#33 - How to Fix Mental Health Care in America – Ben Miller from Well Being Trust

Apr 13, 2020

Ben Miller, Chief Strategy Officer at the Well Being Trust joined me to discuss what’s broken, what works, and what the future of mental health care in America can and should look like. 

Ben is a clinical psychologist and spent a decade as a professor at the University of Colorado School of Medicine where he did extensive work to understand how we can better integrate Primary and Behavioral care resources and what an idea mental health care system would look like in America.

Ben is one of the most well-informed people I’ve spoken to when it comes to:

1. What is wrong with mental health care in America?
2. How did it get this way?
3. How do we fix it?
4. Who is responsible?

I hope you find this conversation as helpful and educational as I did.

Connect with Ben: LinkedIn, Twitter, OpEd: Mental Illness is Epidemic Within the Coronavirus Pandemic by Ben Miller

Well Being Trust: Healing the Nation Report,  Well Being Trust Website, Twitter, Pain in The Nation Report,

HERE ARE SOME OF THE THINGS WE TALKED ABOUT:

1. Ben is a clinical psychologist by training and has spent a lot of time looking at ways we can better integrate mental health care into traditional health care.  In this conversation we dig into why there isn’t more integration between Primary and Behavioral health care providers and what can be done about it.
   
   
2. The Well Being Trust was launched by Providence St. Joseph Health in 2016 as an independent 501(c)(3) public charity with an initial seed endowment of $100 million plus an additional $30 million to be invested in California from 2017 to 2019.  Well Being Trust is now investing in approaches that have the potential to model the way forward. Well Being Trust was created to advance clinical, community and cultural change…to transform the health of the nation and improve well-being for everyone.
   
   
3. The Well Being Trust focuses on 5 key areas when trying to advance its mission including clinical transformation, community transformation, policy and advocacy, social engagement and learning and data systems.  You can read more about each of these functional areas here.
   
   
4. Ben explains that he and his team are keenly focused on how they can do something positive for mental health in the United States including how we talk about mental health and lately, what we can do as a nation to lift up communities that are going to suffer the most after the COVID-19 pandemic subsides.
   
   
5. I asked Ben about the mental health provisions in the current COVID-19 stimulus legislation and he explained that about $450mm had been allocated to SAMSHA from the stimulus which really seems like an afterthought considering the size of the overall stimulus spending.
   
   
6. Over time the U.S. government really hasn’t invested in mental health in the same way we have other major health issues.  The $450mm allocated to mental health int eh current stimulus package seems like “budget dust” relative to other spending and this has always been the way the government treats mental health.  Ben details his thoughts in this recent OpEd.
   
   
7. Why does it seem like the government doesn’t get it when it comes to mental health?
   
   It all started when JFK signed the Community Mental Health Centers Act in 1963.  The problem with that legislation is that a mental health system was created, separate, of the rest of health care.  That separate system was never integrated, and the science and leadership weren’t there to see to this separate system becoming successful.  This policy sounded good in speeches, but there was no plan for weaving mental health into broader health reform.  This “separation” was codified in Medicare and Medicaid in 1965 and we have been paying for it ever since.  This separation includes separate systems, separate benefits, financing mechanisms, training modules, etc.  As a result, the government and many people still see mental health as an afterthought since it is separate.
   
   
8. On the whole, mental health care is a mess of competing businesses and interests.  There are businesses that are kept afloat by making sure things are kept the way they are.  When we start talking about integrating services, we are talking about creating financial loss for an established business even though it may be what’s best for a community.
   
   
9. Ben explains what an integrated, thoughtful, good mental health care system or solutions would look like based on a decade-plus of research and efforts to understand this problem.  He uses two words to describe what the ideal system needs to look like:
   

   Seamless – We shouldn’t have to work as hard to make addiction and mental health care available or accessible to those who need it.  We shouldn’t have to make as many referrals.  People should be able to get mental health help in the places where they show up for primary care. We need an integrated care delivery model.  Fragmentation of delivery is the problem.

   Comprehensive – Mental health care needs to be provided in a way that takes into consideration social needs, displacement, immigration issues, and other social determinants of health.

10. “Fee for service” versus “Global budget” - Ben talked to me about how we pay for mental health care.  He explained the difference between “fee for service” and “global budget” payments and who global budgeting provides better care to more people than fee for service.
    
    
11. Our language needs to change. Ben talks about how our language needs to change because when language changes, cultures change.  If we don’t start using different language, then we just perpetuate things that are broken.  He tells me that “Mental Health is NOT separate from your health.  It is central to your health.”

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