Moderator: Leslie Brenowitz
March 30, 2010
2:00 pm CT

Coordinator: Welcome and thank you for standing by. At this time all participants are in a listen-only mode until the question and answer session. Today's conference is being recorded. If you have any objections, you may disconnect at this time.

The PowerPoint presentation PDF version, the audio recording of the teleconference and a written transcript will be posted to the SAMHSA 10x10 Campaign Web site at http://www.10x10.samhsa.gov.

Our presentation today will take place during the first hour and will be followed by a 30-minute question and answer session at which time you may press star 1 to ask a question.

I would like to turn the call now over to Leslie Brenowitz. Thank you. You may begin.

Leslie Brenowitz: Thank you. Hello everyone and welcome to "Focus on Wellness to Increase Life Expectancy and Healthy Living of Individuals with Mental Health Problems."

Today's teleconference is sponsored by the Substance Abuse and Mental Health Services Administration 10x10 Wellness Campaign. SAMHSA is the lead federal agency on mental health and substance use and is located in the U.S. Department of Health and Human Services.

The views expressed in this teleconference event do not necessarily represent the views, policies and positions of the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Food and Drug Administration, or the U.S. Department of Health and Human Services.

My name is Leslie Brenowitz and I will be moderating the teleconference today. Our first presenter is Joseph Parks, the Chief Clinical Officer for the Missouri Department of Mental Health and Clinical Assistant Professor of Psychiatry at the Missouri Institute of Mental Health and University of Missouri.

Dr. Parks practices psychiatry at a community health center and has authored or co-authored a number of original articles, monographs, technical papers, and reviews on the implementation of evidence based medicine, pharmacy utilization management, and behavioral treatment programs.

Joe will share with us information about the research work that underlies the issue of wellness among people with mental health problems as well as the efforts of the National Association of State Mental Health Program Directors Medical Directors Council to address wellness. Joe...

Dr. Joseph Parks: Yes. Well good day to all of you and thank you for taking time today.

I would like to thank SAMHSA for putting on the teleconference, and I'd like to thank my co-presenters, Peggy Swarbrick and Lauren Spiro for speaking on this important topic with me.

You should all be on slide number 5 now I believe, the title slide, mobilizing to achieve wellness and inclusion. Let's go on to slide number 6 at this point. So what I'm—my job in the talk is to set the context and give, to present to you the evidence around the needs of people with severe mental illness have with regard to their wellness.

And it's very much a good-news-bad-news story. The bad news is there are a lot of unmet needs there. The good news is that a lot of action has been taking place in the last couple years. Overall there is increased morbidity and mortality associated with severe mental illness.

By morbidity I mean illness and the burden of illness, simply being sick and having symptoms. And mortality I mean early death; death earlier than expected for a person of that age and gender in the general population.

When we do more analysis and look at the causes of death, we find that the additional illness and the additional death is mostly due to preventable medical conditions. Things like diabetes, other metabolic disorders like high blood pressure, heart disease, stroke.

And a lot of the risk is due to modifiable risk factors; things we can do in our own lives to change our health. Things like weight reduction, increasing activity, eliminating smoking.

People with severe mental illness are actually a more severe case of the general population. And that's what I mean by an epidemic within an epidemic.

You know, the general population in the United States has had more obesity in the last 10 to 15 years, more diabetes. There's been a doubling of the rate of diabetes in the general population. And people with severe mental illness really are kind of like the extreme case of what's happening in the country overall.

And of course some of the medications that people need to take to control their symptoms can also contribute to the risk. And that can be a hard tradeoff to decide whether the benefit is worth the risk and then how to manage the risk.

Finally, in some ways most importantly because it's something that can be acted on relatively easily, the usual recommended treatments for medical disorders, the usual treatments for things like heart disease, for diabetes are underutilized in people with severe mental illness.

People with severe mental illness don't get screened like they should for their health risks. And when the screening is positive, the kind of prompt action that one would want to see is not always taken. Let's advance to slide 7.

Well this really came to our attention back around the year 2003, 2004 with a study that looked at the years from 1997 to 2000 and this was a study that was done in six states, Arizona, Missouri, Oklahoma, Rhode Island, Texas, and Utah.

And what these states did was they compared the death rate and the age of death for people in their public mental health systems with people in the general population.

They looked at all the death certificates in the state and sorted them out by those people that had received public mental health service and those that hadn't and then did statistical adjustments so the population artificially would look the same in terms of age and gender.

