kaiser poll showed one in four people, one in four say they are following this debate closely. >> let's not talk specifically about public opinion on mental-health and mental illness. and i guess the bottom line question that i would have, and i did some polling for the american psychological association and for believe it or not, mtv when they did a series of public service ads on depression and suicide four teenagers. the bottom line question that i have is when americans think about healthcare reform, do they even think about mental-health? lisa, do you have any evidence from what you guys have done? ..

say that conditions got worse as a consequence. they do that lots of other mental issues and the% getting worse is one of the high cindy mental health issues because of lack of treatment. we have about 14 percent of the people in the survey to a knowledge they had a serious depressive issue and this is i

think the connective tissue of a majority of the country saying that they either or someone in their family for a very close friend has had an alcohol and drug or significant oppressive issue so it touches their lives. i have one suggestion in terms of have to translate those percentages. i do seat belt safety, i started in 1996 to make sure kids whenever in the front seat seat belt and i broke all over the country for monetary seat belt laws with enormous effect a substantial of the fact, but three asked parents like how you secure your kids and 60 percent said they did not secure the adderall. people in this survey know what the socialize response is going to be so 6% say i don't restrain my town at all in the car it is at least 6% and so you say that

is so small so what we have them to is we have a million children in our country, that is 4.8 children and every day we are driving and 5 million children whose parents and knowledge they didn't secure the model and a car. when we changed the release and the dialogue of 6% to 5 million all of a sudden the senate 5 million kids and it is bigger than the entire metro area so we can into a circle and around the press conference and said here is how big the radius would be around this town to cover 5 million children whose parents signallers the never secure in the car and when we did the press conference with a bull's eye and a big circle or how broad you have to go and is to get out of major natural american 5 million people -- a big circle. when you're in that west and drawing a 5 million persons circle is a lot of america.

[laughter] and so the point is in these are things we did to make dramatic for people their risk and who we receiving untouched and uncovered by not having mandatary seat belt laws and so i can a chorus and there is a very tragic stories about happens so if you can combine a personal story and try to find ways like that and that the scope all of those things are much more powerful than talking about percentages. >> one thing i have been inside the pollster is people tend to use too many numbers and if you are you saying for members of on a single page people are going to walk away and remember one of those numbers. if you use the right number and i think you're much more likely to have success.

>> i would differentiate what bill is talking about about the idea of the overall stigma, and try to change not just policy but the way people feel about something and it brought home to see the connection and the numbers do will supply and as the world gets father with a internet traveling all over the condition gets even closer because they're apt to someone who brings of a different situation not only different background bit different, afflictions and different groups all talking about the sort of things or did not talk about five years ago so yours has been around a long time but there are a lot of people who are getting connected marra to that in changing policy is a different thing and look at the number is not just the public opinion numbers but when people have

done polls in devastates or mental health parity issues are coming up there have not been the polling like 85 percent saying they support that. also have not picked up anything an airline that will focus groups and dozens of the past two years haven't heard anything where people saying that disease is important and that isn't and one of the things looking in campaigns i have used mental-health parity in many races the specially the key for something to grab onto that can make a step wrap alone if you're running for governor or senator they don't say though i did this for mental health parity or major taste contrast and saying stood up to people make decisions on how so the idea of

the rising tide as people are focused on health care that can help you get in the door and to push the message about the need for equal achievement which is something people do believe in here to the more you get to the specifics it is hard to expect candidates to campaign on that were put that on the air is an issue not because it's not important but because the 10% of the people in the kaiser coal who said they were affected directly and if you start going to their families gets higher but when you can broaden and include everybody you're going to use that in your campaign. >> muskett even more specific on this message think pernod if you'll excuse the expression. the goal of this group here i am sure in the next several months as we go through this health care reform exercise and as one who has the scars of the clinton health care reform exercise i know what these folks are in

for. their goal is to make sure that mental health as an integral part of the package to make sure the quality goes up and services on march accessible. the tell this group but to say, tell them how to approach the issue. use the right words and you'll get nothing for it. [laughter] >> here is my thought. we did do some work for mha in 2001, we interviewed the family physician, and represent said they did to depression or mental health screening is part of a routine check. there is a very powerful movement for prevention well as in terms of magi to reorient our economy and so when i tell people is in is a lot better if there is a big ring current it's better to put that to build a new pathway.

some my instincts are to look at prevention and wellness, to make mental health under the rubric of something under prevention and wellness and i thank you have to have a message of some optimism and hope that it transforms lives in a way from survey data. and from people with chronic depression bruces those who have had a mild depression and you look at the people who have had it chronic episodes and, of course, in education. they're not being able to work. i can tell from members of the human story that is their but you've got to sell people on that that's the stuff mesa difference and it can ultimately it is connected with the use and is ultimately cheaper and we asked people of this question and try to the low over time is

depression a state of mind or a disease. it is very clear that people see it as a disease and enormously different attitude and i think that learning to talk about this is a treatable disease white of the diseases. it is pivotal to win in these arguments so those are two or three things that instinctively think about in terms of what has to be done and then i would say this having been two health care, like a lot of other advocacy groups the fi that we are now, it is hard to be in that fight because we're not talking about in the plans, talking about what the structure would be so it is not surprising to me you'd feel frustrated and it is hard to get your foot in the door in terms of this discussion at this point.

