The following is a conversation between Chuck Ingoglia, President and CEO of the National Council for Behavioral Health, and Denver Frederick, the Host of The Business of Giving.
Denver: The National Council for Behavioral Health is a unifying voice of America’s healthcare organizations that deliver mental health and addictions treatment and services. Both have been under severe stress since the COVID-19 pandemic and face difficult times ahead. And to learn more about these challenges, it’s a pleasure to have with us Chuck Ingoglia, the President and CEO of the National Council for Behavioral Health.
Welcome to The Business of Giving, Chuck!
Chuck: Hey, Denver! It’s great to be with you.
Denver: Start off with a little of the history and mission of the National Council.
Chuck: So the National Council has its roots in what we call the “community mental health movement” in this country. President Kennedy, the last piece of legislation that he signed before his assassination was a bill to create community mental health centers in this country. Up until that time, most people with mental illness received treatment in residential, large state hospitals. In the 1960s, we had a whole movement of community mental health, and our organization was created to support that movement.
Denver: How many member organizations are part of the National Council? and then, Chuck, talk specifically about what you do to support their work?
Chuck: So right now, we have about 3,500 organizations around the country that are members of the National Council from every state. They serve almost every county in the United State, and the National Council supports them in numerous ways.
One, by giving them educational opportunities to understand best practices. We offer a number of big conferences, other learning opportunities, as well as supporting their work through legislative and regulatory advocacy here in Washington.
Denver: Well, every nonprofit organization has been under incredible strain since this pandemic began. How serious is the picture for mental health organizations and those who provide addiction services and treatment?
Chuck: You know, Denver, we’ve been surveying our members since the beginning of the pandemic, and that’s certainly one of the questions we’ve been asking. And throughout the pandemic, our members are reporting about an average of 20% to 25% reduction in annual revenue, and obviously, that’s an average. So, we have some organizations that are much more severely impacted and others that are less, and then this has resulted in them closing programs and laying off staff. And as you could imagine, the end result of that is that they can serve fewer people, which is a real concern.
…it’s a confluence of things. It’s the impact of social isolation due to the COVID pandemic. The economic downturn affects how people feel, and it’s kind of a perfect storm of how these things are interacting.
Denver: Yes, because we’re going in the opposite direction. And to that end, I just saw a Gallup poll, just in the last couple of days, which indicated that American’s mental health ratings have sunk to a new low. What are you seeing in that regard in terms of the state of our mental health in America?
Chuck: I think every survey like that points to the same thing… that people are reporting worse mental health right now, that they’re feeling more anxious or more depressed. And it’s a confluence of things. It’s the impact of social isolation due to the COVID pandemic. The economic downturn affects how people feel, and it’s kind of a perfect storm of how these things are interacting. But every single survey says that people are feeling more mental health distress now than previously.
Denver: What have you been seeing among young people?
Chuck: I think it’s all ages that are reporting this discomfort, but certainly, young people are not exempt from this. I think the social isolation that they’re feeling as a result of not being in school is also heightened, so the same kind of increase in terms of anxiety and depression.
Denver: I think most Americans know by now that our healthcare system was completely unprepared for this pandemic. How fragile, how prepared, Chuck, is our mental health system?
Chuck: Well, what concerns me a great deal… I talked about the twenty-five percent reduction in annual revenue… is that we know that most behavioral health organizations operate on very thin margins and don’t have substantial reserves. So, this is exactly the concern that we have is: What will our system look like on the other end of this?
And I think, Denver, we’re also at a place where state budgets are also quite shaky. So right now, the public mental health system, the system that exists to serve low-income individuals has two major sources of funding — Medicaid and state general funds. Both of those are going to be under severe stress next year as a result of the pandemic because states have lower tax revenue and therefore, less money to spend.
Denver: Man, oh man! So, when people are getting symptoms of mental health conditions, what, Chuck, generally are they looking for? What kind of help are they reaching out for?
Chuck: The cool thing is that technology is also rising to fill the gap. So we have lots and more resources available right now online. There are different websites that you can go to, both to answer questions to give you a sense of your mental health, as well as to get support.
So there are a number of online tools that you can use to get mutual support and/or to contact health professionals. So some of the things you can think about are self-help groups, as well as reaching out to a mental health professional for counseling, and/or a psychiatrist if you think that that’s necessary.
Denver: I need to ask you this: Come 2022, there is going to be a new three-digit phone number that people should know about. It will be 988. Tell us about it.
Chuck: Yes. It’s an incredible development. So the idea that has been put forward by advocates and now endorsed by Congress is that we should make it easier for people to access care when and where they need it.
And we’re going to have a new three-digit number as you indicated – 988 — that will be available to people, both if they’re experiencing symptoms that might be associated with suicide, as well as anybody who’s having a mental health crisis, if you think you need help. And then those will be connected to local call centers, which will then also be connected to local resources in order to get you into care.
Denver: That’s great work. Congratulations on that. That is a big, big step, and I know you guys had a lot to do with it.
Chuck: Well, it is a big step, and I keep helping myself remember that 911 took a lot of years in order to reach its fulfillment. And we’re going to be on a similar journey with 988. In 2022, that number will be universally available, but I still think we’ve got a long way to go to make sure that we have adequate resources so that when people call, they can get the help they need.
Denver: Speaking of resources, let me get back to the funding issue. And I recall back in the spring, the National Council, along with a whole bunch of your member organizations, requested $38.5 billion infusion of emergency funds for community behavioral health organizations. Since that request was made, what kind of action have you seen, or not seen?
Chuck: Well, Denver, certainly, when we made that request, we thought a new coronavirus stimulus bill was right around the corner. It has proven to be a little more elusive–
Denver: Yes, it has.