That's a way of standardizing across populations that have different ages since of course there's increasing death with older age. And then they converted it to the years of life lost. You can actually calculate how many years earlier than expected people died


And what this graph on page 7 shows you is that across the six states and across the four years people were dying somewhere between 32 to 25 years earlier than would have been expected. This means that they were dying at an average age of around 53 as opposed to an average age of around 78, which is what you'd expect in the general population.

Also remarkable is just how tight the results are. There's not a lot of variation year to year. There's not a lot of variation state to state. And that's more evidence that these are sound and believable results. We'll go on to the next slide, now up to slide 8.

So of course then the question immediately came after these results were published around 2003, 2004, well what is causing this premature death? And as I said in my introduction comments, what we found is that most of the deaths were due to common medical problems and not to suicide or accidents.

This table breaks out the years of life lost. That's the person years of life lost. So for instance, if somebody died at 60 and would have been expected to die at 78, they lost 18 years. Another person may have died at 40 instead of 78 and lost 38 years. And you can add up all those years and that's what this table does.

So if you look at the bottom row for all causes of death, in the six states I showed you, four years of the study, there were 1,829 deaths of people in the public mental health systems reported in those states. Those people died a total of 47,812 years earlier than would be expected if you add up the individual years lost for each individual person. About 48,000 years.

Now look at the number for suicide. That's 4,726. That's only 10 percent—only 10 percent of the additional years of life lost came in the form of suicide which was everybody's hypothesis. Mental illness is associated with suicide; we expected to be more of the deaths there. And that was simply not true.

Now look at heart disease. A third of the premature deaths, almost 15,000 of the 47,000 years are due to heart disease. And you also see significant numbers of extra years of death related to respiratory illness, diabetes and cerebral vascular disease. That's another word for stroke, people dying of stroke. We'll go on to the next slide, slide 9.

So Maine was not one of the—no, no, I'm sorry. Rather this is particularly concerning because during the same time we were seeing a decreasing rate of death in the general population from cardiovascular disease.

But as slide number 9 shows, in the years from 1970 to 2000, the mortality deaths from—for people with schizophrenia was increasing in both men and women.

I should have another slide here that would show the rate in the general population which would show you that during the same years, from 1970 to 2000, the rate of heart, deaths due to heart disease decreased by about 50 percent.

So we have a 30-year period during which death in the general population due to heart disease is going down but death among people with severe mental illness and in this case schizophrenia in particular is going up. Let's advance on to the next slide, slide number 10.

Now Maine took a different take on it. They were not part of the original study that looked at people that had died. So Maine said, let's take a look at people and their illnesses while they're still alive. And they compared people with severe mental illness in their Medicaid program to people that did not have severe mental illness in their Medicaid program.

And they looked at how many episodes of illness they had and what percentage of the people had particular kinds of illness. In this graph the people with severe mental illness are represented by the red bar. The people without severe mental illness are with the light blue bar.

So for instance for skeletal connected tissue disease, arthritis if you would, about 60 percent of the people with severe mental illness in Maine Medicaid had arthritic or other skeletal connected tissue disorders compared to about 42 percent, 43 percent of the non-mentally ill people.

Now you don't die from arthritis but it certainly can disable you, make you miserable and keep you from participating in your community and having the kind of life you want to on a day-to-day basis.

You see the higher rates in the red bars in for really all of the different disorders whether it's gastrointestinal stomach disorders, COPD, that's congestive obstructive pulmonary disorder, emphysema, lung diseases if you would. You see about a doubling of the rates there; higher rates of course of hypertension, of infectious disease.

In every case, the people with severe mental illness were having more illnesses while still alive. This was also a helpful study because one criticism of the earlier study is that some of the extra years of life lost in people with severe mental illness could be due to not having as much money, to be impoverished.

People in poverty are—have—die earlier than people not in poverty and often mental illness commonly interferes with people's ability to earn money and they end up being impoverished and maybe just being poor is part of the problem.

But of course if you look at Medicaid, nobody has money in Medicaid. They all are in the same economic group and you can't attribute these differences in illnesses to a poverty differential. It clearly has something to do with the nature of mental illness.

So the overall history of this focus in the last five years on the premature death and the additional illness and the need for wellness in people with severe mental illness started in 2003. The mortality report was done by a group called the National Association of State Mental Health Program Directors Research Institute and SAMHSA paid for that study and we should thank them for it.

Without SAMHSA's backing, we would not have found out about this huge problem. The report was published in a professional journal in 2006 and in that same year we did a policy paper with the National Association of State Mental Health Program Directors Medical Directors Council that alerted the state departments of mental health nationally that this was a major policy issue.

