[music] hello. i'm ivette torres, and welcome to another edition of the road to recovery . today we'll be talking about building public awareness and support for prevention, treatment, and recovery issues in behavioral health. joining us in our panel today are arthur c. evans,

commissioner, department of behavioral health and intellectual disability services, philadelphia, pennsylvania; fran harding, director, center for substance abuse prevention, substance abuse and mental health services administration, u.s. department of health and human services, rockville, maryland; john shinholser, president, mcshin foundation, richmond, virginia; pat taylor, executive director, faces & voices of recovery, washington, d.c. fran, why is there a need to increase public awareness and support related to mental and substance use disorders? it's a good question because many people are thinking that they've seen way too much information on this, and, in fact, what we have learned is that we have to

get the message out so people understand the facts. they understand that substance abuse and mental health disorders are-is just another chronic illness or problem in the public health realm, and we want-as we move closer to health reform, we want the american public to understand that where we fit into overall health and general medicine. so we're-we need to get the message not only to parents, not only to young people, but to schools, to faith-based organizations, to communities, to businesses. every piece of america needs to understand how substance abuse and mental health fits in overall health. and arthur, there are, indeed, many aspects of that message, aren't there? i mean, you know, fran mentioned some of the audiences, but-but what other types of messages? are there issues related to discrimination and-and-and public attitudes about our field?

yes, i think there are, and i think fran's comments are right on point because the reality is that substance use disorders, mental health conditions are conditions that are very prevalent and that they are very treatable, so i-i think the-the two messages are, one, that-that people who have these conditions are not abnormal in the sense-in that sense, but more importantly that there are treatments that work and that are very effective. one of the challenges we have in the field is that most of the people who have, for example, addictions, don't go onto treatment, so less than 10 percent of the people who have an addiction that could be treated will actually access treatment. so that means 90 percent of the people who are addicted in this country could benefit from treatment, don't come to treatment, and most of those people don't recognize that they have a problem or that they could seek help and get help. so i think we have a long ways to go, one, to-to raise awareness about the prevalence, but more importantly, that

there's help out there that can work for people. and pat, they really do fail to go into treatment because they feel that it's-it's their own moral failing and they don't view it as an illness? i think that's part of the situation we face today, but another part of it is that we have treated addiction as a criminal justice issue rather than a health issue, and what's really exciting about health reform is it changes the conversation and it changes the message about the fact if you have a problem with alcohol and drugs or if you have a mental health condition, that there's a place that you can get help not in the criminal justice system. so that remessages changes how people think about themselves but also how society thinks about people with addiction and with mental health conditions, so it's an exciting opportunity to help people change how they think about themselves but also the systems of care and support that are out there-to readjust how they're thinking about it as well, so that more people can get the help

that they need to recover. john, that's easier said than done, isn't it? well, you know, i was sitting here thinking, you know, there's so many people out here that would like help that are trying to get help and they can't even get it. it's nice to think of trying to get the message to the ones who need it-that don't think they need it, but we're not even dealing with the ones that need help, so i-i think our priorities need to be realigned. we need to actually serve the ones that are asking for it, give them appropriate help as they ask for it when they need it, and we'll get a much better outcome for the other ones. who would you see as the primary audience that we have to reach with that kind of message? well, we-we already know that, as pat mentioned, the criminal justice system-full of addicts and alcoholics, substance use disorders, co-occurring disorder. they're crying for help. and then you have what i like to call the-i don't know, the social media aids, you know. it's-it's obliterated, you know, just so much information is out there on making drug use and alcohol use

look so good and glamorous. well, that's a bad message in there. we-we need to send the truth to these people as well, so like i said earlier, if we help the ones that need it, that right there will be a back draft to help the other ones, and then you'll get greater awareness and, you know, you deal with one problem, opens a door to dealing with the next one. there's a batting order for this, i think. and fran, we're really talking about-as we look at what john mentioned in terms of social marketing in the context of new media, twitter, facebook, on and on and on, youtube-are we going to reach-for prevention, for example. are we going to reach, you know, the families, the youth, but who else beyond them do we have to reach? we look at it in the field of prevention because you need both prevention treatment and recovery services to be able to bring all of this information and change if you're going to-if we're going to succeed in changing the country's messaging and behaviors around substance abuse and

