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Finding Courage Through Mental Health Struggles w/ Former Congressman Patrick J. Kennedy


Recent political events have brought mental and cognitive health into the national spotlight.


As more Americans confront mental health crises, the urgency for both heightened attention and effective treatment solutions has never been greater.


According to MentalHealthAmerica, nearly 20% of adults are currently experiencing a mental illness, which translates to approximately 50 million Americans.


In our latest episode of CareTalk, David E. Williams and John Driscoll welcome Patrick J. Kennedy for a compelling discussion on the complex and escalating challenges of mental health in the US, exploring their intersections with current political events and insights from his new book, Profiles in Mental Health Courage.



This episode is brought to you by Matrix Medical Network. Matrix Medical Network is an independent, at-scale provider of comprehensive in-home health assessments.


The company’s national network of nearly 3,000 clinicians delivers comprehensive, personalized care for Medicare Advantage, Managed Medicaid, and Commercial patients across all 50 states.


Care visits include diagnostic testing, risk identification, medication management, and tailored lifestyle improvement plans.


Download Matrix Medical Network's White Paper: "Improving Health Equity Through Whole-Person Care" 👇 https://www.matrixmedicalnetwork.com/whitepaper-improving-health-equity-through-whole-person-care/


Episode Transcript:


David E. Williams: Former Congressman Patrick J. Kennedy is out with Profiles in Mental Health Courage, a new book that portrays the stories of resilient Americans living with mental health challenges and addictions. What can we learn from these courageous people and what are the implications for mental health policy?


This episode of Care Talk is brought to you by Matrix Medical Network. Matrix Medical Network pioneered the first national in-home clinical network nearly 25 years ago. And today is an independent provider of in-home health assessments serving people across the nation. The company's national network of nearly 3000 clinicians delivers comprehensive personalized care for Medicare Advantage and Medicaid.

manage Medicaid and commercial patients across all 50 states. Care visits include diagnostic testing, risk identification, medication management, and tailored lifestyle improvement plans. Welcome to Care Talk, America's home for incisive debate about healthcare business and policy. I'm David Williams, President of Health Business Group.


John Driscoll: And I'm John Driscoll, Senior Advisor at Walgreens.


David E. Williams: Today's guest is the Honorable Patrick J. Kennedy, making his third appearance on CareTalk. We're here to discuss his new book, Profiles in Mental Health Courage, and of course we'll get his take on President Biden's momentous announcement. Meanwhile, join the fast-growing care talk community on LinkedIn, where you can dig deep into healthcare business and policy topics, access care, talk content, and interact with the hosts and our guests.

And please be sure to leave us a rating on Apple or Spotify while you're at it. We love those


John Driscoll: ratings. So Patrick, what is your take on the president's momentous decision to step aside and the, the, the, the enormous momentum around Vice President Harris?

Patrick J. Kennedy: Well, first when I first got sober and My stepmother, Vicki, hosted a engagement party for me and Amy and all of her family down in Washington in my dad's old house.


Then Vice President came, Biden came over and he said to me, I know your dad can't be here, so I'm here. And I also want you to know how difficult I know it is to recover and anything you need, I'm here for you. And Shortly thereafter, as you know, my sister Cara died, and Joe Biden was there to give the eulogy.


So, I could just tell you, personally speaking, I love Joe Biden, aside from all the amazing years of public service. I Absolutely. I'm so grateful for him as a human being. And of course, as a mental health voter, and I want to make that clear, part of my whole mission is to create a special interest movement, much like we have every other special interest group in Washington, but to do it for mental health and addiction in much the same way we do a chamber of commerce or an AFL CIO.


We just have not learned the lessons of other sophisticated advocacy groups. So if, if I were to evaluate Biden, I'd say he's the best president we've ever had on mental health and addiction. He's put more money in. He started the Certified Community Behavioral Health Centers and right now of interest to your listeners, he's about to release the most powerful rule in the 15 years since we passed the Mental Health Parity and Addiction Equity Act to enforce that act.


And so you know, obviously, I think, We also want to have good mental health going forward for the next four years. So I, I'm happy that he made the decision he did because our mental health as a nation wouldn't fare very well under a President Trump presidency. And I'm not just talking about the fact I served on the Trump presidency.

Opioid commission governor Christie. I live in New Jersey and I was a good friend and had me on but Trump never showed up to any one of those commission meetings, not one, even though at that point we were still spiking in terms of overdoses and he had Roy Cooper. He had Governor Baker, Governor Cooper, he had all of these governor.


