Speech given at Grand Rounds, Department of Psychiatry
Dartmouth Hitchcook Medical Center
Thursday, January 14, 1999
Good afternoon and thank you, Dr. Silberfarb for the kind introduction
It’s great to be in the Granite State again. I am especially glad to be here at Dartmouth Medical School to talk about an issue that affects millions of Americans and matters to us all: mental health. I say this because the Dartmouth-Hitchcock Medical Center is leading the way in our ever expanding knowledge of the connections between physical and medical health. Your efforts here are breaking new ground every day and helping so many people live fuller, healthier lives.
As we celebrate the 50th anniversary of Mental Health Month this May — as well as the last year of what has come to be known as the ‘Decade of the Brain’ — I believe we are finally turning the corner on how we, as a nation, view and treat mental illness. But I also believe that we still have a ways to go.
I want to talk to you today about what I believe we must do as a nation — and what the Clinton Gore Administration is doing — to help more Americans with mental illness reach their full potential, and to fight the stereotypes and stigmas that for too long have been directed at people with mental illness. Especially now, at the edge of a new millennium, in a time of great prosperity, I believe every one of us — at every level of government and in every community — have an obligation to do our part to meet this challenge.
President Clinton recently received a letter from an 8-year-old North Carolina girl named Lacey. She wrote about her father, who is schizophrenic, and often gets lost on the street. She wishes he had the food, shelter, and medication he needs to get better — and she hopes we can help.
The President received another letter from a man named James, who described how mental illness has made him feel different from other people. As he puts it, mental illness has caused him to live with “the fear of rejection on a day to day basis.”
These are just two stories in a virtual encyclopedia of experiences shared by millions of people with mental illness. So what are we to do?
We must start by being honest and open about the problem of mental illness. When I first approached this subject, one of the things that confused and confounded me was why mental illnesses couldn’t be discussed publicly. I didn’t understand why mental illnesses were often trivialized as passing personality issues, dismissed as character weaknesses, or not acknowledged at all. Why weren’t these disorders the focus of scientific attention in the same ways as cancer or heart disease? Why weren’t they covered as other illnesses are covered under health care plans? And why were we so afraid to talk about them?
Amazing breakthroughs in science are teaching us much more than we have ever known about how genetic, social and environmental factors come together to cause mental illnesses. More and more, we understand that the brain is an organ of the body that can sometimes break down — just like the kidneys, or the heart. And mental illness can be as debilitating as a stroke and as life threatening as cancer.
Let’s face it: when you break your leg, you go to the emergency room. When you feel a pain in your chest, you get to the doctor. But, unfortunately, too few people seek treatment for mental illness — fearing the shame and stigma attached to these disorders. This is particularly ironic, because both research and experience have shown us that mental illnesses are treatable, often more treatable than common physical ailments. To give you just one example, only 41% of people treated for heart disease with balloon angioplasty make a full recovery — but 80% of people with bipolar disorder — or manic depression — are treated successfully.
Yet, despite the many advances we have made in treating mental illness — with new drugs, less institutionalization, and better community health services — mental illness continues to be treated differently from physical illness. This in turn leads to more misunderstanding, greater stigma and discrimination, increased reluctance to seek help, and greater disparity in insurance coverage. It’s a vicious cycle, really — but we can do something about it.
President Clinton and my husband, Vice President Gore have worked hard to change this, and I have been proud to work with this administration to draw attention to this problem.
Over the past six years, we have accomplished a lot. We fought for passage of the Kassebaum-Kennedy bill to help people keep their health insurance when they change jobs — and to help ensure that people with pre-existing conditions cannot be denied coverage.
We fought to make sure that our historic Children’s Health Insurance Program, which will help provide coverage for up to five million uninsured children, included a strong mental health benefit. Health care — including mental health care — is essential to assure that our children grow up healthy and strong and ready to learn.
We continue to fight to make sure that people with mental illness get equal treatment — and equal coverage — by public and private health care programs and insurers. I was proud to work for passage of the Mental Health Parity Act in 1996, and I applaud what you have done here in New Hampshire to pass even stronger protections.
We have made historic investments in research and development that are leading to some of the remarkable breakthroughs made here at Dartmouth and around the country. Later this year, the Surgeon General will issue the first-ever report on mental illnesses. This report will document how widespread mental illness is in our nation and help provide a roadmap to move forward.
But you and I know that these are just the first steps. When people like Lacey’s father still don’t have access to the treatment that could help them lead more productive lives, when men like James still feel like second class citizens because they have mental illness, when countless Americans are reluctant to seek treatment because they are afraid of the shame and stigma, we know that we must do more.
Just yesterday, the President and Vice President unveiled a series of new steps to help people with disabilities, including mental illnesses, return to work. The President’s budget includes landmark legislation proposed by Senators Jeffords and Kennedy that helps remove one of the greatest obstacles people with disabilities face by ensuring that they can keep their health insurance when they enter the workforce. Americans with disabilities should never have to choose between the dignity of work and the health care they so desperately need — and with this legislation, they won’t have to.
The Administration also just unveiled a new long-term care initiative that is critical for people with mental illnesses — and for the millions of caregivers who frequently experience depression and other illnesses. Not long ago, the Vice President and I visited an adult day care center in Sacramento where we learned that an astonishing 60 percent of the family members and other caregivers who relied on long term care in California suffer from depression. Our Administration’s initiative is designed to provide critical financial support for these families through an $1,000 tax credit and a new National Caregiving Support Program that provides a range of support services — from counseling to respite care.
We are also continuing to fight for a strong enforceable patients’ bill of rights that ensures Americans have access to quality health care. Our bill of rights says that Americans have the right to see specialists for the care they need; they have the right to keep their doctor throughout a course of treatment; and they have the right to appeal a health plan’s decisions. People with mental illness often need these protections more desperately than anyone else — and our patients’ bill of rights will give them that security.
And there is even more that we have to do to fight mental illness and the stigma suffered by too many people. Today, on behalf of the President, I am announcing three new steps that the Clinton-Gore Administration is taking to meet this challenge.
First, we must improve access to prevention and treatment that we know can work. The President’s budget includes the largest increase ever in the mental health funding for states. This increase will enable them to launch innovative community-based programs that reach the most vulnerable populations among those with mental illnesses — children, minorities, and women.
Second, we must work to eliminate discrimination for people with mental illnesses — from health care systems to the workplace. The President has directed the Office of Personnel Management to do more to hire people with disabilities in the federal workforce. Today, we are taking another step by ensuring that people with mental illness are considered under the same standards as people with physical disabilities.
Third, we must develop new strategies to eliminate stigma and improve care for people with mental illness. That is why I am pleased to announce that this spring we will hold the first ever White House Conference on Mental Health.
This historic conference will bring together people from the mental health community — from mental health providers, to advocates, to people with mental illness and their families — with community and state representatives, private sector entities, and foundations from around the nation. Together, we will explore the barriers we face and the best way to tear them down. We will highlight promising practices around the country that are working to fight discrimination, put an end to stigmas, and improve prevention and treatment. And we will explore the next steps the public and private sector can take to do their part.
Both President Clinton and my husband often say that we don’t have a person to waste. The steps we are taking today — and the work we must continue to do — will help ensure that people with mental illnesses can make the most of their lives. That in turn, will help us build a stronger nation for the 21st Century. And I thank you for being an important part of that effort.