mental health disorders, then we have to approach everyone. so we're-we're looking at not only families and kids, especially when you're talking about prevention. they think those are the only-. you have to-anyone that touches a child is the easiest way to think about it in the prevention field. anyone that touches a family member of someone who is in recovery is another way to look at it, and then, of course, anyone that touches someone who is in current treatment. so we need to get to families and communities and people that are in all the communities that support-like teachers and faith-based organization leaders and the media. the media sometimes can be our friend when they send out messages for us. for instance, samhsa just sponsored, just finished sponsoring, 9 months' worth of a parental message around underage drinking in times square. nine full months. we had millions of-of hits on that because every 15 seconds was a message. that was shocking for some to look up in times square and

see a message around underage drinking. though every little piece has its part and that's why we do multiple messaging; we're using multiple people with multiple targets. and arthur, the-the messaging, we-we're all talking about we need to message, message, message. what is it that we need to say because there-there're various tiers? for example, there's-you're in a state, you have to work with your legislature or else if you don't get resources, you're not going to get it. you-you're in a state where you need to talk to other policy people because you're trying to sustain a recovery oriented system of care for both mental and substance use disorders that needs to get people coordinated. and what is-what is the primary message? well, i think that there are multiple audiences and that there are multiple messages so-and-and i think one of the things that i've learned being an administrator in the field is that you really have to tailor those messages. so, for example, when you're talking to the

criminal justice system, the messages are about how do you reduce recidivism, how do you reduce costs in that system? if you're talking to the educators, one of the things we know is that one of the best predictors of whether or not a child is going to be successful in school is whether they have a social and emotional problem. so you have to frame the issue that way. when you're talking to businesses- and you have to talk to them about assessing the students, you have to talk to them about providing continuity of support or- yeah, but i think you first have to get their attention on the issue, and i think people don't necessary connect the dots that when you have untreated addiction and mental health problems that that lead to problems in their systems or into their-their realm. when you're talking to the business community, you've got to talk about dollars and cents. we know that there's a huge cost to businesses in terms of absenteeism and presenteeism where people show up and they're just not productive. so i think we have to frame the messages based on the audience, and, unfortunately, because of the prevalence of-of behavioral health conditions, these conditions impact every aspect of society.

there's no part of society, there's no tier of society, or no part of society that's not affected. i think we have to just make sure that people see the-the connection and understand how treatment, prevention help folks in some of these other areas. and another audience is policymakers. part of our job, and part of our messaging, has to be to policymakers that it's a good investment, that people can and do get well, and that there's a reason for them to make it possible and support the prevention, treatment, and recovery support services that people need; and unless we can deliver that message to policymakers, we really have-we have a big job ahead of us in terms of letting them know about the reality of recovery; that it's a good investment and that the discriminatory laws that they have passed that are barriers to people staying in recovery need to be repealed because with the advent of health reform, we're going to

be investing in millions and millions of more people getting help and getting well. if those people can't keep their lives together, can't get jobs, can't get housing, then we've only done half the job. so policymakers need to understand the implications of their policies in terms of community health, in terms of parents, in terms of kids, and what that all means. john, i do want to come back to you because i know that you've talked to those policymakers, and i want to get your-your absolute input. oh, i'll be glad to give that input. we'll be right back. [music] this year, as the affordable care act rolls out and as increased coverage rolls out, we know that people with mental health and substance abuse issues have a harder time sometimes getting enrolled in insurance and in other opportunities they have for getting coverage.