>> when did you find out about preventive care and your attitude. >> preventive care is popular and the people see it makes sense to and even though it is hard to document costs savings in a sense of the public eye basic level that you could say help people leave happier healthier lives. and so we had tested different ways of talking about prevention and wellness came out the best verses' the disease management where some of them aren't negative testing. so it is important to frame it as a basic prevention and wellness, how can people be more productive on the job in savings and when talking to the public i think on this and anything it is important to stay away from talking about systems and talk about in terms of the patient and his or her doctor because it is that how people to think

about things and the personal stories. the to the point as people start talking about the benefits package one of the dynamics that overlays everything on health reform is the financing and current economic climate. the financing sources are very controversial and hard to find so to the degree that are ways to highlight cost savings both to health care over all the productivity for individuals that is a good time to take because it is top of a mine for many members of congress. >> i have been hard and have a preventative care and thomas on not only is accepted by people but you don't have to give it some of the evidence of how much is and people instinctively trusts that. wellness programs will say everybody money and actually i have found those messages looking at the broader health care debate actually more persuasive to people than any

specific the mandates and things they don't understand and address and the top tier system or structure referring to its. the well as programs can understand and they have one that are in now of this and that can be something and the other thing looking to what you want to get at the debate as he said the elements fighting and one of them falls down there are looking at big issues now but the idea of pushing there should be no denial of benefits and the more broadly say is we're looking at insurance reforms not let insurance companies not let bureaucrats made those decisions and was sort of kerry debt and that is something that has tractions the part of the message didn't work at times but politically and for the

patient's bill of rights and the idea of let your doctor make decisions and not bureaucrats whether in washington or insurance companies. >> a cautionary note for the staff working hard for these reforms -- human beings and patience and americans believe wellness is a cost savings and congressional budget office did not. in yen so they have a very important responsibility which is space for these reforms and tried to look at what the impact of the federal budget would be and there is not a time i am familiar with presidio has congressional budget office substantial expansion and the cost savings to the federal government because they looked only at the net outlay in the beginning. and so is one of the huge gaps between what americans intuitively believe and what cbo and omb is willing to score some

it is a problem because it is hard, it is really hard to get the money devoted to those firms because it is zero credit for it as a reformer because cbo was scored it that way so i want to make sure that lobbyists and others here nor are fighting hard every day on your behalf, the people have read that and understand why is it hard to do -- that is the reason it doesn't get score that way. >> i think that we have one advantage right now in seeking this and that is the guy who is running a office of management and budget has for the last several years when he was head of the cbo and in the white house and the five health care as the primary culprit in economic recovery and growth and so having him there make some difference that is anybody's

best guess. >> on the one hand, and looked at the details and the scoring of these worries, on the other side and the beginning about how little was understood in in the public and preventive care and will thus, i've been heartened by how many people in those instinctively i believe there were good things but a lot of other terms you in this room use all the time use quickly and is not that they are not well understood kennedy townsend but completely misunderstood. i did it focus groups last summer and testing terms like single payer. people say i hate to single payer, i pay my insurance company and keep the money in and we stopped asking the same questions because after a while you have proven to yourself that people do not understand and usually there is only one or two people in a group with a single

pair is this and get on the wrong track so people not only don't have an understanding what is the misunderstand and it is not always that. they have all sorts of different ideas and they will say i'm surprised at the continue to use this and i think they're not doing in a polling or focus groups to get this because you ask people do like single pair or health care they may just not know what it is. people don't understand a lot the market into talking about terms like public plan. even now i wonder how many people and has become the parlance in washington i don't know how many people who have an idea what that is akin to realize something for the government takes care of but the idea of being with the critics would call a government run health care, something they may not have even thought about let alone have a strong opinion on.