Christie didn't bother. To show up once, so furthermore, he put no money. Mulvaney put no money into solving this problem. So, even though, like all of us, he has a personal experience losing his brother to alcoholism. And by the way, there's no difference. It's alcoholism, opioid stimulants. You know, these are diseases that are multifaceted, all of which share the same necessary solutions.


But it says a lot that it's not just the fact that he hasn't put any effort behind policy. He also hasn't he, he creates an environment that's mentally toxic to so many people because of the, you know, just the tenor of the politics when he's kind of spouting off and going after groups and, you know, marginalizing people and attacking people with disabilities and attacking.


It's just not good for the mental health of our country. So for a lot of reasons,


John Driscoll: actually take a position on this for, for no show, no money for mental health, Trump.


Patrick J. Kennedy: Yeah. I mean, obviously I think if it should be. Kamala Harris will have time now to start to put together the kind of campaign that thankfully I think will give him a clear competitive you know, opposition, credible opposition in November, and he can no longer count his chickens before they're hatched because they aren't, and I don't believe the American people at the end of the day are going to want to, you know, Cosign all of that that he's brought to the table, but that doesn't mean we don't have our work cut out for us.


And as a mental health advocate, I'm looking forward. And the reason we put in the Kennedy forum, a comprehensive policy agenda together. So there wasn't 1. And we now have a curated by every committee in Congress, just like any other special interest group would, and we're ready to download it for her team so that she can pick up the ball.


People care about this issue, but as you know, John, I found it difficult when they do care about it to make sure that they know what their road map is. If they care about this issue, we now have the road map. At the Kennedy board,


John Driscoll: I want to, I want to get back to the importance of that rule, but, you know, having established cognitive capability as a standard for Qualification for the presidency with a new race in hand.

Do you think it's fair to hold Trump to a standard of of cognitive competence?


Patrick J. Kennedy: Well, you know, you know, the Goldwater rule is that you don't diagnose people from afar So I'm not going to do that. I'll let professionals, you know, say what they will. I will say that I, I don't think he was cognitive in President Biden.

I just think that he, you know, he's at this age, caught up to him. And I, I would go, I have a very elderly constituency in Rhode Island, and I would go to senior centers. Where there are people good deal younger than Joe Biden, you know, sitting in their chairs doing bingo in the afternoon. I mean, God bless Joe Biden.


He's been able to keep up an incredible pace and, you know, he'll go down in history as one of the most effective presidents we've ever had. So but you know, at the end of the day, you run up against, as they say, father time and he did, and he was good enough to recognize it and pass the baton and certainly Kamala's.


I think as a former prosecutor, as someone who will just wipe the floor with Donald Trump in a debate. I think if he's smart, he'll avoid it. I hope not because I want to see this happen. But yeah, we're going to be in good shape. I think in November, we're going to have to mobilize our base. And I think Kamala does a good job at that.


David E. Williams: John, I'll ask you to put your John, I'll ask you to put the question on ice until Nikki Haley shows up for our show and we'll, we'll ask her about that.


John Driscoll: I just, I just think it's a, the reasonable standard for one candidate is a reasonable standard for the other. But Patrick, maybe you could talk. I want to reverse the tape a little bit.


I don't think people understand how weakly we've enforced it. Parity and how consequential the new rule is. Can you maybe describe a little bit about how big an opportunity it is and how important that what that rule really means for people wanting equal access? To mental health treatment and care


Patrick J. Kennedy: So I have worked with the insurance companies for years and basically tried to say Much in the same way that John McCain and you know, Oran Hatch would tell my dad.


He didn't understand My dad would tell them that They don't understand. But at the end of the day, they would come up with something that both of them could sign off on and pass for the good of the country. I tried to say to them, you know, we're into a new world. You know, if you thought me too was a wake-up call or black lives matter is a wake-up call.

Guess what? When you keep going in the way that we have historically, where we marginalize mental health and addiction treatment, and we pay for it in a substandard way, and we force people to jump through all kinds of hoops that we would never force them to do if they had another illness, you got to fix it.


And at the end of the day, for the benefit of. You know, reducing costs, we know that mental health is the secret sauce. We've squeezed everything we can can out of the rest of health care, but mental health is a chance for us to really reduce costs. Obviously, we're going to have to reorganize the way we set up the financial incentives so that insurance companies are not motivated just to do it within a year's time because of course, the big ROI are years down the road.


So we have to come up, but I've always tried to get them to say, what's the new mousetrap? I mean, they can operate most effectively know what the rules are. We just haven't been very good at putting the rules in place. I've told them they need to step up. They can't just be opposed to parody, which unfortunately, I think has been a reactive approach.


