11 Points For Mental Health Care Reform

Due to greater understanding of how many Americans live with mental illnesses and addiction disorders and how expensive the total healthcare expenditures are for this group, we have reached a critical tipping point when it comes to healthcare reform. We understand the importance of treating the healthcare needs of individuals with serious mental illnesses and responding to the behavioral healthcare needs of all Americans. This is creating a series of exciting opportunities for the behavioral health community and a series of unprecedented challenges mental-health organizations across the U.S. are determined to provide expertise and leadership that supports member organizations, federal agencies, states, health plans, and consumer groups in ensuring that the key issues facing persons with mental-health and substance use disorders are properly addressed and integrated into healthcare reform.

In anticipation of parity and mental healthcare reform legislation, the many national and community mental health organizations have been thinking, meeting and writing for well over a year. Their work continues and their outputs guide those organizations lobbying for government healthcare reform..

MENTAL HEALTH SERVICE DELIVERY

1. Mental Health/Substance Use Health Provider Capacity Building: Community mental health and substance use treatment organizations, group practices, and individual clinicians will need to improve their ability to provide measurable, high-performing, prevention, early intervention, recovery and wellness oriented services and supports.

2. Person-Centered Healthcare Homes: There will be much greater demand for integrating mental health and substance use clinicians into primary care practices and primary care providers into mental health and substance use treatment organizations, using emerging and best practice clinical models and robust linkages between primary care and specialty behavioral healthcare.

3. Peer Counselors and Consumer Operated Services: We will see expansion of consumer-operated services and integration of peers into the mental health and substance use workforce and service array, underscoring the critical role these efforts play in supporting the recovery and wellness of persons with mental health and substance use disorders.

4. Mental Health Clinic Guidelines: The pace of development and dissemination of mental health and substance use clinical guidelines and clinical tools will increase with support from the new Patient-Centered Outcomes Research Institute and other research and implementation efforts. Of course, part of this initiative includes helping mental illness patients find a mental health clinic nearby.

MENTAL HEALTH SYSTEM MANAGEMENT

5. Medicaid Expansion and Health Insurance Exchanges: States will need to undertake major change processes to improve the quality and value of mental health and substance use services at parity as they redesign their Medicaid systems to prepare for expansion and design Health Insurance Exchanges. Provider organizations will need to be able to work with new Medicaid designs and contract with and bill services through the Exchanges.

6. Employer-Sponsored Health Plans and Parity: Employers and benefits managers will need to redefine how to use behavioral health services to address absenteeism and presenteeism and develop a more resilient and productive workforce. Provider organizations will need to tailor their service offerings to meet employer needs and work with their contracting and billing systems.

7. Accountable Care Organizations and Health Plan Redesign: Payers will encourage and in some cases mandate the development of new management structures that support healthcare reform including Accountable Care Organizations and health plan redesign, providing guidance on how mental health and substance use should be included to improve quality and better manage total healthcare expenditures. Provider organizations should take part in and become owners of ACOs that develop in their communities.

MENTAL HEALTHCARE INFRASTRUCTURE

8. Quality Improvement for Mental Healthcare: Organizations including the National Quality Forum will accelerate the development of a national quality improvement strategy that contains mental-health and substance use performance measures that will be used to improve delivery of mental-health and substance use services, patient health outcomes, and population health and manage costs. Provider organizations will need to develop the infrastructure to operate within this framework.

9. Health Information Technology: Federal and state HIT initiatives need to reflect the importance of mental-health and substance use services and include mental-health and substance use providers and data requirements in funding, design work, and infrastructure development. Provider organizations will need to be able to implement electronic health records and patient registries and connect these systems to community health information networks and health information exchanges.

10. Healthcare Payment Reform: Payers and health plans will need to design and implement new payment mechanisms including case rates and capitation that contain value-based purchasing and value-based insurance design strategies that are appropriate for persons with mental health and substance use disorders. Providers will need to adapt their practice management and billing systems and work processes in order to work with these new mechanisms.

11. Workforce Development: Major efforts including work of the new Workforce Advisory Committee will be needed to develop a national workforce strategy to meet the needs of persons with mental health and substance use disorder including expansion of peer counselors.

