Interviews

ronmanderscheid.jpeg Since the 1970s when he worked for the National Institute of Mental Health, Dr. Ron Manderscheid has written hundreds of articles about mental health and substance use services. He continues that work today as Director, Mental Health and Substance Use Program for SRA, a provider of information technology and health consulting. He also writes a monthly column for Behavioral Health Care. Manderscheid's leadership branches to professional associations such as the American Public Health Association, and American College of Mental Health Administration for which he chaired the 2008 Summit. Since retiring as the chief of SAMHSA's Survey and Analysis Branch of the Center for Mental Health Services in 2005, he has been consulting and teaching.

Recently Manderscheid talked with MIWatch about his current involvement in the Whole Health Campaign, a coalition of 91 organizations working to influence a reform agenda for mental health and substance use care and programs.


Q: Can you describe the Whole Health Campaign?
A: WHC is coming together of major entities in mental health and substance abuse care fields to develop a common agenda going forward.

Q: What is the agenda?
A: There are three principles, and they are the basis of our advocacy. We want parity and universal coverage for mental health and substance use care; good integrated care for people who have these conditions; and good research that moves the agenda upstream toward prevention and early intervention.

Q: Do we need another advocacy organization?
A: Our purpose is to bring these 91 member organizations together to create a larger voice than any of them would have, and to span mental health and substance use care field in a way the individual organizations do not.

Q: Why is the reason for linking mental health and substance use?
A: In three important reports since 1999 there was an emphasis on problems of co-morbidity between mental health and substance use conditions. In 1999, ten years ago, Surgeon General David Satcher said the very next agenda is to achieve integration. In 2003 the President's New Freedom Commission on Mental Health said essentially the same thing. And in 2005 the Institute of Medicine viewed integration as the major agenda item going forth.

Pressing humanitarian, moral and medical reasons argue for integration. It no longer works for substance abuse care and mental health care to remain separate from primary care. So there's a huge push about this.

Q: Is there research about this?
A: My own research on those populations says that people already in care die 25 years younger than other people. People in public mental health care do not get basic primary care services that you and I take for granted.

Q: With the current financial crisis, do you think health reform will be postponed?
A: The next president can't afford not to look at health care reform. If done in a good way, it's a vehicle to actually control the growth of our expenditures in health care which in my opinion are near out of control. Now we have 10-12 percent rate of growth each year. When people with no insurance get care, they get the most expensive care. They go to an emergency room that costs as much as $2500 a day, and sometimes they stay there for four or five days.

Q: Can you give a specific example?
A: We know that one-third of the people who have no health insurance have mental health or substance use conditions. That's one-third of between 45 and 51 million. If we could get that person who now uses the emergency room insurance linked to a primary care provider so some of these basic problems are addressed upstream before they become acute, there would be less cost increases in the future.

We're going to have to start thinking that way when the costs of the bailout are going to be in the trillions in the next year or two. There will be no choice but to have some kind of health care reform.

Q: Are you involved in the '08 campaigns?
A: We wanted to get Whole Health Campaign principles into the platform of the Democratic Party and Republican Party. On the Democratic side we hosted an Obama event to discuss some of the major needs of these fields going forward. We talked about Whole Health Campaign, the principles, and completed an electronic submission to the Democratic Platform Committee.

Similarly on the Republican side. They had a slightly different process where you could submit written principles and many of our members submitted written comments.

At the end of that process we ended up with all three of our principles in the Democratic platform and two of the three in the Republican platform. We got in the principle of parity and the principle of prevention and early intervention. What we didn't get was integrated care.

Although the Republican platform talks about primary care, it doesn't talk about integrated care. It specifically recognizes the importance of good mental health care.

Q: Is this the normal procedure for bringing these issues to their attention?
I've been in the field a long time and have no awareness that the field has ever tried this before, that we tried to get the message of mental health and substance use there. Sometimes it would have something about mental health because someone on the platform committee was interested but there was never an organized effort before.

Q: You were at the conventions weren't you?
Yes, we had a wellness room at the Democratic Convention. We had wanted that at both conventions. By a wellness room we meant a place where someone could go if they felt the need to have respite, whether they felt it because they were drinking or were depressed or whatever, we wanted to create that opportunity.

We were successful in creating that opportunity in the Democratic National Convention in having the facility on-site where the convention was. In both instances we had an off-site facility, but only at the DNC did we have an onsite facility. They held a press conference, were able to give out materials. Tom Codere of Faces and Voices of Recovery went to Denver and was blogging. It was very successful.

At the RNC, it was the same concept and it wasn't as successful because it was off-site, but we are now in the early phases of asking how to create a tool kit for a wellness room in other places.

Q: How much of a barrier is stigma?
A: We were very pleased with what we were trying to do and the reception we got. Stigma has decreased. It's more okay to say "I drank too much last night." It's acceptable to say "I'm depressed" or whatever the situation for the person.

Q: And after the election?
A: It matters less who gets elected than the fact that this agenda is going to move ahead. Whole Health Campaign agenda fits very well into the national health care agenda.

Our third agenda item for 2008 is to craft the strategy for the next Congress and next administration. We're literally in the process of trying to put that together right now.

We need to come up with practical and operational. They can agree with the principles, but par tof our work going forward will be to define a small number of actions.

We've learned to be incrementalists. We've gone from a lot of hubris in the days of the Clinton health care looking for the perfect bill. A good example of working incrementally is the change we got this year in Medicare, the ambulatory co-pays. We were able to get it reduced from 50 to 20 percent over six years. They had to figure out a way to pay for it and it was much cheaper to do so over six years than if they did it all at once.

Financially we can't afford another four years and not do anything about this.


The Whole Health campaign welcomes new members. For information about membership, visit them at http://wholehealthcampaign.org

Transcribed and edited by MIWatch.

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