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SAMHSA Administrator Charles Curie on Mental Health Parity and the President's New Freedom Commission

Moderator: Welcome to the National Mental Health Month 2002 Web chat. Our host today is Charles G. Curie, M.A., A.C.S.W., administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). Our topic today is mental health parity and the President's New Freedom Commission on Mental Health. This online discussion will address issues that include identifying needs of patients, examining barriers to care, and investigating community-based care models that have success in coordinating and providing mental health services.

Question from chat: What is mental health parity?

Charles Curie: Parity means that insurance benefits for any group of mental health diagnoses are the same as insurance benefits for medical/surgical diagnoses with respect to cost sharing, service limits, and annual or lifetime spending limits.

Question from chat: Why don't people get help for mental illness?

Charles Curie: The President said in a recent speech that there are three obstacles to people seeking treatment. The first obstacle is stigma associated with living with a mental illness, which leads to isolation and discourages people from seeking the treatment they need. The second obstacle to quality mental health care is our fragmented mental health service delivery system. Unfortunately, many Americans fall through the cracks of the current system. And, the third obstacle is the unfair treatment limitations placed on mental health insurance coverage.

Question from chat: How will/does the government help individuals diagnosed with autism contribute to society?

Charles Curie: While autism is more of a developmental disability than a mental illness, it still would be considered a condition disabling and thus would be a disability considered under the President's New Freedom Initiative. The President's New Freedom Initiative is this Administration's approach to ensuring that people with all disabilities — physical, developmental, and psychiatric — have the opportunity to live full lives in the community. This would include people having the opportunity to pursue vocational goals, housing goals, and other appropriate means for being a part of the community.

Moderator: To learn more about the President's New Freedom Commission on Mental Health, you may visit: http://www.whitehouse.gov/news/releases/2002/04/20020429-2.html

Question from chat: How many individual States have mental health parity laws?

Charles Curie: More than 30 States have some form of parity legislation, although many are limited in terms of the disorders covered or plans that are subject to the mandate. Previous studies of State parity laws have found that there has been a small effect on premiums. Cost increases have been lowest in systems with tightly managed care and generous baseline benefits. Employers have not attempted to avoid parity laws by becoming self-insured, and they do not tend to pass on the costs of parity to employees. The low costs of adopting parity allows employers to keep employee health care contributions at the same level they were before parity. Costs have not shifted from the public to the private sector. Most people who receive publicly funded services are not privately insured.

Question from chat: Is the President's New Freedom Initiative based on choices made by the individual consumers?

Charles Curie: One of the fundamental principles of the New Freedom Initiative is that individuals with disabilities, including those with mental illness, will have more choices and will be able to make more choices to determine their own future.

Question from chat: Will the initiative address issues related to our young people, especially those who live in poverty and are the most likely to be overlooked?

Charles Curie: Absolutely. And the President sees the best way to help individuals with disabilities — including those of lower socioeconomic means — is to ensure that all Federal agencies are aligned and working together to meet the needs of individuals, especially those of the vulnerable populations, for which the government is responsible.

Question from chat: Why has our Congress and President allowed businesses who are concerned about the additional cost of parity for health care insurance take precedence over treating the mental ill humanely and not discriminating against a population that cannot protect itself?

Charles Curie: The fact is this President has taken the unprecedented step to support legislation which ensures parity for mental health benefits, which would be offered by employer-based and corporate-based insurance plans.

Moderator: For more information on the President's views on parity, visit the transcript of a recent Presidential speech: http://www.whitehouse.gov/news/releases/2002/04/20020429-1.html

Question from chat: What do you believe the President's New Freedom Initiative will reveal that the Surgeon General's report did not?

Charles Curie: The President has established the President's New Freedom Commission on Mental Health in order to develop an action plan for the Nation's mental health system to ensure that people with mental illness will realize the goals stated in his New Freedom Initiative. Again, that is to have an opportunity to have a full life within the community. And the commission will be informing the administration based on data and other sources of information (such as the Surgeon General's report) as to what an appropriate action plan should be. That plan is due in 1 year.

Question from chat: The Decade of the Brain showed that mental illness and addictive disorders are medical illness of the brain, yet we continue to describe them as behavioral health problems. The methods of dealing with these illnesses at the community level are criminal sanctions and underfunded community mental health centers. How are we going to change the paradigms to direct appropriate resources away from criminal sanctions into treatment?

Charles Curie: One of SAMHSA's major priorities is addressing the issue of the number of individuals who end up in the criminal justice system with mental illness or addictive disorders. We first must define and recognize that this is a problem that needs to be addressed. Then we need to define what treatment and interventions work with these medical conditions and ensure that individuals obtain access to needed services and supports prior to getting involved in the criminal justice system. For those who have ended up in the criminal justice system, we need to find the bridges through treatment to bring them out into the community. We also need to continually educate the public that treatment does work and focus on rehab and recovery. There is both a medical component to these disorders as well as a behavioral aspect to be addressed.

Question from chat: What are the goals of the Mental Health Commission?

Charles Curie: The goals of the President's New Freedom Commission on Mental Health are to develop recommendations on improving the nation's mental health service delivery system. The Commission will be composed of 15 members, appointed by the President, and 7 ex-official members from executive branch agencies. The Commission will identify the needs of patients and the barriers to care and investigate community-based care models that have success in coordinating and providing mental health services. The Commission will have 1 year to recommend immediate improvements that can be implemented by all aspects of the public and private mental health system to improve coordination and quality of services with existing resources.