so we are trying to do special efforts to help people understand how they might do that, to work with providers who work with people with mental health and substance abuse issues to know how to get people enrolled. the enrollment process is going to be a simplified enrollment process for everyone, and we're-so it's going to be a change and yet it's going to be easier, so the trick is getting people information about that and also, frankly, getting people information about why it's important to have that coverage. the overall purpose of increasing community support and public awareness about prevention and treatment recovery is to assist those who are in need of treatment services, to enhance the ability of those in the community to promote prevention activities and awareness about the various issues associated with mental illness or substance use disorders, and also to mobilize

the resources in the community to help facilitate early intervention and to promote recovery. every day i seek a positive- direction for my life- through my accomplishments- and, now, with help- and support for my family and others, i own- i own- i own my recovery from addition and depression. join the voices for recovery. it's worth it. for information on mental and substance use disorders, including prevention and treatment referral, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] well, i think the-we have to overcome that negative stigma out there.

we have still got to sell ourselves to the-to the community. it's necessary. we have got to let everybody know that a recovery is abundant, it's available, it's not that expensive, and, you know, where to go get it. we have to let people know where we're at, like our recovery center. you know, we have over 2,000 meetings a year open to the public, and we constantly let our neighborhood know we're there, so you have got to keep reinventing your message. you know, you don't have to reinvent the message, you've just got to keep redelivering, you know. you've got to constantly be out there like a daily newspaper. so, john, let's continue. i know that you are always-you're in richmond. you talk to people. what is your message? well, i did want to follow up on that little prevention dialogue we had. what i wanted to point out was that out of the-there must be 25 million americans in recovery today, and i'm in long-term recovery myself. and in the recovery community, we always marvel on how we're probably one of the best prevention mechanisms out there because when we're recovering, our families are recovering.

the people whose lives we come in touch with are in recovery, so i just wanted to touch on that. when we do move forward with prevention ideas, evidence-based practices, i think the recovery community- i know the recovery community has got to be one of the biggest underutilized prevention mechanisms out there, and-and to put some attention in that direction, i think, would benefit us greatly, so- and how do you use them in-in-in your work in richmond? well, if you're in recovery in our circles and you have families, you will talk about your recovery process. how did you recovery? what did you do that worked? you know, you hear a lot about evidence-based practice, but rarely do they really get down to the nuts and bolts. okay, this is what we do, you know, we show up, we-we get part of the recovery heard, we become part of, so- and is that effective with the legislative sector of the state? i don't think anything's more effective than when you take actual recovering people down to the general assembly building. when-when you've got 100 people running around those floors, giving out recovery information,

this is what we're doing. we're not only talking about stories, we bring the burning bush to the legislators. this is the situation. this is what worked. this is what needs to be done. very, very effective, and after a while, these legislators start calling us up when they need help. hey, my nephew's got a problem. could you, you know, can i send him over to you? so we're building not only information networks, but actual service networks. these-these politicians are coming to the recovering people for services as equal as they would any other provider out there. so i think that speaks volumes right there. well, and also recovery community centers and other services and places in communities that recovery community organizations have developed are places where the whole community can come and do activities that don't involve alcohol and other drugs, so the prevention message, the prevention lifestyle is the recovery lifestyle in so many ways. and as-like there are 25 recovery community centers in

new england alone that are open 7 days a week where people know they can come if they need help, family members can come for support, so it's developing a culture of recovery in our communities, is also developing a culture that supports people not using alcohol and other drugs. so that's a really important contribution in terms of changing public attitudes, because someone knows that on main street there's a place people can go if they need help. and if you're in long-term recovery, you're there also, so it's changing the culture. fran, part of the messaging to the various audiences that we talked about is the cost of addiction and mental illness to society. yeah, it's one-it's one of the most difficult conversations to have with people, and the-the reason why is because we haven't been able to get the messaging out there that we are talking about people with an illness or people with a disease or a condition. it is a biological, psychological, physiological

