Friday, January 23, 2009

A Health Care Conversation: Unmasking the Stigma

William Moyers, the son of commentator Bill Moyers, is the guest speaker at this morning's "Healthcare Conversation" at the Beechwood in Worcester.  His book talks about his struggle, and he has spent the last few decades working to raise awareness and break down the stigma associated with mental illness and substance abuse.  Lots of people in the room, politicians and providers, most of the leaders of health care in Worcester County.  The talk was sponsored by the Health Foundation, and, given the reform efforts in play in the Commonwealth and the country, the topic is important.  Substance abuse is a mental illness, but the impact on the rest of health care system is huge.
His story is that of "everyman", a youth who experimented and got hooked, fell into the depths and managed to go "clean and sober" in 1994.  He made sure that we understood that people with the chronic illness of substance abuse look like us, and live among us, invisible and in need of help.  Substance abuse is a mixture of nature and nurture; as he put it, while he voluntarily experimented with substances in adolescent, it was the structure of his brain meant that he quickly developed a "baffling inability to 'just say no'".  He wanted us to understand that treatment works, but that it takes time (4 rounds of treatment before he was able to enter long-term recovery).  It is a story that is common, but that needs to be told over and over again, because, despite the science, many persist in believing that addiction is moral weakness rather than a real disease.  He is an excellent speaker;  I suspect that his book is worth reading.  I especially liked his last point, that as a child of privilege, he may have access to resources that mean that, while addiction doesn't discriminate, treatment still does.   What he really wanted us to know is that addiction treatment NEEDS to be part of the health care reform that comes out of the new Obama administration.
He's right, of course, but how does that translate into policy?
1)  Change the war on drugs:  Interdicting supply hasn't worked;  we need to put equal energy (or more energy) into things like drug courts and treatment of those incarcerated.
2)  Implement parity at both the Federal and State level:  The devil is in the details, and the details are written in the Labor Department at the Federal level.  We need to be sure that intent of the law is not undermined in the writing of the rules.
3)  Organize:  Local coalitions, national organizations;  we all need to have a voice in this process.
It occurs to me that, while he focused on substance abuse, the same could be said for other forms of mental illness.  There was more, but I had to leave to go to another meeting.  I guess you should all read the book.

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