Exercise, Physical Activity and Mental Health

Exercise and physical activity play a crucial role in both maintaining one’s mental health condition and in recovering from a mental illness. Breaking research indicates that exercise actually produces a chemical that stimulates the growth of brain cells, thus allowing for recovery from sever substance abuse disorders. Furthermore, physical activity and mental health recovery coincide in fostering a social network and encouraging self-reflection, both of which are crucial on the path to mental health recovery.

The human mind evolved in an environment which required it to travel over twelve miles daily. And no, that drive to work in the morning does not count…but that would make things easier, no? This evolution was due to survival instincts when humans migrated from the jungles into the flatlands. Humans also developed an adrenaline reaction which both encouraged movement and triggered immediate learning reactions; as Doctor Carl Clark from the Mental Health Center of Denver once stated, when early man saw that saber-tooth tiger charging out of the brambles, the neurons must have been firing pretty fast to teach them to stay away from the bushes next time…that is assuming their get away was fast enough to allow for a next time!

This adrenaline rush encouraging learning has become neutralized by the flow of activities in modern western societies, wherein the normal individual is seemingly on a constant, albeit generally unnoticed, adrenaline rush. Consequently, stress levels have continuously been on the rise, consequently decreasing the rate at which an individual learns when in a compromising situation, thus decreasing mental wellness levels.

Physical activity is a huge aid to mental health in the fact that exercise allows for a stress outlet, thus decreasing day-to-day stress, while creating functional adrenaline for the mind. In reality, physical activity is important for mental health due to its role in creating Brain Derived Neurotropic Factor (BDNF), which is a key factor in the creation of brain cells. The myth of the old days is past; you know the one, where once your brain cells are gone they are gone. Well such is not the case, physical activity and exercise can increase BDNF levels and allow the re-growth of brain cells, consequently making physical activity immensely important for mental illness recovery.

Exercise and mental health further coincide in regards to the alarming statistic that people with mental illnesses, on average, die 20 years sooner than mentally healthy individuals. While there are many factors that go into this involved in substance abuse risk factors, two considerations that one would be remiss to ignore is the fact that those suffering from mental illnesses have a tendency to stagnate and become physically inactive. This has resulted in a large percentage of mental health consumers being considered overweight, which can ultimately result in adult onset diabetes. Diabetes is very dangerous in sedentary individuals who, in a depressant state, care little about taking care of themselves, for such a medical ailment can result in numerous health related issues, some of which can be very serious.

Physical activity and mental illness recovery are highly correlated. In some of the most successful recovery-based treatment facilities one will find strong proponents of mental health consumers engaging in physical activity. These activities also subsidize the development and formation of a support network populated by individuals interested in similar hobbies. Furthermore, exercise can often be a form of active meditation, and as practitioners of Dialectic Behavioral Treatment (DBT) can profess, meditation, including meditation absent any religious connotations (whether it be active or seated), drives self-reflection which is crucial to mental health recovery; for more information on the importance of self-reflection, you can access my article on Spirituality and Hope in Mental Health.

Stay physically active, exercise and mental wellness are highly correlated. Exercise is one of the best ways to prevent the development of serious mental illnesses, and is also one of the most effective treatment plans. Stay active, stay healthy, stay happy.

Weaving Mental Health First Aid Into Workplace Wellness

Every month Anne LaFleur sends employees in her office a quiz about various wellness topics. When the topic was depression, she received twice as many responses as usual from co-workers.

When LaFleur, vice president of human resources at a credit union in Pawtucket, RI, took a Mental Health First Aid course in February, she quickly understood the reason for the high level of interest in these types of issues. The training also helped her identify people in her office who may be suffering a mental health problem and taught her how to provide help and refer people to self-help and professional resources.

“The training made me realize that mental health issues are very common, yet one of the least talked about problems,” LaFleur says.

More than one in four people suffer from a diagnosable mental health problem in any given year. Mental illness likely costs businesses more than $79 billion a year, $63 billion of it in lost productivity. The statistics point to the significant need to incorporate mental health into burgeoning employee wellness programs, which have received a shot in the arm with the passage of federal healthcare reform legislation.

Mental Health First Aid has proved to be an ideal program to promote improved mental health in workplaces across the country.

LaFleur is one of more than 6,000 people certified in Mental Health First Aid since the training was introduced in the United States two years ago by the National Council for Community Behavioral Healthcare along with the Maryland Department of Health and Mental Hygiene and the Missouri Department of Mental Health.