issue that is all combined, so when we try to show them that if we could prevent-and when we get the ear of policymakers, state legislators, or congress, or even county or community leaders-that they can see if we can prevent people from even entering into-to the danger zones of addiction, if they could understand that there's a predisposition. so they need to look at their life a little differently. just like a-a family that's raising a child with diabetes. well, when they have another child, there's a good chance, because the parents have the diabetes to begin with, that that child is predisposed to have it. doesn't mean they'll have it. same thing with addiction we're finding out. if your parents have addiction, then there's, then you are predisposed of having a greater risk. all of that information and facts are just part of

so many issues that we want to get across to the american public, and part of that, especially now with the economy and health reform, is showing them all the cost savings and the expense of treating someone with an addiction, the expense and the pain in a family of treating someone with a mental illness. it's very difficult, very expensive, and preventable, and if we can't prevent certain things, we can intervene and make it easier for them in the future. so, arthur, i go to someone, i say $247 billion expenditures for people with alcohol or drug problems, over $200 billon for people who smoke, etc., etc., those that have an untreated mental illness or a mental disorder, and-and people say what to you? first of all, if you say that, their eyes are going to glaze over because they're not-not going to be able to comprehend the number. you know, i-i really think we have to-to make things

relevant to people's lives and to what they do, and-and so that's why i think that you have to break those numbers down and-and put them in terms that people understand. so teachers understand when children don't graduate from school or children can't pay attention in a classroom, and businesspeople understand when their bottom lines are affected, so i think we have to break those numbers down and make-and make the connection for people; but then more importantly, it's to talk about when you do make treatment accessible to people, we have a tremendous return on our investment. so, for example, in-in medicine, one of the highest drivers of-one of the biggest drivers of cost in medicine today is untreated mental illness and addiction, and studies after studies show that if you treat addiction, you save a lot of money on the physical health side, and so we're going into health care reform. i think we have an opportunity, because of how health care is going to be refinanced, to make that argument and to build in

mechanisms for treatment of addiction, behavioral health conditions to be a part of it. if the incentives on the physical health side are such that you don't get paid as a provider unless you meet certain kinds of outcomes, there's a tremendous opportunity for the field to say you can't make those outcomes unless you treat these conditions. and i think the-the smart providers understand that, and so you see now, with accountable care organizations and those kinds of things, people on the physical health side saying we need you and if we don't have you, we can't meet the outcomes; if we don't get the outcomes, we don't get the payments. and so i think that health care reform really gives us an opportunity to really change the dynamic, from one where we're trying to convince people to one where people are going to be coming to the field to say we need your help in order to-to be successful. excellent point. i also want to touch on the fact that because of this

transition with the affordable care act, there will be talking about messaging, we will need to message to the people that are going to get those services, and how-how does one go about in formulating the message to those people? well, i think that there's some public policy issues that we-we really have to deal with, and i think one of them is-right now, we have a health care system that is based on illness. some people have referred to it as a sick care system instead of a health care system. i have a billion-dollar budget in philadelphia, over a billion dollars. less than 3 percent of that budget is spent on anything other than treatment. that means that most of the resources in health care today are spent after the fact, after people are sick, after people need treatment. if we spent even a-a small proportion, a third of my budget, on things like early intervention, on prevention, we'd have a much more efficient health care system, and

i-i think that the-the messaging has to be how do we get further upstream, how do we build into our health care system the mechanisms to do early intervention. and some of these technologies exist. there's a technology called screening or brief intervention, but in most systems, it's not a reimbursable service. that's a service that can be built into health care primary care settings that is very effective at both identifying people who have addictions but intervening in a very low-cost way that has been demonstrated to have pretty significant outcomes and-and impacts in terms of both cost and-and health outcomes. so the message has to go to cms who's putting together- i think cms. i think certainly cms. i think, you know, i'm a policymaker, but, you know, i'm at-i'm at a local level. the policy changes have to happen throughout our-our health care system. they have to happen at the local level, at the state level, and especially at the federal level.