Question from chat: I am one of the newly Traumatic Stress Center sites funded by SAMHSA. I'd like to know what can be done to get the child welfare system to begin to take domestic violence and other abuse as a serious problem for children living with the behavior. In this State, while welfare has a definition for "emotional abuse," they refuse to act on it when it is reported by those of us who are mandated to report it.

Charles Curie: You've just pointed out a very critical long-term problem which has interfered with children and families receiving needed treatment and services. The first major step that needs to take place is a true collaboration and partnership between our public mental health systems and public child welfare systems. Secretary Thompson has made it very clear that one of his top priorities is ensuring that the U.S. Department of Health and Human Services functions as one department in the interest of all Americans. SAMHSA is committed to working with the Administration of Children and Families (ACF) to develop approaches and guidance for State mental health authorities and State child welfare authorities to ensure better collaboration and communication. This can lead to educating both systems as to how to best meet mental health needs — including trauma needs of children and families at risk.

Moderator: For more information, see the U.S. Department of Health and Human Services's Web site: http://www.dhhs.gov/

Question from chat: How will stigma, which is deeply rooted in our society, be addressed?

Charles Curie: We have identified addressing stigma and barriers to service as well as promoting recovery as major cross-cutting principles for all that SAMHSA does. The only way to address stigma is through a comprehensive approach which engages not only the mental health system but, more importantly, the education system in schools and the workplace. In other words, we need to ensure the message about what mental illness is and what it is not. Finally, Secretary Thompson has committed to launching a major anti-stigma effort through SAMHSA.

Moderator: To learn more about stigma, visit: http://mentalhealth.samhsa.gov/stigma/

Question from chat: One of the early criticisms of the New Commission is that it will only focus on a small segment of the mental health system—severely mentally ill adults and seriously emotionally disturbed children—while leaving out the rest of the population. Can you respond to this?

Charles Curie: While it is true that the Commission must focus on people with serious mental illness and children with serious emotional disturbances, as those have been core populations which have been supported by government funded programs for centuries, the Commission will also be examining the mental health system as a whole. This would include not only effective interventions for these populations, but also how to effectively address mental health needs of children and at-risk youth. It will also be up to the Commission to determine how broad of a focus it will need in order to ensure a relevant action plan for the President to consider.

Question from chat: With the growing threat of terrorism, there is an increasing need for prevention, particularly for children and adolescents. Is it realistic to think that more funds will be made available for prevention?

Charles Curie: SAMHSA has several programs and grants focusing on prevention. The Building Mentally Healthy Communities Grant is intended to help cities, counties, and tribal governments increase their capacity to provide prevention and treatment services to meet emerging and urgent mental health needs in their communities. SAMHSA sponsors the Communities Together: Caring for Every Child's Mental Health communications campaign, a national public information and education campaign to increase public awareness about the importance of protecting and nurturing the mental health of young people, among other things. Also, the SAMHSA Initiative on School Violence focuses on the collective involvement of families, communities, and schools to build resiliency to disruptive behavior disorders.

Question from chat: I am from the National Asian Women's Health Organization. We are a current grantee and thank SAMHSA for its commitment to addressing Asian American mental health needs. Will SAMHSA continue to make addressing racial and ethnic health disparities a priority, including education-focused programs to reduce stigma and raise awareness about mental health issues, and will minority populations be a priority of the Commission?

Charles Curie: Cultural competence and eliminating disparities are both priorities for SAMHSA as they reflect — again — cross-cutting principles which need to be apparent in all of our initiatives. We know today, more than ever before, what works in achieving culturally competent systems as well as how to begin to eliminate disparities. We will not begin to make progress in these areas by only having separate special initiatives, but we need to begin applying what we know in all that we do. We need to start making sure that cultural competence is part of everything we do; it is part of the fabric of our programs and the communities that we are serving. Services needs to become part of the neighborhoods in which they exist.

Moderator: For more information, see: http://mentalhealth.samhsa.gov/cre/.

Question from chat: What are you and the Administration doing to address co-occurring mental illness and substance abuse disorders?

Charles Curie: Co-occurring disorders are at the very top of our list of priorities for SAMHSA. We recognize today that typically from a third to over half of the individuals seeking treatment in our mental health systems and drug and alcohol systems have a co-occuring issue or diagnosis. We also know that in the criminal justice system, of the 10-15 percent of individuals who are seriously mentally ill, 90 percent of that population has an existing addictive co-occuring disorder. Our capacity to address this is developed throughout our systems, including integrated treatment models to ensure that this population is served effectively and efficiently. If we treat people appropriately in the first place, not only will their quality of life improve (which is most important), but public dollars will be better used. And it is time for SAMHSA to show national leadership on this issue.

Question from chat: What are you and the Administration doing about human rights?

Charles Curie: Embedded within the President's New Freedom Initiative, his stand on parity, and the establishment of the mental health commission, this Administration has taken a strong stand to ensure that people of mental illness have more choices and options. People need choices in order to be able to chart their own destiny and this does not come about through "forced choices." Recovery is about people learning how to manage their own illnesses and their own lives. And we need to look at those things which get in the way of individuals achieving those goals. For example, making a strong stand to reduce and ultimately eliminate the coercive measures of seclusion and restraining, which at one time (and unfortunately sometimes still are) measures which were used in inpatient and other treatment settings. This Administration stands four-square behind providing all people with mental illness an opportunity for full participation in American society, including a job, safe places to live, and meaningful relationships.

Moderator: Our hour has concluded. For more information, visit SAMHSA's Center for Mental Health Services at http://mentalhealth.samhsa.gov and our special feature on National Mental Health Month at http://mentalhealth.samhsa.gov/highlights/2002/may/mhmonth/. We would like to thank our host, Charles G. Curie from SAMHSA, for his participation in this online event and thank our participants for their questions.