Click here to listen to the audio.

Scroll down to the bottom of the page to view a special video from Mrs. Carter about the
Carter Center's efforts to fight stigma and improve mental health treatment.

By Robin Jay, BHC Editorial Director

With uncanny timing, health policy experts at the 25th Annual Rosalynn Carter Symposium on Mental Health Policy wrapped up productive debate on solutions to restructure the broken behavioral health system just as the House of Representatives prepared to vote on an historic floor vote on its healthcare reform bill.

On November 5 and 6, more than 200 mental health advocates, policy-makers, practitioners, educators and researchers from around the country gathered with former First Lady Rosalynn Carter to hold expert panel briefings on "Healthcare Reform Challenges and Opportunities for Behavioral Healthcare." The Rosalynn Carter Symposium on Mental Health Policy is part of The Carter Center’s Mental Health Program, which works to reduce stigma and discrimination against people with mental illness, as well as promote positive policy change on mental health issues.

Mrs. Carter welcomed the Symposium attendees. “In 1985, I envisioned bringing the nation’s mental health leaders together to work cooperatively. Our gathering remains the only opportunity for such diverse groups to convene and discuss the issues at hand,” Mrs. Carter said. “I am honored by the esteem in which the symposium is held and proud of all that we together have accomplished. The field of mental health has changed dramatically in the last quarter century. We have learned so much about mental illnesses and how to treat them. Most importantly, we know that most people can recover from mental and substance use disorders and lead fulfilling lives. Yet stigma continues to be an obstacle, and we have a tremendous amount of work to do to ensure that everyone receives the mental health services and medical care they need. In the 25th year, let us celebrate our partnership and renew our commitments to improve the lives of all those who summer from mental and emotional disorders.”

Keynote speaker and national health policy expert Dr. Kenneth Thorpe of the Rollins School of Public Health at Emory University spoke on “Important Issues We’re Not Hearing About in Healthcare Reform.” Dr. Thorpe addressed the need to modernize the infrastructure of healthcare delivery with one that focuses on chronic disease management, preventive medicine, moving away from fee-for-service payment systems to bundling for better integration, improved care coordination, treatment for co-morbidities (such as obesity), and sifting from a —our presently fragmented system to an integrated model that treats the whole person. Dr. Thorpe called for payment reform, and evidence-based care with a focus on outcomes analysis.

A common theme at the panel discussions was the patient-centered medical home. Research shows that many patients seen in primary care setting also suffer from behavioral or emotional health problems, such as depression, anxiety or substance dependence. According to The Carter Center, under the medical home model, the patient is supported by a team of health care professionals who share responsibility for the patient's health. Medical homes can strengthen the primary care system by replacing poorly coordinated, illness-focused, episodic care with a coordinated primary care-led delivery system focused on the whole person.

On the second day of the Symposium, Mrs. Carter sat down with Behavioral Health Central for a conversation about on the important issues at hand. To listen to our interview, click on the media player, or read the transcript that follows.

BHC: Mrs. Carter, thank you for having us here. This is a tremendous event. Mrs. Carter, this is your 25th Annual Symposium on Mental Health Policy and you have been a champion of mental health ever since you were a First Lady of Georgia and First Lady of the United States. How did you become passionate about advocating for mental health?

Rosalynn Carter: Well, I have worked on mental health issues for a very long time. I became interested while campaigning for my husband for governor. When he ran for governor the first time he was defeated. I don’t think a lot of people know that. There had been a big exposé of our central state hospital, a big institution, and its conditions were terrible.

Then, not long after that, the community mental health center site was passed and they were moving people out of institutions, all over the country, [and] into the communities. The intent was good — to be able to treat people at home — but the problem was that the community centers were not built before they started moving people out of the institutions. And everywhere I went campaigning, I had people say to me, “What would your husband do about my mentally ill son or daughter, mother, loved one, who is in the state institution?”

Well, I became really concerned because it was everyday that I campaigned, so when I asked Jimmy what he was going to do about people with mental illness he said, “We’re going to have the best program in the country and I’m going to put you in charge.” And somebody heard him say that to me because I knew nothing about the issue. And of course he did not put me in charge, but he appointed a Governor’s Commission to improve services to the mentally and emotionally handicapped.

