regulations like this rule that will enable them to get the treatment for their family and friends and, in their own cases, for their own treatment. But they need to know what the rule says and they need to know the law is on their side.

I know that you have another interview scheduled, but is there any last thing you want to add?

I would just say that this October marks the 50th anniversary my uncle, President Kennedy, signing the Community Mental Health Services Act of 1963, and we're hoping to bring the same kind of national attention to the importance of providing whole health that he did...50 years ago in his address to Congress on Nov. 5 of 1963. He really spelled it out.

So even though we're still dealing with stigma, it's perhaps good to recognize that this is not a new issue, and it's long past time for us to treat this the same as the rest of physical health care.

Go to Psychiatry.org/mentalhealth for more information about the importance of this campaign. Kennedy is also the co-founder of One Mind for Research, a group dedicated to research of brain disorders.

Angela E. Gambrel can also be found on Google+, Twitter and Facebook.