Mental Health and Civil Rights: The Kennedy Legacy
"Now the trumpet summons us again -- not as a call to bear arms, though arms we need--not as a call to battle, though embattled we are -- but a call to bear the burden of a long twilight struggle, year in and year out, 'rejoicing in hope, patient in tribulation' -- a struggle against the common enemies of man: tyranny, poverty, disease and war itself." -- Inaugural Address of President John F. Kennedy
Washington, D.C. January 20, 1961
I had the opportunity to interview Mr. Kennedy (PK) and Dr. Sacher (DS) at the second Kennedy Forum, a gathering in DC that considers the identification and effective treatment of mental and addictive disorders as a medical civil rights matter. In fact, when seen in that light more than the moral imperative comes into play: A combination of state laws on parity for mental health and the federal American Disabilities Act may mobilize the clout needed for change.
Here are some excerpts from my exclusive interview:
LS: Your Medical Civil Rights and ADA strategy is brilliant, humane and powerful. But there are those who will resist. Who constitutes the 'mental health industrial complex' whose interests don't align with yours?
PK: Insurance companies are too much in control. Which is why we are insisting that they have a "fiduciary" responsibility to those they insure; this means they need to be held to clinical outcomes not to the pursuit of their financial interests. They have to report on what they do for their subscribers, how health and mental health are improved.
DS: Morehouse School of Medicine is also focused on disparities in health care, how people of color don't live under the social and environmental conditions that allow for health and longevity and when they get sick they don't have proper access to good care. There is too much silence - too much that is unspoken. It is not a struggle by others, it is our struggle. I was arrested when I was a student protesting for civil rights - I got out of jail because Dr. Martin Luther King had also been arrested and Bobby Kennedy intervened. I got out of jail because of him and President Kennedy. That experience has sustained my hope and began my dedication to the work of the Kennedy's.
LS: Who are your (our) allies?
PK: We all see how education is curtailed, how general health is thwarted, how business productivity and success are compromised, how doctors can't do as well as they wish, how our jails and prisons are over-populated and our streets full of the homeless because we have been too silent about mental health. These are places where we can find allies - and of course with people who are ill, their families and the advocacy organizations they have spawned. Our work will be getting effective mental health care implemented, and we have so much to do.
DS: we have good models of care, particularly integrating mental and substance use screening and treatment into primary care practices. Leadership in advancing effective care strategies will help serve our aims.
LS: The ADA has incredible clout in changing organizational practices in this country. How will you capitalize on that clout? Can parity legislation have that clout?
PK: We can't let insurance companies behave like the banks did in creating toxic debt that led to the 2008 crash. We are preparing tool kits for states Attorneys General so they can see patterns of denials. NYS has had two successful suits against managed mental health companies. Patterns of care that can be tracked will also allow states and consumers to see which companies are doing right, and those that are not. We need to expose those companies who are not meeting the moral mandate; we need more than just financial penalties.
DS: We have strong evidence for what can help people with mental and substance problems. We can show how to help effectively but to do so we must stop discriminatory practices like lack of coverage, denials and poor access to treatment.
PK: First, we have to change practices. Changing attitudes may follow but we can't wait. We have to fight discriminatory practices then maybe minds will follow. Mental health has faced the same stigma, discrimination and injustice as the civil rights movement, as have people with HIV/AIDS.
LS: Is this a bit of a "moonshot?"
PK: We launched our campaign on the same date that President John Kennedy made his 'moonshot' speech, when he said the U.S. could put a man on the moon! We are passing through a new frontier. This is a race, however, to inner space. My father, Senator Ted Kennedy, liked to say we are making history by what we do and that is what we are doing today.
DS: I like to think as a former U.S. Surgeon General that we have a public health crisis, not just a mental health crisis. Public health is about the conditions in which people can be healthy. As I have said for a long time, there is no health without mental health.
LS: What will it take for parity of mental health and substance use benefits to be properly delivered? The law you led passage for, The Mental Health Parity and Addiction Equity Act, has been on the books for almost 8 years. Where do we stand? What's ahead?
PK: I am not at all satisfied with where the legislation is today. The administration in Washington, Health and Human Services (HHS), is not doing enough to make parity work. This is a political campaign! We will do what it takes to win.
LS: Thank you for your leadership, and that of your many compatriots. As you know, my day job is about improving mental health practices in my state. We all need your help.
Patrick Kennedy was a member of the U.S. House of Representatives from 1995-2010 and has been a leading voice on mental health, addiction, and brain diseases. He founded both The Kennedy Forum and co-founded One Mind for Research, which sponsors brain research and open collaboration among scientists.
David Satcher, MD, PhD, has been director of the CDC and was U.S. Surgeon General from 1998-2002. He is now the director of the Satcher Health Leadership Institute at the Morehouse School of Medicine.
The opinions expressed here are solely my own as a psychiatrist and public health advocate.
Dr. Sederer receives no support from any pharmaceutical or device company.
This article first appeared on Huffington Post on February 24, 2016.
Dr. Lloyd’s two new books are now available: Improving Mental Health: Four Secrets in Plain Sight (2016) and Current Controversies in Mental Health and Addictions: An Expert’s Anthology (2017)