Those who participate in the 12-hour Mental Health First Aid course learn a five-step process to assess a situation, select and implement appropriate interventions and help a person developing signs and symptoms of mental illness or in crisis receive appropriate care. Participants also learn about the risk factors and warning signs of specific illnesses such as anxiety, depression, psychosis, and addiction.

Evaluations show that the evidence-based Mental Health First Aid program saves lives, expands people’s knowledge of mental illnesses and their treatments, and reduces the stigma associated with mental illness by helping people understand and accept mental illness as a medical condition. One trial of 301 randomized participants found that those who took the training had greater confidence in providing help to others, greater likelihood of advising people to seek professional help, and decreased stigmatizing attitudes.

Unexpectedly, the study also found that Mental Health First Aid improved the mental well-being of the participants themselves.

“By understanding the signs and symptoms of depression, I learned to recognize this in myself,” says Kellie-Ann Heenan, director of human resources at a company in Lincoln, RI.

Heenan, who had the training in February, has an adopted son from Russia who suffers from a number of emotional issues.

“The tools I learned made it easier to connect with him and better understand where he’s coming from,” she says. “In the end, the training improved my own mental health.”

LaFleur has also applied the lessons she learned in the course to her home life.

“My kids are in their 20s and they go through the typical ups and downs,” says LaFleur, “I use my Mental Health First Aid training to see how my kids are feeling.” LaFleur says she was surprised by the range of issues covered in the course.

“We looked at how to deal with both crisis and non-crisis situations, and it made us very aware of the terminology we use that may not be socially correct,” she says, noting that describing co-workers as “crazy” or a “nut case” may be hurtful to people going through an emotionally trying time.

The training proved to be particularly helpful to Lynn Corwin last January when two fellow employees walked into her office in a panic. They told Corwin, director of human resources at the organization, that a co-worker was extremely upset about the recent earthquake in Haiti. The distressed young woman had a close friend in Haiti and had been unable to contact the person for five days. Fearing the worst, the woman was having difficulty managing her emotions, let alone being able to work.

While the two workers had no idea how to deal with the situation, Corwin sprung into action.

“I used what I learned in the course to calm the woman down and talk with her about how she’s feeling,” says Corwin. “I explained to her that it was OK to be upset, and to not be embarrassed about it.”

“The training left me with a greater sense of confidence about how to deal with a variety of people issues that come up in every office,” concludes Heenan. “There’s such a stigma around mental health and people don’t want to talk about it, so having the information gives me confidence that I’ll be able to handle these types of situations when they arise.”

Mental Health Maintenance Is Made Simple

Your mental health is often drastically improved when you use the techniques Dr. Kuhn teaches in this article. When you are able to experience this improvement, your relationships blossom, career paths open, and people find you attractive and accessible. You deserve to have fun and joy in your life – and Cliff Kuhn, M.D. will help you do that.

In the classic Frank Capra film, It’s a Wonderful Life, George Bailey’s mental health is overwhelmed by the difficulties of his life and he wishes he’d never been born. George’s guardian angel grants his wish and takes him to a grim reality as it would’ve been without him. George feels nothing when he reaches into his coat pocket to retrieve the flower his daughter, Zuzu, placed there – and that’s when George knows that his wish has come true…he’s never been born.

Wishing she had never been born, Roberta became my patient, seeking desperately to improve her mental health. Like the fictional George Bailey character, Roberta’s depression and anxiety had grown so strong as to threaten her ability to lead any semblance of a normal life. Fortunately for Roberta, she soon discovered exactly why the natural medicine of humor is one of the most powerful adjunctive treatments for improving mental health, because humor literally pours water on the fire of depression and anxiety.

Roberta is not alone. As many as 35% of all Americans suffer from depression and anxiety, the twins that make mental health elusive for millions. Your depression and anxiety is exacerbated by your seriousness – taking yourself too seriously. As we move into adulthood, we unfortunately buy into the notion that responsible and productive people must be “serious.” As we make the biggest mistake of our lives and relegate our humor nature and fun to recreational activities (if we experience fun at all), we doom ourselves to all the symptoms of the corresponding seriousness that fills the void – declining health, rising stress, increased pain, lessened energy, impaired creativity, and more.