That the people we were trying to get to recovery from their severe mental illness were in fact many of them dying of chronic mental disease shortly after they gained recovery. This is part of the tragedy of this. If you think about the natural course of severe mental illness, people become ill in their late 20s to—in their late teens to early 20s.

They often don't get any meaningful diagnosis or treatment until they're 30. It often can take another five, six years to really get a handle and learn how to manage their illness. Many people don't get a good solid grip on recovery until they're in their 40s. And now to learn that they die 10 years later in their early 50s after all that work to regain a life, this is clearly a public policy issue.

We can't succeed at helping people recovery if they die first of a chronic medical illness. This really became a national public issue in 2007 when it was a news item on the front page of USA Today. And that's also when SAMHSA launched their first Wellness Summit that resulted in the 10 by—launching the 10x10 Campaign and making public the wellness pledge that we'll hear more about from Peggy and from Lauren.

So that's kind of a history of this coming to the public policy attention and becoming a national issue around health. Now going on to slide number 12, there have been some additional actions on the policy side on the part of the states and the public mental health system in the various states.

In 2005 we did a—we put out a policy paper on integrating behavioral health in primary care to try and help overcome some of the fragmentation. I spoke about the policy paper about the general mortality issue in 2006. And at that point we also put out a policy paper around what can be done to offer people more smoking cessation, smoking prevention activities for people that have severe mental illness.

The major cause of death from smoking is actually heart disease, not lung disease and a lot of those excess deaths are undoubtedly related to the higher rates of smoking in people with severe mental illness.

In 2008, year before last, we did a review of the extent to which medications can contribute to medical problems and also did a paper on obesity reduction and prevention strategies. We've been fairly good in the public mental health sector on offering groups and supports and counseling around getting more social interaction.

But we can use those same methods to help people get better physical illness; more activity and watching their food intake and preventing obesity, which is the best way to stay out of it as opposed to reducing it.

We also did a more policy-oriented paper on measuring the healthcare status. You know, you can't really improve anything unless you measure it and the standard we talk about there is that agencies and departments that help people with mental illness need to be tracking their health status if they're going to be doing something about it to make it better.

Going on to slide number 13. There's a toolkit available online for tobacco cessation in mental health programs. New York as a state has been requiring metabolic screening—screening people for high blood pressure, for diabetes, for high cholesterol, and high blood lipids.

Missouri, my state is also requiring metabolic screening at community mental health centers and it's added primary care nurses to all its community mental health centers to act as a resource to the consumers there and the staff there to help them get linked up to good primary care and monitor for the illnesses that should be monitored.

New Jersey has done a wonderful survey of all their mental health provider organizations on how much capacity they have internally to support wellness. This is one more step along the idea that if we're going to improve something we have to be measuring it. And I think it's important that we do benchmark mental health agencies on their ability to support consumers and achieving wellness.

Those were my prepared comments. I look forward to your questions when we get to that part of the talk. But I think my next job is to hand the talk over to Peggy Swarbrick who will talk about taking action on wellness. Peggy.

Leslie Brenowitz: Sorry. This is Leslie. I'll just jump in for a moment and remind people that we will be opening the floor to questions after we hear from each of our three presenters. Thank you Joe for sharing the data with us and very clearly laying out the issue of wellness and the need to work with people with mental health problems in promoting wellness.

Peggy Swarbrick, as Joe said, is going to be our next speaker. Peggy directs the Institute for Wellness and Recovery Initiatives at Collaborative Support Programs of New Jersey, which is a large statewide agency run by persons living with mental health problems in collaboration with professionals.

Peggy is also Assistant Clinical Professor in the Department of Psychiatric Rehabilitation in the School of Health Related Professions, University of Medicine and Dentistry of New Jersey. She has published on wellness and health issues, employment, and recovery and will talk to us today about the process of wellness and some of the models for delivering wellness support in the community. Peggy.

Peggy Swarbrick: Great. Thank you. Thank you very much for the opportunity to talk to you today about taking action on wellness. So I really want to spend a little bit of time today telling you about sharing what I believe is a vision of health promotion and wellness that we want to really start to foster and really think about what we can do.

And hopefully through this presentation I would like to give us a working definition of wellness and some models of wellness, talk about what's happening particularly in the peer support—consumer survivor peer support community around this initiative and then really think about how you in whatever role you have today listening whether you're pursuing recovery yourself, someone who supports people in recovery, someone who designs, delivers or funds services, what we can all be thinking about as a framework to move this agenda forward to try to help promote wellness for people with challenged.