>> so what i am seeing here is an advertisement of someone with a mental health problem standing up and looking into the camera and saying you can spend $1,400 to keep me healthy for the next year we cannot spend that money in cost to $15,000 in two weeks in the hospital. >> that is a bummer. [laughter] >> i'm trying to get to the person side and the cost side. >> what i would do is obviously, the end of the spot is i'm back to work and paying taxes and taking care of my family because what you want to pay at the end is not just the choice, you want to pay its choices says what to do with it is even talking to in doing this research with

patience because what they say is i am not cured. and there are not cured so i am dealing with a lifelong problem i've got to keep treating so i talk in health care about my powerful words that are very powerful, choice, control, competition and cure hear the cheers have been incredibly powerful four people and a lot of other groups i work with conductor back here. realistically your patience to talk to don't use that word and so the point is when i talk about hope and optimism as a way to compel action that are not going to say i am cured and back at work and taking care of my family, they say i'm better into in this and that's the option but i'm saying when it takes that spot you want to paint its mission because people want

advocacy and so i'd want to sound terrible but incredibly hard picking stories about africa and they will say it will never get better, we can spend hundreds of billions of dollars and will never get better and it is a barrier to action seven ending in so it is a better option so people understand that that's a lot of money transforms not just his or her life but provides a way to kind of make sure that others can and do something that hasn't efficacious ending. >> you know why bill has been so successful and i had to dig out of it. [laughter] >> what we take a couple of questions in the audience. i don't know if there is a mike but of people are interested in

asking questions. >> [inaudible] [inaudible]

>> the question is about the use of media and identify the problems in defining these problems and why there is in better and more coverage really of these issues here. >> i think part of it is you have a culture -- patient privacy is important and i think the culture of their pre and psychology is the patient privacy are huge concerns and a creates among practitioners and a per. out deeply rooted sense of an aid for her personal privacy and packin spill over in terms of how much they feel comfortable because it is hard when you are a position to tell these personal finance because a lot of them here themselves and talk about them. so my guess is that could be a contributor and i think was

interesting michael talked about the explosion of the disease and advocacy groups in this era, is a constant battle with the law of constant, a lot of other stuff and i would say looking and did it when you do the cancer, heart attack in some others i give you guys 50% of riss connection, there are huge. the crossover sociological boundaries, socio-economic boundaries and when we did the connection to depression there was different results based on education and income. so those are at least, the nice thing is and you can do better and is this window in 93 or four and we are going to possibly do big changes in health care so i

love this story about how powerful love story is and during this window is a proper and you're going to be asked to crank up in a way that is different in the level you got to do because these windows really open about once every 15 or 20 years and when they don't get done we relate another very long time and so this era is next and about the next year are usually critical to defining a lot of health care system where a long time to come because either it will change or if it doesn't change it is not going to come up again for another long time. >> that is a cheerful thought. >> and say not just put in a plug for what i do, but i do think online connections to the

younger people in particular can work and that youtube is wise to buy more than a few people. unfortunately if you look at it from more than half an hour will look at the center of the entire world's population. [laughter] other questions? >> thank you all for coming. and i just want to say that i'm not just better, i am cured. [applause] my question is, what you guys see in terms of the chronic care model because looking at trading they base or asthma or any other care physician if you look at health care reform i think it is important in and talking about perfection and chronic care but we're also preventing the worsening of symptoms once we have a diagnosis so how can that

be part of a conversation when we talk about healthcare reform? >> i think as we have mentioned the idea and prevention is a powerful with the public and they get it intuitively that if someone has diabetes and can self monitor his or her condition and treat it it costs a lot less and has a far better outcomes and if you put out here until you have to have a leg amputated so i think the messages about the positive aspects of prevention and wellness is common sense we intend to reinforce and that. in terms of the coverage one of the more powerful messages to emerge through recent things is your insurance company should be able to deny treatment because you're sick five years ago or your child has asthma and so i think hitting does your friends when messaging to the public is something that resonates and people understand both from this

makes sense without having taken into the number of dollars that goes to health care management and highlighting the potential both in terms of unwellness and out comes as well as prostrating. >> is an example of the approach to have which is it is not just about this condition that the swing to diabetes and expanding greatly and giving people does m.r. publicly discuss and quicker to understand the idea don't think everyone knows and is a chronic care and understanding and the more it sounds like on care management system at the more their eyes are glazing over and sing whenever. if you can say people have conditions that are treatable but can't be cured by a blank, blank, blank and i don't know about the way you interact with a different group but the message to other people the more you have of those examples the

more is inclusive and the more they will understand it. >> when you talk about cost savings, i see cost savings at one level a really good discussion but at the same level in his riding to talk about cost savings because it is almost like you're giving them permission to take money away from mental health services when you say we can save money if you do this. i think house and across the country by serving in georgia where mental health is so horribly underfunded and cost savings is not really what i'm talking about, i'm talking about taking that money and doing a much better job with it. i want them to stop spending the little their spending so had to craft the message that says we can do better without cost

savings because the minute you say that where to put that money and i want to give them that permission. >> somewhat partisan and so excuse me and i don't want to step into my democratic hacks but i will say in georgia part what has happened and all services and levels is people are not standing at and saint here is what has been cut. they have not a here's where it has been the democraticarty and advocacy groups they have just not been willing to say we've got two not cut this program. this one we have to protect so now when the debate is on what programs to save a there is very little left and i think no one is focused on the we have to cut more things. >> we found that talking about improving value and getting more for your money is