Carter Center, Atlanta GA, November 5 - 6
Sylvia Caras, PhD

Carter: There is no distinction between mental health and physical health

My departure was irregular. Tuesday I slept through both the alarms I had set for 2:30 AM, the car service airport transfer sent a huge limo where I got to stretch my feet way out, I realized after about five minutes that I’d forgotten my wallet and we had to turn around and go back (removing pennies to lighten the weight, I replaced it in my home pocket book instead of my travel bag), American Airlines had some problems with my ticket that it took 10 minutes to correct (and which were repeated in Dallas when I changed plans and my boarding pass was invalid), there was no alarm as I walked through security despite my new belt with a metal buckle, Starbucks opened half an hour late, when I got to the Atlanta hotel and used my key to open the room door, I found a room with unmade beds and an unflushed toilet and it took another half hour to get another room (there apparently was no housekeeping available in the evening). I settled in and walked around the block, a warm and muggy evening, and as I reentered the Westin, Matthew Mathia said hello, and accepted my invitation to come to the SOCSI meeting the next morning.. I wondered if all the downs and ups of this travel day were a wake up call <pun intended>. I wondered again when my departure flight left 45 minutes late..

The Subcommittee on Consumer/Survivor Issues gathered in the hotel lobby on Wednesday morning and we were driven to the Carter Center for our meeting. The driver had been given an incorrect destination for us and so we also had a tour, through morning rain, of upscale Atlanta suburbs.

Thom Bornemann greeted the SOCSI members and spoke about total health needs in the context of family and community, making new partnerships with other illnesses and even wider collaborations. CMHS is charged with the implementation strategy, but we shouldn’t expect this to be federally driven. He noted the many silo funding streams for mental health and health. Perhaps mental health is the canary, leading in transforming the whole health system towards primary intervention and prevention. Sharon noted "the cost of keeping everybody down." Matthew Mathia told about the move to "re-story" in New York. The terms of Juli Lawrence and Kevin Fitts are completed. SAMHSA will be appointing two consumer/survivor members to replace them as well as some representatives from the National Advisory Council to the Subcommittee.

We thought we might wear buttons "We are the evidence."

The NFCMH is planning a 6 month review of the impact to-date of their Report..

Hogan: consider moving mental health beyond the block grants, beyond the mental health department to, in a state, the governor’s level.

Arredondo: Recovery is the basis of all the report recommendations

Insel, NIMH: Employment is an intervention that works.

Satcher: continuum between mental health and mental disorders. No one can take their mental health for granted. Stigma, stigma, stigma. Globally, depression interferes with the ability to treat disease, in particular diabetes. (While I understand the concept of continuum, and know many hear occasional voices, get depressed, ... I think there is a chasm, a rift along that continuum for ordinary or serious vicissitudes and the chronic, though maybe intermittent, experiences some of us have. S.)

Kessler: Mental disorders are the major chronic illness of youth; average age of onset 15 - 20+. Mild first occurrences. Energy must focus on the mild disorders, intervening early. The earlier the age of onset the longer it takes it to get into treatment. Early onset disorders tend to be more biological. On average you have to see three doctors before you get help. School-based early screening, outreach, and treatment. But we don’t know if early-intervention works.

Bell: prevention and early tx

Druss: adopt and *adapt* best practices and evidence to local needs

Burns: omits domestic violence and sexual abuse from her list of six psychosocial risks for kids, subsuming it under "family conflict." Analysis of all evidence-based practices revealed 26 core components.

Fricks: PBS documentary underway on cemetery restoration projects.

Stanton, CMS: Some 50 Medicaid programs. Federal dollars follow where the state wants to go. Purchasers must be in the dialog. Medicaid eligibility still holds for IMD residents and other public institutions. 35 % of SSI and 28 % of SSDI populations use psychiatric disability for their eligibility. States must do better at using the Medicare options. There are ways under current law to keep kids at home. Medicaid services must be medical, and must not duplicate other agency services (like VR). Give end-users choice to self-direct their rehab benefit as an option to day treatment. Financing reform is needed. Rx coverage, parity. Stop medicalizing long term care.

Power, CMHS: Report’s vision: unified, consumer-driven, focused on recovery. Transformation is a continuous, profound, ongoing process. Real change is intensely personal and enormously political. Lawrence-Kaiser - 10 Lessons: people will resist difference until they personally accept that radical change is needed, readiness comes from education and insight; experimenting may be better than planning, permit failure, learning from mistakes, if the current way were working well, this change wouldn’t be needed; block grants will be restructured to performance partnership grants; pay close attention to timing, careful pacing, cadence of change must not tear apart the organization; people who don’t adapt well to change must be replaced; senior team must pull together and work collegially, one agency with one voice; boards can be active change agents, Congress, legislatures, Planning Council; coherence, cental mission, themes; methodical building process, initial capacity analysis; fluid and dynamic campaign, winning people over, social marketing, branding; celebrate along the way.

I spoke with one person who has been on the Carter Center Advisory Committee for 15 years, and another who has served on the state PAIMI Council for 11 years. I would favor term limits for all positions of this sort.

Charge to Breakout: five themes from Report: recovery and resilience, integration of health care, fragmentation, science-to-services and services-to-science, shame – action items relating to each - research, mental health a national priority, funding a social marketing campaign

Breakout brainstorm input:

CMS consumer advisory committee, role clarification, systematic collaboration and resource sharing, get to children earlier, art of collaboration, protection and expansion of Medicaid, Scallett - anti-stigma campaign, financing, give states the tools, stop talking about stigma, business plan, action plan, financing, choice within an individualized plan, mental health czar, change dialogue is haphazard, transformation guru in each state, mental health as a part of public health (parity), silos of funding, and conflicting rules for eligibility for them, for instance SSI - unable to work; VR - able to work

Permanent executive steering committee for Report being created across federal departments.

Summaries of breakouts

New knowledge, research including stories, education, Public awareness, System/community self-examination, Bottom-up too, Change in the language to pro-recovery; people as holistic human beings; define recovery, especially for children, Form follows funding, fix funding, silos

Normalizing care will normalize attitudes, from illness to focus on struggle and love

Emmett: Campaign for Mental Health Reform - NASMHPD, NAMI, NMHA, Bazelon

Thompson: Reduce social exclusion

Carter: There is no distinction between mental health and physical health