I want to first start off—go to slide 14, to 15. And move, and let us think about wellness. I think one of the things that is very, very important as we get into this campaign, we need to have a clear definition of the word wellness. And so when I think about wellness, this definition that I've got on—have on the slide here is something that really is an important framework for this.

We don't want to just—unfortunately we hear about what's happening for people and typically what happens is we start to just narrowly focus on telling people that they're overweight or telling people to read labels and focus on an important area which is nutrition. But we forget or get them exercising. But we forget what the whole idea of wellness is.

And what I like to think about is wellness is just more than just health and non-illness. But more about people's purpose in life, their active involvement in satisfying work and play, their connections with joyful relationships. It's about a healthy body, healthy living environment. And it also has to do about their sense of satisfaction and happiness.

So when we think about wellness, it's much more about this concept of high level wellness. And we move to—it's more about this idea that we have—make a conscious deliberate process that we are aware of and we make choices for a more satisfying lifestyle.

And this really is important. It's about the choices and about our lifestyle and we like to identify that lifestyle, include the self-defined balance of health habits. Health habits being our sleep and rest, our sense of productivity, our level of activity or exercise, the participation in meaningful activity that we identify as meaningful.

But a diet and nutrition is a piece of it but it's only a small piece of that as well as our relationships. So thinking about wellness in terms of more about our holistic sense of ourselves, more about—to 17—that self-defined balance because all of our needs, our preferences and that sense of balance in the various areas may vary from person to person.

For myself, may people joke with me that I'm considered a workaholic. And I work a lot and I self confess that. I actually would look for a support group but I don't have time because I'm working so much. It's something that provides purpose and meaning and it finds—I find a sense of balance.

For some other people, work is one piece of it but they have their family life, they have their volunteer work, they have their taking care of themselves, everyone's sense of balance needs to be identified by the person. So we don't want to start to prescribe an activity routine or diet for people.

We want to help people to come to some sense of their own wellness in these different dimensions that I'm going to talk about in a minute and start to look at it from their own needs, their preferences and what they see as a sense of balance for them personally.

We think about it in this balance in terms of all these different dimensions. There's various models of wellness. There's the National Wellness Institute has a six dimensional model. And we've identified—added two extra dimensions to that.

This eight dimensional model looks at having a spiritual side, looking at our occupational side, the mental and emotional piece, the environment, social, physical, financial, and intellectual looking at ourselves as having all these different areas that impact on our sense of wellness.

So as Joe had mentioned, issue of poverty being a factor in people's ability to have a lifestyle that supports their wellness and many times maybe contributing to some of these statistics that we're hearing.

We need to, as we think about moving forward ourselves personally in our recovery or supporting someone or funding new services or designing services, we can't just focus only on the physical dimension though that's important. We need to be helping people to look at themselves more holistically.

And as we help to support people, we need to be thinking about how their physical dimension that might be impacted is—relates to—these other dimensions of wellness.

We see as we've heard from Joe that particularly the physical dimension is significantly impacted whereas people not having access to good medical care or screenings, preventative care is not something that's on people's agenda or people getting access to it. And the other areas that we see in terms of self-care, sleep and rest, nutrition, and level of activity are many times impacted for people for various reasons.

So what we want to do when we think about wellness and moving forward of taking some type of action to help impact this discrepancy that's happening in people's lifespan as well as quality of life, we want to help them to think about them more from a holistic perspective and particularly help people to look at themselves from a strength's perspective.

Help them to see themselves first of all as having—being—multidimensional not just having mental and emotional issues that might be impacting them but looking at themselves as - and physically what's going on in terms of strength socially, spiritually as well as the other dimensions and help people to see themselves in terms of the strengths that they have and then help them to come to looking at what they do—they need.

What kind of unmet needs is happening for people and then what are some opportunities where we can help support them to help them achieve some sense of balance in the various areas that they may feel are out of balance.

So this framework for wellness is something that is very, very important for us to think about as we move forward and not just be solely focusing on that physical piece. And I want to give you some examples where this has been taken to heart—have taken this wellness approach focusing on physical dimension but not ignoring the other dimension has been in the consumer survivor movement.

There—I'm going to share for an example of three states that have had peer delivery models that are addressing health and wellness. The state mental health program directors issued some transformation-transfer initiatives to fund states to do some pilot projects around transformation.

And three states put together different projects that were similar in that they all were addressing health and wellness. And all they were, all of them were similar in the aspect that peers were designing and delivering the model.

