Nebraska Senator Mike Johanns presented a keynote address at the Alternatives
2009 Conference held in Omaha, Nebraska. Many listeners were encouraged by
Senator Johanns words. The following transcript was obtained of the Senator’s
speech entitled “Celebrating the Successes, Maintaining the Commitment”.
As prepared for Sen. Mike Johanns: Celebrating the Successes, Maintaining the Commitment.
Thank you for that kind introduction and warm welcome. It’s so good to be in the presence of people who work daily, having committed their lives to helping some of the most disadvantaged people in our society—the mentally ill. It is a great, great honor to be here today.
I am going to talk tonight about the successes we’ve had legislatively in terms of treating and handling mental health issues. And I’ll fill you in on the building commitment I see happening not just in Nebraska but across the nation.
I’ve said many times before that a big reason I got into public service is my desire to prioritize the needs of those who face mental health challenges and developmental disabilities. I’ve now served Nebraska in the U.S. Senate for not quite ten months now and I’m pleased to report some progress in how Congress addresses mental health issues. Let me detail some of that progress.
When we talk about the disadvantaged, it’s not hard to imagine that our tribal nations have more than their share of poverty and other society issues. Perhaps the most insidious on reservations and in the Native community is that of teen suicide. The Native teen suicide rate is dramatically higher than the rest of teenage America. For too long this horrible problem has been ignored. But I’m pleased to tell you that this year the Congress has acted decisively.
Suicide is the second leading cause of death among Native American youth. This should compel all of us to action. And the rate of suicide among Indian children in the northern Great Plain is 10 times higher than the national average. Ninety percent of all Indian teens who commit suicide have a diagnosable mental illness at the time of their deaths. Unfortunately, more than half of these youth have never seen a mental health professional.
One effective way to reach these troubled youth, who are often in remote locations, is through telemedicine. A trained professional through video conference can do psychiatric assessments, complete diagnostic interviews, intervene with crisis counseling, and provide needed mental health therapies. For too long, we have felt powerless to reach these individuals in need. Now, we can harness technology to open the door to long distance mental health care.
The use of telemedicine in rural areas is one of the issues I worked on as Governor and as Secretary of Agriculture. I remember the day we unveiled the statewide telehealth network in Nebraska, while I was Governor. Back then, we were blazing new trails when we announced the ability to connect more than 100 sites across the state. This milestone opened almost unlimited possibilities for providing mental health treatment and other care.
I realize many of you are well aware of the benefits of the network, being that the medical center right here at Creighton is a network site. I also know that, even today, efforts continue here in Nebraska to utilize this tool to the fullest extent. Advancements in the technologies that drive the network opened new doors of opportunity. I learned this in a very direct way when I became Secretary of Agriculture.
Many people are unaware just how involved and invested USDA is in telehealth – particularly in rural areas – through the Distance Learning and Telemedicine Program. During my time as Secretary, we awarded more than 2-hundred grants totaling more than $50-million dollars to strengthen a national telehealth network. It was pretty remarkable to do a telehealth event as Secretary of Agriculture. It was very similar to a kick-off event I hosted as Governor, but on a much larger scale.
The first event connected sites across our state, and just a few years later, we were connecting doctors and hospitals across our nation to offer a live demonstration of the power of telehealth for the media. In my farm bill proposal, I advocated an additional $5-hundred-million dollars in grants for telehealth and other infrastructure needs. I will continue this support of telemedicine in the United States Senate.
Earlier this year I co-sponsored the Indian Youth Telemental Health Demonstration Project Act of 2009. This bill authorizes the Department of Health and Human Services to initiate a demonstration project for awarding grants to provide telemental health services to Indian youth. We have a moral obligation to address the alarming suicide rate among Indian youth and this is a step in the right direction. With the impressive advancements in technology and telemedicine, living in a rural area should not prevent people from receiving the care they need.
Of course, telemedicine alone will not solve the high suicide rate, but it is one piece of the puzzle…and we must remain vigilant in our efforts. I can assure you that I don’t plan to ease up on this issue until we have found a way to provide hope and care to these young people. My seat on the Indian Affairs Committee will help me to do just that.
A focus on this deserving population also led to one of my most memorable moments as Governor; when I signed into law LB 1083 - mental health reform. On the day I signed that bill, the hearing room was overflowing with hundreds of courageous, cheering people who were overcoming the challenges of mental illness. I was proud to have won that hard-fought battle on their behalf. And, many should be proud of the progress since then.
We knew change would not occur overnight, but there are some very impressive facts that illustrate the tremendous strides being made for this deserving population. Commitments to state psychiatric hospitals dropped more than 60 percent. That alone is a triumph. An additional 9,000 people have accessed services closer to their homes and support systems. This represents a 30 percent increase in the number of people receiving community-based care. Remarkable.
Placements in emergency protective custody – due to patients being judged a danger to themselves or others – have fallen ten percent since 1083 was enacted. This is significant because, if you’ll remember, some feared the emergency calls for protective custody would skyrocket. Quite the opposite has happened. It is a sure sign that the state is moving in the right direction when the rate of patient readmission has been cut in half.
