For many years advocates worked these issues separately. Now they are uniting to make sure that the 84 million people afflicted with a mental illness or substance addiction get noticed.

The Whole Health Campaign represents a timely shift in thinking about the intersection of mental health, substance abuse, and physical health. Roughly 80 percent of those with a substance abuse disorder also have a diagnosable mental illness; people suffering from a mental illness die younger than their non-mentally ill peers. And increasingly, primary care doctors are being asked to screen for psychiatric conditions, while psychiatry is being asked to pay attention to medication side effects leading to diabetes and cardiac conditions. It is plain that the costs are unsustainable -- $787 billion in 2005 -- for neglecting illnesses for which there are evidence-based treatments leading to recovery.

At last count 43 national organizations were backing the Whole Health Campaign. A web-site, the virtual headquarters, was unveiled in early December at a meeting in Washington, where Bill Emmet (left) and Ron Manderscheid (right) discuss the agenda.

IMG_0833.JPGIf the Whole Health Campaign has its way, every televised debate, every town meeting, every elevator conversation will address mental health and addiction disorders. The issues are vast, and the solutions have often been embedded in other reform measures. But they are making their way into political arena through legislative proposals about ending discrimination of insurance coverage in the private and public marketplace, including parity for Medicare; expanding funds for children qualifying for their state’s insurance programs; seeing that a soldier gets the treatment he or she needs, and that their families get needed help.

Bill Emmet has spent most of his professional life advocating for people with mental illness, including a stint at the National Alliance on Mental Illness (NAMI). Currently he is the executive director of the Campaign for Mental Health Reform. Below he talks with Phyllis Vine about some of the organization’s objectives.

Q: How did the Whole Health Campaign come about?
A: It was just through conversations among several people recognizing that the presidential campaigns were focusing increasingly on health care reform. And this is an opportunity to project the reality that mental health and substance abuse belongs in that conversation, and to have an impact on the positions that will presumably result in actions in a new administration.

Q: Has this not been the case before?
A: Look at the last attempt at health care reform in early Clinton years. Mental health was looked at more than substance abuse – and mental health was on the table only briefly. There just wasn’t a consensus that mental health was part of overall health. Now, 15 years later, we have much greater recognition that mental health and substance abuse are part of any person’s health care picture.

Also there’s been effective advocacy during that time. We’ve had a chance to talk to various politicians and pose the question, "how can we avoid what happened to us during the Clinton years of health care reform?" And they’ve said "it’s not going to happen because we do recognize they are part of the picture."

Q: What are you hoping to accomplish now?
A: Financing for services that actually help people, and that look at the whole person. Medicaid policies on the public side are not aligned with encouragement of recovery. Mental health and substance abuse in the context of health care reform, you can’t look at health care narrowly divorced from rest of life. There can’t be policies that in any other ways separate mental health and substance abuse services from whole.

Q: Are there specifics?
A: A commitment to parity is bottom line. There’s been very little attention paid to support of prevention and early intervention and that’s an area that we can adjust some of the financing mechanisms to make more attractive and possible.

Clearly children are part of this. That means early intervention, research, prevention, policies that fuel events in childhood. And we need a real educational process about things like increased morbidity and mortality, from conditions like obesity, heart disease, and respiratory ailments. We need to see that candidates understand the relationship between mental health and substance abuse.

Q: How far is Congress willing to go to make this happen?
A: That’s the question. The purpose of the Whole Health Campaign is to make sure they recognize that it’s integrated completely.

Q: How do you get this message out?
A: What we’re relying on now is the time tested strategy of reaching out at policy-making levels to advisers on health care of all candidates. And bringing together the many organizations committed to Whole Health Campaign.

At same time we need to employ a grassroots strategy. Many of the organizations that are part of the Mental Health Campaign have significant grassroots structures and will make sure that their members participate in town hall meetings in key states, Iowa, New Hampshire, South Carolina.

Q: How many voters are we talking about?
There is a large body of voters. If together they affect one in five Americans, which is virtually every family, then we are talking about a ubiquitous concern. Stigma has kept many from being very open about it. The purpose of the Whole Health Campaign is to let them recognize that they are not alone and if they speak up they will not be speaking in isolation. Whatever they say will be picked up by others.

Q: How has it been possible for politicians to ignore this?
These families have not been well organized. Even when families were organized, they have not been conveying the same message. We agreed that people concerned with mental health and substance abuse should come together.

Q: Hasn’t there been a tension between them?
A: Yes, historically. But personal experience and science have driven the two groups together. And we realize they have much more in common than the issues that divide us. Mental health and substance abuse co-occurring disorders are more common than not. You have one and you’re very likely to have the other

The fact that we were able to do this means we are able to present an organized and united set of positions. In the past our hearts were in the right places but we were saying different things. And politicians were hearing conflicting messages and therefore they thought they had the right to disregard them.

Q: How will the campaign reach people?
A: The campaign is a “virtual campaign.” To the extent that it has headquarters, the web site is the virtual headquarter. It provides linkages allowing the tendrils to reach out in a number of different areas.

The web site ( out there for anybody to anybody to access. It is intended to be interactive and allow anybody who wishes to join in and participate in commenting on blogs. That will generate a conversation which will be watched by policy and media.

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