In Georgia there's the whole health initiative were peers, certified peers, specialists. In addition to being certified peer specialists are getting additional training around whole health and being able to help peers around making some lifestyle changes in the different areas of wellness that are impacting their quality of life.

In Michigan, they created an initiative that was based on the Stanford Lorig model which is a chronic disease management model that uses a peer to peer support around helping people manage a chronic medical illness by providing peer support, providing education.

So in Michigan there is a peer-to-peer model of providing the support based on this model. And in New Jersey, which is a project that I'm very, very involved in is what we call a peer wellness coach training where we have trained peers to work with peers around using wellness strategies and using coaching strategies to help people with health and wellness goals.

The two trainings in—the training in Georgia and Michigan provides the training for people to develop the skills and to work in various roles as peers support specialists around this whole health and wellness.

In New Jersey the initiative around wellness coaching was able to provide six college credits for the peers taking the training, which has helped people in terms of having a career ladder and providing this wellness coaching and it's been a model that's now a role that's being adopted in many of the programs throughout the state.

So this gives you an example that people—peers and the peer consumer survivor movement are moving forward this agenda of wellness by actually finding ways that peers can get trained and have a role in supporting other peers around the health and wellness issue.

Our Agency Collaborative Support Program has been very much looking at this issue for quite some time. I can remember back in the 90s even bringing the statistic to people's attention when it was actually in—the literature was about—was saying about 15 years disparity.

And I remember not having such a warm welcoming to the people wanting to do too much about helping people. And we've been a slow steady movement in our agency to try to start to address wellness.

Well as we learned about more and we've had the—in 2007 I was part of the Wellness Summit that you're going to hear a little bit more about that led to the 10x10 Campaign. I really came back to the agency and some people in our state said we really need to start doing some more things.

So as an agency we started to look at what are we doing, how are we helping people, how is the number really affecting the people that are involved in our extensive —we have a lot of peer run centers around the state as well as we provide supportive housing to people.

So we decided we need to start to do something but we also needed to start to collect data and started to—start to see how this number looked with us and started to create some benchmarks for ourselves. So one of the things that we did was we started a series of metabolic screenings for our community and we collaborated with staff throughout the agency and we started to do screenings. And as of to date we've done 10 screenings with about 160 people.

We also helped coordinate a screening at the alternative 2009 conference that was—had about 70 people participated in that screening. And at these screenings we would—we took body mass index. We did waist circumferences. We did blood pressures. And we were able to do a test which was the hemoglobin A1C testing that was a test that can help people understand their risk for diabetes.

And at these fairs and these screenings we also started to create—provide some education for people and a lot of interest in people's overall health and wellness. And it's moved into a lot of training, education, support that we've been able to now provide to people throughout our networks. And we've actually been able to provide some technical support for other peer groups around the country looking to start these kinds of initiatives.

So we have this wellness framework. We have this problem and this issue that's facing us. So we've taken this action and we have a number of other things that we're looking at we've been doing that I—one of them was also on slide 22.

We had a—we have a Fall Fest every year where about 400 people come together. And at that fair we did another metabolic screening and we provided this literature. But we also designed the festival to have opportunities for people to have healthy options and had very healthy—were paid very much attention to the menu that was offered as well as had stations where people could learn how to make healthy meals on a shoestring budget.

So there was like stations and demonstrations—had a lot of activities, recreational activities. So we took the whole event that's an annual event and had it around the theme of staying alive and keeping the message of wellness being there.

So really our message in sharing this is to help you understand that there's a lot of things we can do in our own spheres of the universe wherever we are. We want to be thinking about this and not wait for someone to fund something or wait for someone to tell us how to do something.

The key as is here in all these different examples is that we understood as a peer group there was this issue and we started to take the steps to start to do something about it.

And that's what I really want to encourage us to all think about is that wherever we are, you know, as a person pursuing recovery, a family member, someone providing services funding or designing services, there's a lot we can do. There's a lot we can continue to do that we're doing well from a strengths perspective. We want to sit back and think about what we're doing well.

There's a lot of things we might want to sit back and say we may want to stop doing because they might be things that are getting in the way of people and/or contributing to this issue and there's a lot of things that we might want to start doing that might be helpful that could really be helping people.

And we want to be thinking about this continue, stop and start perspective in terms of the policies that we have, the procedures, the funding that is available or could be available and the metrics. What are we doing in terms of collecting data and actually then using the data to inform what's happening?

And I think that's a really place where we—there's not a lot of systematic way of collecting data. And then also if there is, many times there's not systematic ways of using it to inform and improve what we're doing.

