Like most Americans, I am caught up in the excitement of a new administration and the hope that our new President will guide this country well. One of the issues I focus on, of course, is his stance on health care, particularly behavioral health care. President Obama has a good track record of being an advocate for mental health and has been a strong supporter, along with the managed care industry, of establishing parity, that is equivalent benefits for mental health and substance disorder treatment in all health insurance. I wonder if you were surprised that the managed care industry, as I mentioned in the previous sentence, was also such a strong advocate and supporter of the parity law recently passed by Congress?

I, too, am very concerned about the fact that upwards of 40 million Americans or more currently do not have adequate health care coverage. No one that I know of disagrees that we must make this a priority to ensure that everyone in this country has access to affordable, quality health care. What I am worried about is the direction that the country might take in response to this problem. Clearly there is the belief growing out there that for-profit companies are “taking money out of the health care system.” I have to tell you that working for a managed care company is kind of like wearing a Velcro suit all the time.  If it is negative and one states/writes it about managed care, then “of course it must be true.” Anything negative just sticks without regard to facts or data. Conversely, if you are a non-profit company, you get to wear the Teflon suit since accusations of waste or misspending rarely, if ever, stick. I know, because I have worked for both profit and non-profit health care entities.

First of all, “non-profit” is simply an IRS tax code distinction. It does not mean that non-profits spend all the money on health care costs, nor that they don’t make a lot of money. One only has to see, (when you can even get a glimpse of non-profits’ financials since they are not required, nor do they make public their financials), some of the huge medical and behavioral health systems reserves held by some of these massive non-profit companies. Second, I challenge anyone to find an industry MORE regulated than for-profit health care. The scrutiny and oversight simply is not there for non-profits.  In contrast, my parent corporation discloses publically it’s financials on a regular basis and is heavily over sighted by agencies like the SEC and Sarbanes-Oxley. Our industry is so regulated that even the size and type of font for some of the information we send to members is proscribed by regulation.  Third, we pay taxes, not only back into the federal system, the same system that pays for public health care, but also locally wherever we operate, to states and communities.

And finally, is it really true that because of profits, that for-profit companies take more money out of the system and are less efficient? A report recently released by the McKinsey Global Institute in December, 2008 reports that U.S. health administration and insurance costs account for 7% of overall spending. And, when you take out private, employer paid insurance, and look at the administrative costs for the publically funded system (Medicare and Medicaid) we are at 6% of overall spending.* In other words, 94 cents of every dollar is spent on health care delivery and treatment.  Other countries spend about 4% but these government plans severely limit choice on when and where you can be seen by a health care provider, what drugs you can take, what procedures and tests you have access to, etc.

Look, I am not trying to say we should not be looking at reducing costs, or that all non-profits are wasteful and not accountable in the same way that for-profit companies are. I would just like to see an end to these broad brush depictions of both non-profit and for-profit health care companies.  Under this new administration, I hope to see a more informed American public, looking at all the facts, looking at data, and not leaping on 10 second sound bites about the sins of for profit health care companies. I hope to see the same scrutiny applied to non-profits as are applied to for-profit health care.

Time for me to put on my Velcro suit and get back to work!

*”Accounting for the cost of US health care:  A new look at why Americans spend more”, December, 2008, McKinsey Global Institute

This entry is filed under Blog.

Many people who work in the behavioral health industry struggle with seeing the human experiences that connect each of us compared to the challenges and struggles that the people we serve overcome.

Last month I came across an editorial in the January 2007 issue of Psychiatric Services regarding recovery being an opportunity to transcend our differences. In the editorial, President of the American Association of Community Psychiatrists Wesley Sowers, M.D. states, “(w)e all have something to recover from, whether it is mental illness, addiction, physical disability, loss of loved ones, victimization, or loneliness. The list could go on.”1

Recovery is a common human experience. In order to overcome any of the challenges mentioned above we must use similar strategies to move forward in our recovery.

We need to appreciate that the challenges we face are no different from the challenges that face the people we serve.  For any of us to move forward we have to have hope and the belief that things will get better. It is with that hope and belief that people find the courage to accept responsibility for taking the necessary steps to move forward in their recovery.

When people recover from any of the challenges that life puts in our path we become part of a community in which we share the human experience.

As people who work in the behavioral health field and people who have received services move forward in their recovery it is important to remember the common human experience we all share.

People have stated that recovery from mental illness is different than recovery from substance abuse which is yet different from recovery of many of the challenges mentioned earlier. No matter the challenges that all of us face, the truth of the matter is that recovery from anything connects us to one another if we allow it to happen.

Recovery does not discriminate because of race, ethnicity or creed.  Recovery joins us in our common humanity. Dr. Sowers concludes his editorial with the following “(i)f we fail to recognize this capacity for recovery to unite us, we will have squandered a great opportunity to integrate our highly fragmented and siloed service systems. If we fail to understand that we are all engaged in a similar struggle, we will miss the opportunity to empathically engage those who seek comfort and hope.”1

As a person who has recovered from a serious mental illness, I continue to believe that “Together We Can Inspire Hope for a Better Life”.

Tom Kelly
Recovery and Resilience Advisor
Cenpatico Behavioral Health of Arizona

1. [(http://ps.psychiatryonline.org/cgi/reprint/58/1/5 retrieved December 4, 2008. PSYCHIATRIC SERVICES ? ps.psychiatryonline.org ? January 2007 Vol. 58 No. 1 (Taking Issue page 5)]

This entry is filed under Blog.

Linda Weinberg went where she wasn’t wanted and made a difference.

