Appearing before the powerful Senate Finance Committee in Washington, DC, recently, Dr. Maggie Bennington-Davis, psychiatrist and chief medical officer of Health Share Oregon, devoted a significant portion of her testimony to the role of adversity and toxic stress during childhood on adult health, both physical and emotional. She explained how Health Share Oregon—that state’s largest Medicaid coordinated care organization—examined the people with the costliest health bills and found them to have experienced high levels of childhood adversity. She told the senators that the CDC-Kaiser Permanente Adverse Childhood Experiences Study (ACE Study), first published in 1998 by Drs. Vincent Felliti and Robert Anda, found exactly this correlation.
At the April 28 hearing titled “Mental Health in America: Where are we now?,”* Bennington-Davis addressed the need to look to people’s experiences in childhoods to improve health, knowing that mental illness and substance use disorders, along with other
ill effects of childhood trauma, can be prevented. She said that principals at Health Share of Oregon are “focusing on helping our members avoid unwanted pregnancies, get social, physical, and mental health supports during pregnancy, have their basic needs met in order to successfully be able to attach to their new babies, and get the support and guidance they need to be effective parents.”
She also highlighted Health Share’s foster child initiative that provides coordinated care for high incidences of asthma, attention deficit disorder, obesity, and mental illness, among other conditions, that persist into adulthood.
During questioning, Bennington-Davis agreed with Sen. Ron Wyden of Oregon, ranking member of the committee, that the No. 1 priority with respect to children and mental illness is prevention, including screening and early treatment. She said that a developmental screening at the correct time is a key “incentive metric” to achieve desired outcomes. The second priority she identified is to provide coordinated physical and mental health services to foster children.
Other panelists included Douglas P. Thomas, the substance abuse and mental health director from committee Chairman Orin Hatch’s home state of Utah; Linda Rosenberg, president and CEO of the National Council for Behavioral Health; and Brandon Marshall, NFL wide receiver and co-founder, with his wife Michi Marshall, of PROJECT 375, an organization addressing the stigma surrounding mental illness.
With his light-up-the-room smile, Marshall provided star power to the afternoon’s proceedings. Both senators and fellow panelists expressed gratitude to Marshall for his courage in sharing his struggles prior to the diagnosis of borderline personality disorder and subsequent treatment, and his commitment to reducing the stigma that keeps many individuals from seeking treatment for mental illness.
Unlike many hearings that focus on a specific legislative proposal, this one was more freewheeling, covering prevention issues related to mental health, the intersection of mental illness and law enforcement, suicide prevention, veterans’ mental health, and other issues. Sen. John Cornyn (R-TX) briefly mentioned the several mental health bills being considered in the House and Senate and Linda Rosenberg highlighted the need to expand the Excellence in Mental Health Act demonstration from eight to 24 states. The hearing was also unusual in that the issue of violence and mental illness was not a focus. One exception was a reference that Cornyn made to the mother of Adam Lanza (shooter in the Sandy Hook Elementary School tragedy). He said she undoubtedly knew that her son had a mental illness, but was unable to identify effective services for him.
Wyden noted that several other Senate committees have jurisdiction over matters related to mental health including the Health, Education, Labor and Pensions (HELP) Committee, and the Judiciary Committee, as well as the Finance Committee (the committee that has responsibility for the Medicare and Medicaid programs). For that reason, Wyden said that members of the several committees will “all have to pull the rope in the same direction.”
Both Wyden and Hatch noted the Medicaid program’s billion-dollar investment in mental health services. Wyden specifically highlighted that the failure of some states to expand Medicaid under the Affordable Care Act could limit life-saving mental health services to millions. An issue brief by the US Department of Health and Human Services released March 28 describes the impact of Medicaid expansion in improving behavioral health care services.
Several members of the committee addressed the intersection of mental illness and law enforcement. The recent selection of a psychologist to run Chicago’s Cook County Jail was cited as an example of the direct intersection of mental illness and law enforcement. Approximately one-third of the 9,000 inmates in the Cook County jail have a mental illness. Cornyn said that only 1% of the total $2 billion provided by the federal government to states and localities for law enforcement is spent on mental health and that a reallocation of these funds should be considered. Among the strategies mentioned that could improve police interactions with people with mental illness were Mental Health First Aid and crisis intervention training, citing a recent New York Times article on teams in Portland, Oregon.
In response to Sen. Bob Casey’s (D-PA) question about the best method for early intervention, Bennington-Davis commented that both the question and the answer are complex, but if you have to boil it down, strategies must be implemented to decrease the toxic stress that a young brain is experiencing both before and after birth. She added that if a child can be in a safe and nurturing relationship with a caring adult, these interactions will help the robust development of a child’s brain. She emphasized the importance of reaching children “the earlier the better” to build resilience through parenting supports, community supports, and programs in the schools.
*The link to the April 28 hearing will take you to the Senate Finance Committee website where you can watch the entire hearing and access all statements made by members of the committee and witnesses.