So we can really sit down wherever we are and think about those policies, procedures, funding, and metrics as well as the training and academic preparation of people working in the field.

Those of us in academia or those of us in agencies what hire and train people, as we hear about this information that we—information presented today and in subsequent teleconferences that you'll hear, you'll want to be able to start to help the people working in the field to understand this information in the practices and improve their skills to be able to help people more in this area because as we can see, we're not—seeing this statistic, we're not helping people.

So we need to be learning new ways of helping people and guiding people towards more positive healthy lifestyle choices to help their - in terms of their overall wellness. So it's a training and then academic preparation that needs to be altered a bit.

There's also where really we have the most control any of us listening to this lecture today. We have practices personally. We have behaviors and we have attitudes that all of us have. These are things we need to sit down and reflect on ourselves personally and professionally.

What are our practices and which ones might be getting in people's way? What are some of our behaviors or attitudes that might be getting in people's way that we want to be able to perhaps learn some new information, start to find some new ways of doing things to start to change this and this is where we can have the biggest impact?

The example, as I said, I was working on this initiative a lot - for many, many years and as we came back to our agency just had us sit down and think about what we could do as an agency, what we could do as individuals and started to make some headway in that.

So I think there's a lot of things—a lot of work for us to do but I do believe that there's things that personally and professionally we can start doing. I think one of the things you could do after this lecture today is just start to think about how do you define wellness.

And how do the people who you work with or work to serve define wellness and really start to have that conversation and come to some kind of understanding there looking at the information we've given you or start to go look at other information that's out there.

Determine how you can impact the policies, practices, funding as well as data and using the data, you know, to be - and form what we're doing to be able to make some positive changes. Particularly examine our personal and professional commitments in terms of our attitudes, our behaviors and practices.

These are things I think we can all do and I really thank you for the opportunity and look forward to your questions.

Leslie Brenowitz: Thank you Peggy. I think it's very helpful to start us off thinking about how at the individual, organizational, and community levels we can apply these concepts to our own wellness and to supporting the wellness of others.

Our final presenter today is my colleague Lauren Spiro, who is the Inclusion and Mental Health Recovery Manager here at Vanguard Communications, the support contractor for the SAMHSA 10x10 Wellness Campaign. Lauren is also the director of the National Coalition of Mental Health Consumer Survivor Organization.

She co-founded two non-profit corporations and is passionate about her vision of an America where every individual is respected and included as a valued member of the community. Today Lauren will discuss SAMHSA's vision, the agency's efforts to address wellness among people with mental health problems and the pledge for wellness that was mentioned earlier on this call. Lauren.

Lauren Spiro: Thank you Leslie. I am very pleased to be here with you all today and I'm actually very delighted about the excitement this campaign is building. Shortly after the mortality study results were splashed on the front page of USA Today newspaper, SAMHSA held a two day national wellness from it and launched the 10x10 Wellness Campaign.

The focus on the campaign is to reduce early mortality of individuals with mental health problems by 10 years over the next 10 years and the approach of this campaign is very broad including, you know, social inclusion model and wellness.

I think of social inclusion as a complex multidimensional process that affects both the quality of life of individuals and the equity and cohesions of society as a whole. Social inclusion is evidence when every individual has the resources, opportunity and access to participate fully in all aspects of life in the community.

We are pleased at SAMHSA. I'm representing SAMHSA on this call. We're very pleased with our partnership with the Food and Drug Administration, Office of Women's Health, and I'll talk a little bit about that later on.

So the wellness challenge is, you know, before us. People with mental health problems deserve obviously to live as long and as healthy as other Americans. And the disparity in life expectancy between people with mental health problems and the general public is quite shocking and clearly unacceptable.

The reasons we're dying, as Joe had mentioned, before our time, you know, dying prematurely are largely preventable and the challenge we face exists within a fragmented system that was not designed to promote recovery. So in considering how to reverse the mortality trend and increase life expectancy, it's important for us to look at this wellness challenge.

There's a lot on this slide and I'm really going over it very briefly but people with mental health problems are vulnerable to early mortality due to many factors and some of them are listed here. Certainly there's modifiable risk factors, which again was mentioned earlier such as obesity and smoking.

There's also issues of poverty, of homelessness, of unemployment, of social isolation, the impact of psycho pharmaceuticals is another issue, access to healthcare, of course that's going to be changing now with healthcare reform as more people will be able to get into care.

But the other issue is getting the right care. And that brings up issues of accessibility, cultural and linguistic competency and meaningful choices that fit one's own self-defined needs.

