NHMH NO HEALTH WITHOUT MENTAL HEALTH A 501(c)(3) non profit   San Francisco - Washington DC Director’s blog

May 2, 2017  

President Donald J. Trump
The White House
Washington, D.C.                                                         

Dear President Trump,

NHMH – No Health without Mental Health, a nonprofit patient advocacy organization, www.nhmh.org, would like to take the occasion of the beginning of the Trump Administration and the 115th Congress to urge you to focus executive and legislative health policy attention on the integration of medical and behavioral care services, not just for the small subset of the U.S. population (4%) with SMI (serious mental illness) seen primarily in the behavioral health setting, but for ALL behavioral health patients, including those seen in the medical/primary care setting.

70% of patients with behavioral health conditions go to primary care.  Moreover, HALF of patients with SMI are also seen exclusively in the general medical setting.  In the medical setting, only 1 in 9 patients receive outcome-changing BH care.  We cannot ignore the medical setting as a vital place to deliver urgently needed effective mental/substance use care.

NHMH fully supports the Administration’s efforts to focus HHS/SAMHSA leadership on truly effective care delivery programs for the SMI who receive their care in the BH setting. And we applaud the unstinting leadership of Rep. Tim Murphy in that regard. Since the SMI are a very vulnerable population in healthcare, they will always require targeted funding for service delivery.  However, this as a sole focus is a too-limited approach – it completely neglects most patients with BH problems – 70% - who will only go to primary care for treatment.

NHMH believes it would be a grave disservice to the American public for the incoming Administration and Congress to neglect the 40-55 million Americans with mental illness now going only to primary care for treatment. This is happening largely because BH providers are not paid to work in the medical setting, and, at the same time, 70% of MH/SA patients refuse to access BH setting care.

We therefore ask that you commit to advance more effective bi-direction integrated medical and BH care delivery models (presently we only have two) since:

- Mental health care truly is an essential component of overall health and must be a core part of all health discussions and debates for health and fiscal reasons;

- Advances in integrated care will greatly help the SMI, whose co-morbid medical conditions often predict repeatedly measured 13-26-year premature mortality;

- Behavioral-physical co-morbidity has rightly become a central focus for CMS since $293 billion in extra healthcare costs are associated with it (Melek et al, 2014);

- Integration of medical and BH EHRs must be a part of the mainstream HIT modernization as now fewer than 20% of BH facilities have currently adopted EHRs; (Walker et al, 2016), predictably leading to poor medical and BH professional communication, co-morbid patient health improvement, and persistent high total healthcare costs, especially a very expensive medical spend.

The undersigned, as Executive Director and a co-founder of NHMH, is also the sibling of two family members with SMI, both of whose lives were cut short due to their illnesses in the context of a segregated medical and BH delivery system.  This is wrong.  Health policy-makers must focus on where patients are in delivering needed mental health services.

If NHMH, with a legacy of decades of focused patient advocacy on improved care services for the SMI, if we have come to this conclusion - that bi-directional integrated care is a vital component of improved mental health services in the U.S. -  we are certain you will listen and “hear” our voices. We ask that your Administration act by developing and advancing health policy that advances evidence-based integrated medical-behavioral care in both the general medical and behavioral settings.


Florence C. Fee, J.D., M.A., Executive Director
NHMH – No Health without Mental Health

cc:  Secretary Tom Price, Department of Health & Human Services
Sen. Lamar Alexander
Sen. Orin Hatch
Sen. Bill Cassidy
Sen. Chris Murphy
Rep. Greg Walden
Rep. Tim Murphy