The good news for your mental health, however, is that we know how to shrink your deadly seriousness to practically nothing and reduce almost completely the sway it holds over your health, vitality, wellness, and zest. The natural medicine of humor is an incredibly powerful resource that you already possess; you’ve only forgotten how to use it to maximum effectiveness. You will soon discover that, while not a panacea, the natural medicine of humor is a tremendous tonic for depression or anxiety and will also supercharge other treatments because it is an amazing adjunctive medicine too!

I have distilled the natural medicine of humor, through my years of medical practice, into an amazing prescription I call The Fun Factor. Based on what I learned over twenty years ago from a terminally ill fifteen-year-old patient, I created a unique set of principles I call the Fun Commandments, then forged these Commandments into my Fun Factor prescription and have been prescribing The Fun Factor with great success for years. This report will show you how to use just three of my Fun Commandments to turn your mental health around, and gain new joy, pleasure, and appreciation from your life!

Improve Your Mental Health Using My Fun Factor Prescription

Step One: Always Go the Extra Smile

The first Fun Commandment I recommend for improved mental health is: Always Go the Extra Smile. This Commandment is doubly helpfully for depression and anxiety because not only does it provide measurable emotional and physical relief, but it also is completely under your control – regardless of your circumstances. Because smiling remains totally under your control, it can be your greatest resource for using humor’s natural medicine to accelerate your mental health.

Smiling produces measurable physical benefits you can experience immediately: your stress decreases, your immunity improves, your pain and frustration tolerances increase, and your creativity soars. And guess what? You experience all these benefits even if your smile is “fake.” That’s right…forcing a smile onto your face perks up your immune system and lightens your mood just as readily as a genuine smile. Fake a smile and you’ll soon feel well enough to wear a real one!

This is great news for your proactive stance on sustainable mental health. You have an amazing amount of pre-emptive control over your mood – you can, literally, choose more energy and happiness. The key for your use of this Fun Commandment in enhancing your mental health is to start practicing right now, so that smiling becomes an entrenched, habitual method of accessing the natural medicine of humor. If you wait to smile until your mental health has taken a turn for the worse, and depression or anxiety has taken hold of you, it will not be as effective.

Step Two: Act and Interact

Smiling leads us right into the second Fun Commandment you’ll find instrumental in maintaining your mental health: Act and Interact. Humor’s natural medicine works best when we are sharing ourselves and this Commandment will teach you how to capitalize on the control you’ve taken over your physiology and mood by smiling. Acting and interacting is now easier for you to do because you’re smiling more. Not only is your mood improved, but your smile is also a pleasant invitation to other people.

My suggestion is that you solidify the power of this Commandment by setting a reasonable goal regarding the number of people you will interact with each day. These social interactions are great for your mental health, forcing you to exchange information and ideas with another person. Combined with your commitment to smiling, your interactions should be pleasant, because your heightened energy, lessened pain, and lowered stress levels are very attractive to others.

Beyond keeping you out of isolation, there is another reason why acting and interacting with the people you encounter fosters improved mental health. It allows you to avoid spiritual “flat tires.” Spiritual flat tires occur when you sidestep, or avoid, an interaction that is about to happen naturally – you duck into an office to avoid encountering someone in a hallway or you don’t answer the phone because you don’t want to talk to the person calling. This type of avoidance drains and deletes your reservoir of powerful natural energy and siphons your mental health reserves.

Have you ever noticed that it usually takes you twice as much mental and physical energy to avoid doing a job than you would have expended just doing it? It also takes twice the energy to avoid acting and interacting with the people who cross your path because you are, in effect, saying, “I’m going to correct the mistake that nature made by putting this person in my path and I’m going to correct it by being mentally and spiritually negligent.” Mental and spiritual negligence have the same effect as physical negligence (isn’t it strange how you get tired if you don’t exercise?). If your mental health can afford to allow this much energy to be drained, then you have a much bigger reservoir than I!

But spiritual flat tires do more than drain our energy, they are detrimental in at least two additional ways:

We miss out on an interaction with a teacher. If nature didn’t have a lesson for you, that person you just avoided would not have been placed in your path. You say that the person you just avoided was a negative influence or would’ve wasted your time? I know we have legitimate schedules to keep, but if I am avoiding people based on my prejudgment of them, I’m cutting myself off from my greatest teachers – those very same people.
We all learn tolerance from the intolerant, patience from the impatient, temperance from the intemperate, gentleness from the ruffian, etc. I am supremely grateful for those teachers and the lessons they give me.