So what also makes us vulnerable and I will mention I am a psychiatric survivor myself. So other factors that make us vulnerable, hopelessness, learned helplessness, trauma.

There's a lot of data pointing out the prevalence of experiences of trauma amongst people with mental health problems. So, consideration should be made to using trauma informed approaches that minimize re-traumatization.

So the vision and pledge for wellness—I get excited about this stuff. The vision is a future in which people with mental health problems pursue optimal health, happiness, recovery, and a full and satisfying life in the community via access to a range of effective services, support, and resources.

So the pledge, the wellness pledge was developed before the 2007 National Wellness Summit and today over 2,000 individuals and organizations have signed on. And basically when you're signing on you're saying I or we pledge to promote wellness for people with mental health problems by taking action to prevent and reduce early mortality by 10 years over the next 10 years.

But the time clock started in 2007. So we're really saying reduce it by 10 years in the next seven years. So I think the pledge inspires action and invites individuals and organizations to set up their own accountability campaigns and I commend Peggy and CSP of New Jersey and others who have taken action to fulfill this pledge.

So now I'm going to talk a little bit about the SAMHSA, the Substance Abuse Mental Health Services Administration, their National Wellness Action Plan. There are over 82 recommendations on this plan. They're very impressive. I'm giving you a very broad-brush stroke here.

In terms of the immediate actions, we've developed a website and I'll go over that at the end of the presentation, the 10x10 Web site. There's a grant program addressing early childhood wellness to demonstrate effective approaches.

Work is underway to develop practice guidelines and related information for providers that includes among many other items and priorities the 10 components of recovery as defined by SAMHSA during a—oh I'll call it conference that they had a meeting of experts some years ago.

So management tools for consumers have also been disseminated. One of them is WRAP that I'll just mention here, the Wellness Recovery Action Plan. In terms of data and surveillance, we're looking at, you know, analyzing existing data measures, looking at what we should be measuring but we're not measuring which we call gap analysis and having centralized data repositories for this information so of course people can legally access it.

We need to look at the behavioral risk factor surveillance system and make sure that in their health survey portion that there are wellness related sections for people with mental health issues. Those are some immediate actions.

Moving more into the midterm under effective practices and policies, certainly we want to see collaboration in the state systems and others to identify and implement effective integrated care strategies and within that certainly we want to incorporate consumer-operated programs into local systems change efforts and use consumer-run alternatives to hospitalization as models for wellness.

We also want to work on further promoting consumer leadership. So this might be developing membership programs, leadership programs and just expanding opportunities for consumer survivor input.

In terms of training and education, we're going to be seeing more self-management tools, shared decision making and person centered planning are in development and the Campaign for Mental Health Recovery, which I sometimes call CMHR, is a national campaign for promoting wellness and also disseminating information locally.

The CMHR has awarded about 25 grants in the past and will soon announce six grants to consumer run organizations. The Campaign for Mental Health Recovery also releases public service announcements nationally. They have the Voice Awards, you know, awarding programs with positive depictions in mental health and other efforts to work on community prevention and wellness.

Let's see. In terms of data and surveillance, we need to examine the SAMHSA outcome measures and their ability to address mortality to determine the effectiveness of the work SAMHSA does particularly with outcomes on early mortality and increasing life expectancy.

So in terms of the longer-range action plans, we certainly want to look at improving financing policies to promote wellness to recovery and adoption of self-directed care and with healthcare reform, we're going to be seeing major changes in financing and how the dollars flow.

But even before healthcare reform, I think there's been a lot of discussion or at least beginning the discussion about lending funding and grading it and just innovative ways of having those dollars flow to where they need to go.

Under training and education, certainly we want to engage and impact academics training for (unintelligible) and accreditation bodies to include wellness approaches and standards. We want to make sure to engage consumer operated programs and systems change and promote strength based and wellness approaches.

Under data surveillance, we're looking forward to increased collaboration with federal partners to develop mortality data reporting and certainly we want to promote collaboration between consumer run organizations and researchers on developing wellness measures and getting that information out widely across the country.

So the campaign overview, again, the goal of the campaign, the Wellness 10x10 Campaign, is to reduce early mortality of individuals with mental health problems by 10 years over the next 7 years and the objectives of the campaign are to raise awareness about early mortality rates of people with mental health problems, to increase our understanding of the causes and the prevention of early mortality and to motivate action to reduce early mortality.