Suicide has been a major problem in Native American communities for decades. According to the Centers for Disease Control and Prevention (CDC) suicide rates among Native Americans have been more than double the general population. As recently as 2003, suicide was the second leading cause of violent death among Native Americans aged 19 or younger behind car accidents. In one tribe, three 12-year old girls committed suicide in a month.

“There are a lot of factors that can contribute to high Native American suicide rates,” Weinberg said. “There are problems with substance abuse, isolation, lack of employment, lack or resources, and the trouble of living in two worlds: Tribal and non-Tribal.”

Weinberg has been with Cenpatcio Arizona as Policy Developer for 3 ½ years. She knows and understands the problem suicide has been in the Tribes in her area and knew she had to help make a difference. “There was no prevention department,” Weinberg said. “There were no enrollment, and no diagnoses services in the tribal areas.”

Tribes can be very protective of their people and their lands. Outsiders aren’t always welcome or trusted; especially those who wish to discuss and help solve a very taboo problem like suicide. This is a fact not lost on Weinberg. “I had to be invited onto Native Lands,” she said. “I learned about each culture and made sure to be seen to prove that I could be trusted. People of any culture want to see that you want to learn and will keep your word. I had to learn who my supporters were and build upon those relationships.”

Weinberg was able to secure funds from the Arizona Department of Health Services (ADHS) for suicide prevention services for the Maricopa Ak-Chin and the San Carlos Apache Nations.

She identified the type of services the Maricopa Ak-Chin felt were needed and got permission to bring services in the form of Critical Incident Stress Management Training and Applied Suicide Intervention Skills Training. She went to Columbia University for training to be able to teach Teen Screen to behavioral health and school personnel so they could screen youth who may be at risk for suicide and trained personnel who worked with youth from each the Maricopa Ak-Chin, San Carlos Apache, and Gila River Pima Tribes.

At San Carlos, Weinberg works closely with the Wellness Center and the Vice Chair of Tribal Council to identify services to meet the Tribal needs and has contracted for training of school personnel, detention center staff, behavioral health, housing department and other Tribal Departments. She also contracts with the Tribe for a public education campaign, the training of caregivers (including all materials) and works with the Tribe on infrastructure development for more staff to be trained to conduct suicide prevention training and debriefing after a critical incident.

In part because of Weinberg’s work, Native American Suicide rates in Arizona dropped below the state mean for the first time in Arizona history. In September 2008 Weinberg was awarded for her works with the Native American Suicide Prevention/MBrace Life Award.

“Change takes a long time,” Weinberg said “When you see the stats and see the changes in a community … rewarding isn’t a big enough word to describe the feeling.”

This entry is filed under Close Up.

And you ask me what I want this year
And I try to make this kind and clear
Just a chance that maybe we’ll find better days
Cuz I don’t need boxes wrapped in strings
And desire and love and empty things
Just a chance that maybe we’ll find better days

-Lyrics from “Better Days” by the Goo Goo Dolls

I’m sure like many Americans, you have been reading about the decline in retail sales, and even the recent news that not only are we spending less, but actually, for the first time in about 50 years, paying down debt. I guess this is a mixed bag for our country. On the one hand, it is bad news since our economy is so driven by consumerism. But on the other hand, it is good news that maybe, just maybe, we are examining our attachment to things, our culture and an economy based on spending. It just cannot be a good thing to have a national economy based on buying stuff and, worse, doing so on borrowed money. I, too, have gotten caught up in buying more things, getting attached to things, and then like most Americans, ending up throwing these things away resulting in an added consequence to our environment.

I think we must all be waking up as if it were the next morning after a wonderful party which involved too much eating and drinking. We have fond memories of the good times but are shocked at how unwell we ended up feeling the next day. I know that times are grim for many Americans now, but I have such hope that our personal sober reflection of how we ended up in this mess will bring us back to what is truly important in life. As you look around at all that you have accumulated, no matter how much or little you think you have accumulated, I wonder if you have the same thoughts that I do lately. None of it is really important, and I could live happily with just about all of it gone. What I know I cannot live happily without is my health, my family and my friends.

What is the true meaning of the Christmas season? Hope and renewal, not gifts, not buying more things. It is an opportunity to reflect on our values as a society and hope that we will all find renewal as a nation next year.

From our employees and myself at Cenpatico, we are wishing you the very warmest and joyful holiday season.

And, here’s to better days for all of us in 2009!

This entry is filed under Blog.

There is no medicine like hope, no incentive so great, and no tonic so powerful as expectation of something better tomorrow.
– Orison Marden.

A common question in our field is why do some people with mental illness or substance use disorders recover, and others do not, even with the same support and treatment interventions. As a young man working on my Ph.D., I decided to tackle this very question in my dissertation by focusing specifically on the phenomenon of “hitting bottom” in alcoholism. What I found in my study, and find in almost all studies on this subject today, is that the difference between those who successfully began recovery from alcoholism and those who did not focused on two factors. One, relationships with peers who were successful in their recovery pointed to the fact that isolation often means death for those with mental illness/substance use disorders. Two, in specific, those relationships were people who could successfully help the person suffering begin to imagine for themselves a better future or outcome for their life.

In other words, Hope. “Inspiring hope” is not just some cute marketing line at Cenpatico. Those of us in the behavioral health field understand that if our consumers have hope for a better life, they can and will recover. It isn’t complicated at all, and it often takes very little. And isn’t hope for a new beginning the very message of this season?

I would like to hear from you. Tell me where you have seen the power of hope help someone recover?

This entry is filed under Blog.