i think cms can do a lot to make the reimbursement of services much more flexible, give the people who are running systems around the country the flexibility to do more of the upstream kinds of strategies, and i think we'd get a much greater return on our health care dollar. very good. and when we come back, we're going to be continuing this conversation, get into what people in recovery can do to get better access to information, and what the government, states, everyone needs to do to really move and improve upon our system of care. we'll be right back. for more information on national recovery month , to find out how to get involved or to locate an event near you, visit the recovery month website at recoverymonth.gov. i felt broken. i needed help from my addiction and depression.

and with the help of my family and recovery support community, i am whole again. join the voices for recovery. it's worth it. for information on prevention and treatment referral, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] the organization that i represent, and am a part of, is community anti-drug coalitions of america. the work that we do, it is changing communities from the inside out so that they are better prepared to address the issue of substance abuse, and it requires everybody working together, whether it be law enforcement, be health providers, the education community, the faith community, parents, everyone coming together around this coalition in order to solve the problems. cadca has been amazingly successful in teaching us

the importance of communicating those messages, best practice, how to do that through strategizers and our trainings where we are educating actually on the grassroots level. on an annual basis, cadca trains more than 12,000 adult coalition leaders throughout the nation. we have our national leadership forum. best thing about cadca's leadership forum is the fact that we really get a chance to hear about the latest and greatest about how to combat the issues. it's an opportunity for everyone that's part of the coalition movement to come together at one point during the year, receive great training, hear from national experts, actually get to ask questions with, you know, major government officials that you think you'd never be able to connect with, but for the coalitions, it's really an opportunity to look around and go, hey, you know, i'm not in this alone. i'm part of a national movement, and there's people out there

that i can network with and learn from. public awareness creates change and without the awareness of the public, then we're dead in the water, and we're not able to move our issues forward, and we're not able to create healthier and safer communities. so we employ a multitude of strategies to make this happen. they have-they have dragged me into the social media age. we have a website. we hold press conferences. we blog. we tweet. we post on facebook. we podcast. we release press releases. we tie those to major news events. [music] and then there's cadca tv, which not only targets a coalition audience, but it reaches an average of 7 million households, so we have an opportunity to talk to the general public about these important issues. one of the major things that cadca has done for us is

in terms of advocacy. you're going to go to capitol hill to meet with my colleagues. about establishing those relationships, why they're important, and how to really make those not only just about the conversations, but truly making friendships, to where when the issues are so important to us, that they automatically become important to somebody who has the power to make a difference. the partnership that we have with cadca and samhsa and our project officers has enabled us to be successful in ways that i never knew we could be. we would not be successful without coalitions. they are critical to our success. they bring to washington the voice of local members, so the members of congress that will then understand and appreciate and react to their voice. our coalitions are working on one of the most important public health issues of our time, and the great thing to note is that prevention works. prevention saves lives, and it saves money.

i come to work every day excited about having the privilege to reach out to communities and to help them address this very critical public health issue. let me go to pat and-and-and note that i know that faces & voices has a particular interest in bringing the message of the changes that aca will bring, and-and what is that message, pat? that addiction recovery is a health care issue. we have a briefing-briefing document on our website that explains why, and one of the important issues that we cover in that is the opportunity for so many people who haven't been covered in the past to be covered, and we've learned from the state of massachusetts, which implemented health reform a few years ago, that people with addiction and people with mental illness have not been able to take advantage of this opportunity for health care coverage. and so one of the great challenges that we have, as a community, is how to message to people about

the opportunity to enroll on october 1st of 2013, and john and many recovery community organizations around the country hold something called rally for recovery each year, and there were 18,000 people in philadelphia, over 100,000 people all over the country. so this year for recovery month , we want to let people know that, with the implementation of the affordable care act, it's time to enroll and to educate families and others about these new rights and benefits that come to them under the law. so with 20 million americans in long-term recovery, we know that recovery works. the question is how can we get help to those who still don't have it, and that's a responsibility that we have. john. well, you know, i was sitting here chomping at the bit listening to arthur and fran speak earlier. recovery, you would think you've got 25 million people in recovery out there, you would lean on those people, the experiences, okay, what worked? let's implement that. let's add value to what you people are doing.