They've always had. But in this case, then they're fighting it. And John, I honestly think that there may be litigation on their part when the rule comes out from everything I'm hearing the 1st time I was invited down to K street since I got a left office, right? Was when this proposed rule was put forward and the insurance companies through their lobbyists invited me down and they said, what can we do?


What can we do? How can you help us? And I'm like, you know, it's the 11th hour and now you're calling. I mean, it's just remarkable to me that. We haven't done a better job preparing for this moment. So what do I want as a consumer? I want insurance companies to pay for recovery housing. I know the people that I'm in recovery with benefit from long term, 6 months support of living.


That's not paid for today. I'd like to see insurance companies pay for it. Clubhouse models for people, schizophrenia, bipolar. That is one of the strongest evidence-based outcomes. Do insurance companies pay for? No, if the insurance company said to me, Patrick, we don't have enough therapists to meet your in network adequacy requirements, which of course is a function of the fact we've never paid for these services.


I'd say let's expand the availability of providers by including recovery housing supports by recruiting Including social supports through clubhouses, and then you wouldn't get in as much of a problem when it comes to not having sufficient and network. And then I would say, let's define what we want mental health to serve.


I'd say we want people who are severely mentally ill to be on the top of the list. And we want to make sure those that are in jeopardy of falling into that. Buckets are on the top of the list. But if all of us can benefit from mental health, we have to come up with a new solution to provide for that whole system.


But for the insurance population, let's hold them accountable for this. If I said to them, they'd be like, hell, yeah, let's do that. But guess what? They've never engaged with the consumers except for now. And now it's, you know, they're crying and the sky is falling. The sky is falling. All this rule does is it says, guess what?


Just treat mental illness and addiction the same. Do not have longer waiting lists. Do not have a higher financial thresholds, you know, make sure you have no more, no more onerous medical management practices. I mean, it's pretty basic stuff. So. Anyway, I think, John, that this rule is going to be the leverage we need as consumers to get payers to the table and listen to us.


And I want them to know, like Orrin Hatch knew when he worked with my dad, my dad knew when he worked with you know, John McCain. We're not going to get all we need and they're not going to get all they want. But at the end of the day, we're going to be better off if we figure out a way to do this together.


David E. Williams: So Patrick, that the new book is profiles and mental health courage. And my first thought was great title. My second thought was you'd probably be pretty pissed if someone else took that title. But in any case what inspired you to write the book and what do you hope readers will take away from it?


Patrick J. Kennedy: Well, I looked into John F. Kennedy's original eight senators and guess what? Over half of them have documented mental illness in their families. John Quincy Adams lost his eldest son George Quincy Adams from suicide. John Quincy Adams, two brothers. In their thirties, died of alcoholism. John Quincy Adams, a father suffered from Great Depression.


Lucious Lamar, another person he featured, John F. Kennedy featured, saw his father at eight years old. He looked at his father, walked out in front of the house and took a pistol to his head and shot himself. That you had Sam Houston, first president of Texas, then a U. S. Senator. was known as the big drunk Daniel Webster, my dad's hero died of cirrhosis of the liver.


So I don't think my uncle knowing how much he cared about mental illness and addiction. Cause of course he was the president who signed the Community Mental Health Act would so much mind me stealing his great title. But I think he'd be especially happy that I made the correlation between yes, all of those senators were known for these other things.


But part of the problem we've had in this country is that they weren't known for all the other things that they were courageous or had to face in their own lives, which we're able to modify in terms of public's understanding of now that we have this chance through profiles and mental health courage to write about it.


John Driscoll: Patrick, do you think that people post COVID, now that people understand how mental health isn't a separate silo, it's integrated into everything, every other part of healthcare, and frankly is unaddressed in every in every sector, with every income level and every type of illness, do you think we've really That the public's understanding has really changed about the mental health being integrated into physical health, or do we still have a lot of work to do there?


Patrick J. Kennedy: Well, we have a ton of work to do there because frankly, most people don't avail themselves of mental health and addiction services till they're stage four illnesses. And that's principally because, one, stigma is still alive and well, and two, none of us want to walk that, kind of those eggshells to tell the person we love that they're in trouble until it becomes really obvious, when in fact, what we need to do is get in there early as if it were cancer or cardiovascular disease and say, listen, this is going to be a lot easier for you to deal with if you start dealing with it now.


We haven't had those conversations with our loved ones and in this book profiles and mental health courage. I not only tell the stories of these twelve courageous people who tell everything, but they had me talk to their parents, their brothers and sisters, their kids. They're therapists, they're friends and colleagues at work.