This is evidence that the fundamental belief upon which the reform was based was right on target; the belief that treatment will be more successful when people are in their communities and connected to their support systems. Nebraska’s rate of readmission is now far lower than the national average – less than half the nationwide rate (NE 7.9% National rate 19.9%).
Does all of this mean we can sit back and say job well done? It certainly does not.
Let’s look at a Nebraska situation that has a lesson for us all nationally.
You have no doubt read or heard about the heartbreaking phenomenon that occurred last year when more than 30 children – from youth to teenagers – were abandoned at Nebraska hospitals. It shows how much work remains in the mental health care arena. All states can learn from what Nebraska is doing to address the gaps in services for children with mental illnesses or other behavioral health issues.
The Children and Families Support legislation is one idea. It creates a statewide hotline for families dealing with behavioral and mental health challenges. The hotline will be staffed 24 hours a day by professionals trained in mental health assessment. The law suggests what it calls “family navigators” to provide one-on-one support to families and help them access services. It also provides ongoing services to families that adopt children with a mental illness. Currently, one in ten such adoptions dissolves. The hope is that ongoing services would increase the success rate.
The state also recently launched a website to collect in one place myriad information and resources on mental health and other behavioral health services. These developments show that our state does care about mental health consumers. They also prove that it does make a difference when voices are raised in unison on behalf of this deserving population.
I mentioned there is more work to be done. Your voices are still needed on a variety of fronts and I’d like to mention a few that I see as important.
When I was Governor, I heard a lot about the effectiveness of peer support services. We called for development and implementation of this powerful tool. The state is making progress, but we can do more.
As you know, many individuals face both a mental illness and an addiction. This combination requires special attention and integrated treatment. As the array of services continues to expand, so too, I hope, will the ability of providers to tailor treatment for clients who face multiple, complex challenges. As we move closer to a true network of service, as Nebraska is moving now, then providing integrated treatment will become easier. I realize that continuing to build the network requires funding and skilled professionals – both of which are in short supply.
If we are unable to build a full behavior health work force, we will be unable to fully achieve the goals of mental health reform. We simply do not have an adequate number of psychiatrists and other mental health and substance abuse professionals. This is true in both urban and rural communities. I know there are creative programs here at Creighton and elsewhere across Nebraska working to address the shortage of behavioral health professionals and I applaud these efforts. We need more efforts like these across the United States.
My interest in advocating for those who face mental illness has spanned my entire career in public service. I can assure you this interest will continue for as long as I am in public service.
As a U.S. senator, I am finding a number of areas that demand the attention and compassion of our nation.
We are seeing increased focus – and appropriately so – on mental health issues affecting those who bravely defend our country in the armed services. Our soldiers and marines and airmen and sailors serve with honor. Many serve in combat and often suffer intense trauma as a result. For too long, there has been a culture of shame around the diagnosis and treatment of mental illness within both the military and the civilian world.
With the intensity of operations for today’s forces, more service members than ever before are at risk for combat-related mental health problems, such as Post-Traumatic Stress Disorder – or PTSD. The rates of PTSD in today’s military are rising. A study released last year estimated that 20 percent of veterans since 2001 have screened positive for PTSD. Yet, less than half of those veterans are receiving proper mental health treatment.
I am proud to serve on the Senate Veterans Affairs Committee and I look forward to working to increase mental health services for both active military and veterans. I am committed to ensuring that we are doing all we can to help our American heroes who are facing PTSD.
There are other positive developments in mental health care at the national level. I’d like to touch on one of them. It’s something that I supported on the campaign trail and became law before I was elected last fall.
The modernization of the mental health parity law requires insurance plans to treat mental health patients on par with those who have physical ailments. No more higher co-pays or deductibles for the mental health treatments. No more limits on visits to the doctor that differ from the caps for other patients.
To be clear, the legislation does not mandate that group health plans cover mental health or addiction treatment. Rather, it says that when plans provide coverage, it must be equitable to other medical coverage. For example, as some of you know, under many plans a 50 percent co-payment is required to see a mental health provider as an outpatient. Yet, to see a dermatologist or a heart specialist as an outpatient, the co-payment is normally 20 percent. The new equal treatment requirement addresses this disparity.
It applies to health plans that cover more than 50 employees — potentially reaching 113 million people nationwide. The changes take effect this fall and they represent another important step toward better services for a deserving population.
If I were to leave you with a final thought, it would be this: Do not give up the good fight. It is a noble cause to champion the needs of people who ask only for the opportunity to live in, and contribute to their communities. Mental illnesses affect Americans of all stripes, whether rich or poor, rural or urban, white or black. Ensuring these citizens have access to treatment is a cause we must continue to rally behind. I’m with you every step of the way and I commend you for your good work and commitment.
We are making important progress and I look forward to continuing to work together to ensure all Americans receive the mental health services they deserve in a system that makes everyone proud.
God bless you.
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