Chuck: –than any of us thought back in May. But certainly, there have been efforts.
So, the government, through this thing called the Provider Relief Fund has made some funding available to behavioral health organizations. And as Congress continues to debate another COVID stimulus bill, there is money in there for behavioral health, not as much as we would like, but we’re encouraged by President-elect Biden’s comments that if they pass a bill now, it’s really a down payment on a bigger bill later.
Denver: And the regulatory bodies have been pretty accommodating during this crisis, along with the insurance companies. Would that be fair to say, maybe not looking for prior authorizations and things that they normally do?
Chuck: Absolutely. The level of flexibility that came into place early in the pandemic has been remarkable, both I think in terms of telehealth access as well as some of the things you mentioned in terms of getting rid of some prior authorization requirements.
The private insurance companies seem to be reverting on some of those policies, and we’re continuing to watch that because certainly, we’re not out of the woods yet. I think the pandemic is still raging, and we’re going to continue to need flexibility for some time.
Denver: Let’s turn our attention to addiction, and what have you seen since this pandemic started in March? Has there been a spike in addictive behavior?
Chuck: So there certainly has been an increase in two things. The alcohol sales have gone up considerably. I think more concerning is that the early data that we’re seeing is that overdose deaths are up significantly, about 18% higher this March than in the same month last year.
Denver: My goodness!
Chuck: And that seems to be continuing. So the opioid epidemic did not vanish as a result of COVID. And then we’re also seeing in some parts of the country an increase in overdose associated with stimulants as well. And all of that seems to be tied to fentanyl being in a lot of the drug supply right now. And that, as you know, is very dangerous and has contributed to this increase in death.
Denver: You know, once we get through this pandemic, Chuck, we’re probably heading into a recession, if not worse. What does history signal in terms of addiction during very, very difficult economic times?
Chuck: So I think what we have seen in previous natural disasters, whether they be natural disasters or economic problems, is that both those kinds of situations lead to increased incidence of both mental health and substance use problems. And so, what we’re seeing right now– people reporting more discomfort– we’re seeing overdose rates going up — we think that will continue to be the case post the pandemic, and actually might even get worse.
I think it’s a combination of things. Some of these things are called “deaths by despair.” Some of the economic changes, shifts that are happening in our country, dislocation of populations, but I do think hopelessness plays a large role in that. But I also think the other part of this is, we have continued to treat addiction as a criminal justice issue as opposed to a healthcare issue.
Denver: You know, just moving on from the pandemic, there has been a rise in overdose deaths across all drugs for about 40 years now. What do you believe is at the heart of that?
Chuck: Wow! There’s a lot of people who write about that. I think it’s a combination of things. Some of these things are called “deaths by despair.” Some of the economic changes, shifts that are happening in our country, dislocation of populations, but I do think hopelessness plays a large role in that. But I also think the other part of this is, we have continued to treat addiction as a criminal justice issue as opposed to a healthcare issue.
We don’t have enough education of healthcare professionals for them to identify and treat mental health or substance use problems in their practice. And so many people are afraid to come forward because drug use is illegal, and they’re worried about the ramifications of being arrested or prosecuted if they admit that they have a drug or alcohol problem.
Denver: Sounds to me what you’re suggesting is that we really need a cultural change in this country about how we approach addiction and how we approach mental health. We’ve been successful with that in the past. We were around drinking and driving. We were successful with gay marriage in terms of changing people’s ideas. What has to happen in this arena to change our attitudes about these poignant challenges?
Chuck: Well, Denver, we’re starting to see this in small ways, right? Look at the number of states that have legalized marijuana either for recreational or medical purposes. In Oregon this year, we see kind of a reducing and taking away some criminal penalties for drugs more broadly. And I know right here in the District of Columbia, 75% of voters approved a ballot measure to make magic mushrooms legal. And so, I think we’re starting to see some of that. It will probably take a little bit longer, but ideas like harm reduction are gaining more traction, both in terms of people’s consciousness as well as public policy. And I think that’s a step in the right direction.
…there is an increased awareness about mental illness and substance use and a normalization that these are real common and treatable illnesses. And so, I think the opportunity we have is to really enhance the type of education that happens so people really understand that.
Denver: That’s an interesting perspective. I think I remember Obama’s old line, which says “Change doesn’t come from Washington; Change comes to Washington.” And it is amazing how much of this all happens at the state level first. And if you can effectuate it there, it eventually will become, hopefully, a federal policy.
Finally, Chuck, traumatic events like this do bring opportunities. What opportunity do you think the nation must seize from this pandemic? And what action would you like to be seen taken as a result of it?
Chuck: Well, I think if anything, there is an increased awareness about mental illness and substance use and a normalization that these are real common and treatable illnesses. And so, I think the opportunity we have is to really enhance the type of education that happens so people really understand that.
Our organization operates a public education program called Mental Health First Aid. And over the last few months, we’ve been inundated by requests for this program, both in schools and in workplaces. People are really recognizing that they’ve got to do a better job of helping people normalize this and ask for help. I think that would be a step in the right direction
Denver: For listeners who want to learn more about the National Council for Behavioral Health, tell us a little bit about your website and some of the other things that they may find on it.
Chuck: So our website is thenationalcouncil.org. You’ll find information about how to access any of our members. If you’re looking for treatment, information about Mental Health First Aid, and ways that you can support the work of the National Council. We have a COVID relief fund, where we’re making funding available to behavioral health organizations around the country and would welcome additional support.
Denver: Thanks, Chuck, for being here today. It was a real pleasure to have you on the program.
Chuck: Well, Denver, you’re a great man. Thank you so much for the opportunity.
Denver: Thank you!
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