A Mental Health Summit Meeting at the White House

In December APA participated in the White House Summit on Transforming Mental Health Treatment to Combat Homelessness, Violence, and Substance Abuse. I chose to represent APA knowing that our membership has very mixed opinions about this presidential administration, and some would have preferred that APA not participate. However, I feel strongly that we must not pass up any opportunity to advocate for our patients and for policies that address the failures and deficiencies of our mental health care system.

The group of speakers was diverse, and much credit belongs to Dr. Elinore McCance-Katz, assistant secretary for mental health and substance use in the Department of Health and Human Services (HHS), for putting together an excellent program. I’d like to highlight some of the most impactful presenters as there is much to learn from their points of view.

D.J. Jaffe is the executive director and founder of the Mental Health Policy Organization. He is a long-standing advocate for people with serious mental illness (SMI) and believes the mental health system is failing to serve these individuals. Homelessness, incarceration, and violence characterize their existence. Forty percent of people with SMI receive no treatment, 140,000 or more are homeless, 400,000 are incarcerated, and 750,000 are on probation and parole. There are 10 times as many people with SMI in jails and prisons than in hospital beds. He believes we should be messaging the truth that it is the untreated people with SMI who are at risk of violence, and it is not stigma that stops them from seeking care but rather the unavailability of treatment.

For those of us who care for these patients, we know there are not enough hospital beds, we are not able to keep patients hospitalized long enough, and outpatient resources and alternatives for housing are dangerously inadequate. Mr. Jaffe took aim at the legal system, which advocates that individuals have the right to choose to be psychotic and delusional and that right must be protected. Nowhere else in medicine is imminent dangerousness to self a consideration for acute care rather than the illness requires immediate hospitalization for effective treatment. All clinicians have been in the situation where we know someone needs hospitalization but does not meet the requirement that they are a danger to self or others. We really do not have mental health parity as long as this different standard exists!

John Snook, executive director of the Treatment Advocacy Center, followed up on these themes and spoke of the preventable tragedies brought on by restrictive laws and the absence of a full continuum of services. Sheriffs and other law enforcement officers spend 20% of their time responding to and transporting people with SMI at an annual cost of over $1 billion. I think it was especially significant that Alex Azar, secretary of HHS, and Ben Carson, secretary of Housing and Urban Development (HUD), participated in the summit and discussed their efforts to bring more federal resources to addressing these crises. It is an indication that mental health and substance use are now high priorities for their agencies. It is HHS and HUD with which APA needs to advocate especially hard to secure more resources directed to helping people with SMI and substance use disorders.

President Trump addressed the summit as well. His remarks were focused on the crisis regarding the lack of access to care, and he thanked attendees for their participation in the summit and efforts to care for people with SMI.

There have been many federal mental health committees, task forces, and reports over the past six decades, yet still we have not made enough progress. But one of the last speakers was Kellyanne Conway, assistant to the president and senior counselor, who made a very important point that should give us all hope. Despite today’s rigid political lines, on Capitol Hill there is one topic on which Democrats and Republicans overwhelmingly agree: We have a mental health crisis in this country, and it’s time to take steps to resolve it. Let’s hope partisanship doesn’t prevent real progress. ■