We create a small, nagging spiritual void of dishonesty, the kind of dishonesty that keeps us from laying our heads down with complete peace of mind each night. Our spiritual flat tire is caused by the pothole our avoidance created; it is a natural consequence, or symptom, of our spiritual dishonesty. These consequences clutter our lives with mental and emotional baggage that further drains us of our energy and vitality.

Step Three: Celebrate Everything

The third Fun Commandment which will help you use the natural medicine of humor to charge up your mental health is: Celebrate Everything. Celebrating everything may sound like a monumental task to someone who’s mental health isn’t up to par, but you will find this part of my doctor’s orders much easier to fulfill once you start practicing my first two Commandments. In fact, celebrating everything is more than a maintenance step providing sustainable mental health. It will also become your lifestyle, the more you practice it, because you will enjoy the results so much.

How do you celebrate everything and how will this keep your mental health on the upswing? The epitome of this Commandment is found in the old joke about the boy who wanted a pony for his birthday. Instead, he found a room full of manure waiting for him. But he dove right into the dung, gleefully exclaiming, “With all this manure, there’s got to be a pony in here somewhere!”

Laugh as we might, we’re quick to remember that, as adults, we would never allow ourselves such “naive” enthusiasm. Why not? Do you realize what is behind such a “grown up,” “mature” decision? Your deadly seriousness (taking yourself too seriously) encourages the attitude that a mature adult should not let herself be so optimistic and thus mental health is jeopardized.

We could do more than chuckle at this birthday boy’s unabashed optimism – we should emulate it! When was the last time you encountered an unexpected pile of manure in your life? You had absolutely no control over the mess, right? But you had absolute control over your reaction to it and this is the key to using celebration to keep your mental health improved!

When you celebrate everything, the natural medicine of humor creates spiritual, emotional, and mental health like nothing you’ve felt before. You will find that your fears become much less controlling when you are celebrating everything because it no longer matters so much how things turn out. In fact, you are literally ready for anything because you are prepared to find the blessing in whatever happens.

My daughter-in-law, for example, broke her back last year. My son, who is often my model for the embodiment of my Fun Commandments, can tick off a laundry list of blessings his family has received as a direct result of his wife’s “tragedy.” Not that his mental health hasn’t been challenged, but faced with the choice of depression and anxiety over an event he couldn’t control versus finding the blessings waiting for him, he has chosen the latter.

The choice to celebrate everything is not a panacea; my son’s choice did not change the reality of his wife’s injury. What did change, however, was his ability to respond to the injury and, thus, keep his mental health on an even keel. Celebrating everything changes our lives because it allows us to positively control the only things we have control over – our actions, ideas, and attitudes.

There you have it. Start by going the extra smile, use your newfound smiling energy and vitality to act and interact with people, and celebrate everything to maintain your positive momentum. Say good-bye to imprisonment from depression and anxiety and welcome to your new world of improved mental health!
Start Using The Fun Factor to Improve Your Mental Health…Right Now

Here are some simple, easy steps you can take right now to turbo-charge your mental health.

Subscribe to my Fun Times newsletter. The Fun Times is all about using your natural power of humor to increase the quality of your life – including your mental health. The Fun Times is 100% free, and is delivered instantly, every week, to your email inbox. If you sign up now, I’ll also throw in a copy of my “Stop Your Seriousness” Ecourse and my book, Ten Ways You Can Be Happier…Right Now! which will show you how you can use my Fun Factor prescription in your life to increase your mental health!

Check out The Fun Factor. This prescription has changed so many lives for the better – it would be a shame if you passed it up. Check it out here if you’re sick of wishing for mental health and want to finally achieve your greatest mental health!
My patient Roberta, by the way, learned to use these three Fun Commandments – and the rest of my Fun Factor prescription. She has enjoyed the same job for three years now and was recently engaged to be married. Roberta occasionally has setbacks, as most people suffering from depression or anxiety do. But, her mental health has never been stronger as she continues to apply The Fun Factor to her life.

In It’s a Wonderful Life, George Bailey is so shocked by the grim vision of a world without him that he decides he wants to live again and begs to return. He knows he is back when he finds Zuzu’s flower petals in his coat pocket again.

Let this article be like finding Zuzu’s petals. Move forward today with a new, positive outlook on your improved mental health by using my Fun Factor prescription.