They really had me talk to people, frankly, that they don't talk to anymore because their illness has so isolated them. This book is different in that it includes all the people around the person, including as you know, John, my cousin, Mark McMurray, his son, Harry died of suicide at 23. The first time Mark really talked about his son's suicide was when I interviewed him seven years after Harry had died.


And Mark was, you know, very full of trepidation. Should I do it? Once he got in, he was, it was cathartic for him, which only proves the point that we need to open up and talk about these things. Then he had me talk to Harry's brother, his other son, Belton. And Belton said things that Mark had never heard.


Then Mark had me talk to Harry's roommate at college. Harry's roommate in college told both Belton and Mark, Things that they had never heard of before. So my point is, if we had had a better chance to for everyone to share, there may have been a better chance for them to have intervened earlier and more aggressively with Harry than was the case because they felt like they couldn't talk about that personal business that, you know, I don't want to violate his privacy.


John Driscoll: Well, and we've got a quiet epidemic that's becoming louder and louder every day of suicide, not just in the military, but across society, particularly of when you start to throw in self-harm and just deep challenged self-image for young people. I mean, it's I, that's a, that's a, that's a it shakes me to hear that Patrick, but I think it's a critical conversation to your point about the only way we're going to intervene early is to understand early.


Patrick J. Kennedy: You know, it is remarkable these illnesses that we wait until they become, you know, real, really sick people and, you know, the African proverb. If you want to save someone from drowning, try making sure they don't fall in in the 1st place. We just don't go upstream and we have to going back to my original point.


John. Come up with a new financial model. You know, all these European countries that have national health systems do so much in terms of social supports for these illnesses, early intervention for these services. Why? Because it saves the macro costs, which, by the way, they bear because they come from these big, you know, centralized health systems.


We have to figure out a way to incentivize those long-term R. O. Y. Bye-bye. And we need partners to be able to do that. Ultimately, this will only work if the financial incentives align with screening earlier. But today payers like, Oh, geez, do I really want to know that they need help? You know, because I, they might not be with me in a year from now.

That's a kind of defeatist system. We have to fix the system if we're going to help people.


David E. Williams: So we've talked about the role of government and advocates and even, you know, insurance companies and individuals. What kind of a role can businesses, employers play, including those in the healthcare sector, but more broadly, can they play a more supportive role?


Patrick J. Kennedy: Well, they're, they're the true fiduciaries. So the thing we lose sight of is the insurance company is not the true fiduciary, because if you think about it, they don't pick up the costs of lack of productivity. They don't pick up the cost of workers comp. They don't pick up the cost of absenteeism. If you start adding those costs and then add the, the number of.


Workers that are churning in and out in any given year in a major company. Some of which is driven by mental health and the lack of safe culture where people feel accepted and embraced in a supportive environment of work for recovery. You know, you start adding huge costs. Now we, as insurance companies, they don't, because they don't bear those other costs.


When it comes to them, they're thinking, Oh, we want to keep a capitated spend on mental health and addiction. We don't want to go that extra mile because it's going to cut into our profits. However, if they had all these other costs in mind, they'd say to the employer or the employer should be saying to them, listen, we'll pay more.

on the insurance side because we know it's going to save us dollars on the human resources side. That's a, again, another point where this all comes down to finances. And these employers have to be the ones that step up because the provider community Is I think limited and what they can do the consumers because of the nature of stigma are limited and what they're able to do the insurers by their nature are going to kind of fight anything that puts them at higher risk for paying for all this stuff.


The employers have to step up. They have every financial reason to step up, and as employers they want to have a workplace where their employees can come, thrive, do well, and stay a long time as opposed to coming in and out


John Driscoll: of employment. Patrick, do you see other nations that have better-funded systems drive better outcomes?


Because clearly there's more access in some of these, these, the other OECD countries. I don't know whether you have looked at measuring their results in terms of mental health, mental health. mental health optimization versus mental health challenges.

Patrick J. Kennedy: Yeah. So in other parts of the world, you know, Germany, England, they have these models where they cover the wraparound services, but you see it back to the other point, John, is they're able to Realize the savings in their criminal justice spend.


They're able to realize their savings in their first responders spend. We don't because we have these siloed budgets. That's the difference. These more, if you will, centralized systems in Europe and the have it clearly on their ledger. All the savings that come from investing in these other places.


What we really need is a mental health addiction czar who can say, HUD, Housing and Urban Development, we need this much support of human services, we need you to do this. Healthcare, CMS, we need you to do this. Department of Justice, Federal Bureau of Corrections, we need you to do that. In other words, if we're not coordinating all those systems, the number of people who are living on our streets today, actively in psychosis, inactive addiction, are costing us a fortune, let alone the suffering that they all have to endure and their families endure.