And then I became really interested when I saw the situation and very few people who would admit that they had mental illness or that they had a family member with mental illness. Nobody would talk about it. It was hard to get people to help. There were five people in the Atlanta area that I could work with who were really even interested in about the issue. I just was so touched by the problem and the needs that I campaigned and I talked about it, and then Jimmy appointed the President’s Commission, and now we have a really good program here at The Carter Center.

BHC: In fact, yesterday, Mrs. Carter, on opening day of the 25th Annual Symposium, one of your distinguished panelists noted how a single voice — your single voice — has made such a beneficial impact on mental health. What would you say are the legacies from the Rosalynn Carter Mental Health Task Force that you’d most like to have in recorded history?

RC: Well, I have tried to overcome the stigma that holds back progress in everything we have tried to do over all these years. It is still persistent. I think that for the first time since I’ve been involved, it’s beginning to lift just a little bit, but it is still devastating to people. I would wish that we could do away with stigma totally. There should be no stigma.

One thing that continues is the separation in healthcare — mental health on one side, other health problems on the other side. There should be no distinction. I can understand the separation in the past because we knew nothing about the brain and nothing about what causes mental illnesses or how to treat them. And so, it has a history of terrible treatment — not even trying to treat people because they didn’t know how, putting them away, and that has lingered.

But now, today, with what we know, there should be no separation. Mental illnesses are biological like all other illnesses. Even now with parity — we’re so thankful that it passed. One of the things that I hear coming up in the planning sessions on implementing parity is that they might possibly have one set of funding for mental illnesses and another that the insurance companies cover. This is so distressing to me. We have a lot of work to do.

BHC: It still maintains those silos and not integration.

RC: It has to be integrated.

BHC: So many of your panelists mentioned yesterday that, in essence, everybody is co-morbid. It seems that the propensity of chronic disease, which is causing the highest impact on healthcare costs, almost always involves some sort of mental health issue that goes along with the health condition. Mrs. Carter, if parity and healthcare reform intertwine and bring about the integration through a medical home process, do you think the fact that mental illness will be a covered benefit for more people will help ease the stigma?

RC: Yes, I think it will help, because for years now we in the mental health field have been following companies who had insurance coverage for mental health issues for their employees. And it’s really interesting to see what happens because for awhile after they provide the insurance coverage people don’t go for treatment. Then one will go and then maybe another few will, and then once a few start going, it just becomes the natural thing to do. I’ve seen it happen so often in companies. We have a great company in Columbus, Georgia [that is seeing this happen.] It’s so wonderful to see what happens when people accept it as an illness like any other illness and go for treatment and recovery because today people are recovering everyday and living productive lives.

BHC: Mrs. Carter, the theme of this year’s Symposium is “Healthcare Reform Challenges and Opportunities for Behavioral Healthcare. What are some of the key elements that are highlighted at this conference that are needed for the transformation in mental healthcare?

RC: I think integration is one of the important ones. I think there are so many myths and misconceptions still about mental illnesses and I think to overcome those myths and misconceptions is to educate people and let people know that people with mental illness are people like anyone else. Sometimes, their thoughts may be affected — their thought processes — but they have hopes and dreams and feelings. Even those with very, very severe mental illnesses, they’re just like we are with hopes and dreams for the future, to have a good life. And I think when we begin to recognize that — that they’re like everybody else but they just have an illness; they might have to take their medicine all of the time, just like someone with diabetes or high blood pressure — there’s no distinction.

I think if we could bring together behavioral healthcare and primary care with prevention and promotion (and behavioral health is mental health and substance use) and I think it can just make all the difference in the world with how people begin to feel about those others around them with mental illnesses. It will also help how people with mental illnesses think about themselves, and the relationships, as you probably have heard from this Symposium, is what makes so much difference — if people are treated with respect, which is the most important thing: with respect, just as you would treat anybody else.

I have worked so hard, for so long, to try to get primary care and behavioral care together, and it’s exciting now because now we’re talking about integration. There is a statistic that showed that people with mental illness die 25 years younger. And I think that brought home how important it is that primary care and mental health are together.

So, integration is the most important thing I think a community can work on for healthcare reform. And that means primary care, behavioral healthcare and also promotion of mental health and prevention of mental illness.
 

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