And we could get so much for the dollars that we spend constantly sending ERs, ambulances out to try to save them. When you look at the imposition this puts on businesses, you know, you go to San Francisco, try to get to Salesforce, you have to step over 15 bodies before. That's not good for business. So when are business people going to come up and say, frankly, it's in our self-interest as business.


We want to be ahead of the curve because more and more people are suffering. Certainly, this next generation that is going to be our future employees. We need to create a. Very nice work environment where they know they're accepted because we want them to be good workers. I mean, there's every reason for businesses to jump all in on this and government has to come up with a new model themselves and they could look to these other countries.


But even if they did, unless we fix our financial models, it won't work. If we try to jam the square peg in the round hole in a system that's already broken, it won't work unless you change the fundamentals of the system.


David E. Williams: So, there's so much demand for mental health care, just given the number of people that need it.


As you mentioned, number of providers is not necessarily going to go up. One way is to look at the wraparound services. What role can technology play? Is there a way to be a force multiplier there to meet some of the need?


Patrick J. Kennedy: Enormous ability for us to really risk stratify the population. So what you really want, as I said before, is to take those resources you currently have, make sure they're focused in the ways that they can do the most good.


Certainly, technology remote monitoring is a whole new field. It used to be that. You know, you go in once a month, once a week to get your therapy and you wouldn't know what the person was going through for the rest of the, you know, week, we can now monitor people like, you know, people do with their patch for their A1C, their, you know, They can manage their diabetes, their cardiovascular disease, all this other stuff.


Why shouldn't we be able as consumers better manage our mental health and addiction?


Now, we can do it through voice recognition. You know, voice is a biomarker now for a lot of you know, indications that someone might be at risk for psychosis. Obviously facial expressions, you know, if you're doing virtual care.


We should be able to have, you know ability to tell whether people are telling the truth.

Frankly, we know with our intelligence system, we figured out that technology. Do people want to do it as a therapist someone in therapy? I don't know, but let's give them the choice. If I coming out of a treatment, the very first time was told, listen, Patrick, you're going to give up these civil liberties, but you're going to increase your chances at recovery by 80%.


I'd be like. Let me let me have that right? Doctors have 95 percent sobriety rates after 5 years. Why? Because there's something called contingency management. Their jobs depend on it. Their livelihoods. So we need to put incentives in place, including. Financial incentives. Now that I know that's pay for patients, you know, there's kickback stuff, but we know in a lot of addictions, if you can give people rewards, It works better.


That's what the evidence says. It's not me trying to argue for some company to be able to, we just got to figure out, as I said, the system that works and pay for that system. And so you know, I think there's a lot of progress that we can make. And certainly if we get better organized, we'll be able to do it.


John Driscoll: Well, John, last question. Yeah. Yeah. Dave, David, I think, I think this is a question that we should, we should have we should nominate and endorse a care talk candidate for mental health SAR. And I think we know who it would be. Patrick, if nominated, will you serve?


Patrick J. Kennedy: 100%. This is such a historic time. We really can rewrite the rules of the system because frankly, the system is so anemic right now.

We wouldn't have to displace a lot of entrenched interests that should be attractive to philanthropists out there and major stakeholders. Because they're not going to run up against the same obstacles. We have not re entrenched our silos yet. But if we fail to move quickly, all those silos from psychiatrists, psychologists, social workers, inpatient, outpatient, pharma payers, those are going to, those barriers are going to be erected and people are going to get their turf and then we're going to be stuck with this current model.


And unfortunately, patients are not going to do as well as a result. So I'm encouraging your listeners, someone out there to join in now, because they could make a difference. Really?


This is a 100 percent an opportunity to make a difference. So I encourage people to join. I'll put another plug in for the Kennedy forum.


So, JFK did this as community mental health. We have our alignment for progress. We have 90 90 90 by 2033. It's been adopted by all the advocacy groups. 90 percent of Americans should be screened. 90 percent should be given evidence based interventions. 90 percent should have supportive recovery. That's with the HIV.


I didn't come up with this. I just took it from HIV AIDS. We in our community don't think big enough. We have to think bigger because our country's health as a future depends on it


David E. Williams: Well, that's it for yet another episode of care talk. Our guest today has been Patrick j Kennedy He is author most recently of profiles in Mental Health Courage mental health advocate and candidate for czar of mental health for care talk I'm David Williams, president of Health Business Group.


John Driscoll: And I'm John Driscoll, senior advisor at Walgreens. If you like what you heard or you didn't, please subscribe on your favorite service. And thank you so much, Patrick.

Patrick J. Kennedy: Thank you, John and David. It's been great to be with you guys.



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