And I want to say a couple things about that last point. One is we want to be mindful of the individual's right to have meaningful choices and to be able to make choices that best meet his or her needs. At the same time, we want to have a big picture perspective, a public health perspective and make sure we have flexible, diverse, culturally attuned, non-coercive services, support, and treatment that assists people on their journey to wellness.

Last but not least, we want to make sure that the end user, people in mental health recovery, are centrally involved in decision making at all levels. Planning, for example, training, policy formulation, service delivery, evaluations, etc.

So the primary focus or target of the campaign is certainly mental health providers, primary care providers, mental health consumers and survivors, and consumer- survivor-run organizations.

So some of the campaign activities are the following if you have the slide in front of you. If not, I'm going over it. But we have a 12 member steering committee representing consumer survivors, providers and researches and the steering committee meets two to three times a year. We've already had our first meeting.

We have bimonthly training teleconference and this is actually the first teleconference to kick off the six wellness teleconferences we'll have this year. We have quarterly information updates and a number of educational materials that will be developed.

And very exciting, very exciting, we have the Web site http://www.10x10.samhsa.gov. So if you want to build a list serve, please sign up and we want to just get information out in various, you know, venues, conferences, newsletters.

We want to send out updates and bulletins and research and promising practice but, you know, it's really—I'm a visual person and I just picture this net across the country and it's a communication net, how we can get this information out to people on so many different stakeholder levels.

So a little bit about the FDA OWH, okay, the Office of Women's Health and their campaign role as partners here. They have free award winning health information that has been focus group tested and it's in multiple languages. They have content for social media and education activities.

They have an amazing Web site. It has a lot of depth to it and it's on your—its on the screen for those of you that have the PowerPoint. But it's http://fda.gov/women. They have teleconferences for healthcare providers serving special populations with chronic conditions.

So in closing, I want to mention three resources. The first one is, I think of it as Joe's study. Of course it's not Joe's study but it is the mortality and morbidity study. That's the first bullet you have on that page.

The second is the NASMHPD Medical Directors Council, just what it says, and there are several reports on there that may be of interest to listeners. And then the third bullet is promoting wellness on the individual level. It's a talk I gave at the 2007 Wellness Summit and the talk includes many recommendations on the individual and systems level for promoting wellness.

Lastly, to co-create our future and fulfill this pledge truly takes a village and I invite everyone to take action. Thank you.

Leslie Brenowitz: Thank you Lauren for sharing with us that overview of the campaign and Lauren did mention the Web site, which we'll continue to populate. I invite you all to go there and please sign up for the list serve to receive announcements of future training teleconferences, our quarterly informational update—and we're currently finalizing one right now—and to share your thoughts for where the campaign can go.

Just a couple—to mention a couple of additional slides we have here. There's a brief biography of each of our speakers to remind you of their qualifications and their expertise. And then on the next slide, slide 40, their contact information as well as contact information for Susana Perry who is the Acting Director of Health Programs with the FDA Office of Women's Health and SAMHSA's key contact for that partnership with the Office of Women's Health.

We'll now take questions from any callers who have them. To ask a question, please dial star 1 on your telephone keypad to be placed in the queue and give the operator your name. The operator will announce whatever name you provide. So if you prefer that only you first name be announced, then please just give the operator your first name.

Upon hearing the conference operator announce your name, please ask your question and after you've asked your question, your line will be muted so that presenters will have the opportunity to respond. Feel free to address your question to a particular presenter if that's appropriate or to the group and after the Q&A period ends, I'll come back on with just a few bits of housekeeping and we'll adjourn.

So operator, do we have anyone in queue?

Coordinator: Yes we do. Just a moment.

(Terry Andrix), your line is open.

(Terry Andrix): Yes. Hi. I am interested in finding out if there is a toolkit for obesity as there is for tobacco?

Dr. Joseph Parks: This is Joe Parks answering the question. You know, if you go to the NASMHPD Medical Directors Web site, the policy paper on obesity has several appendices that have links to existing toolkits out there. There are several different—there's several different options out there.

And if you take a look at that paper on obesity, you'll find some good resources that can help you out. We didn't call it a toolkit but most of the information on how to find the available public programs are listed there.

(Terry Andrix): Thank you very much.

Dr. Joseph Parks: By the way, I would like to add one point. One of the key findings that would surprise some people is that obesity interventions are just as effective in people with severe mental illness as they are in the general population. There's nothing about people with severe mental illness that makes them less likely to respond to an intervention around obesity or weight loss.

In general, when people do these kinds of programs or medications or interventions, about half the people will lose about 15 pounds.

(Terry Andrix): Thank you.

Leslie Brenowitz: Next question. Operator.

Coordinator: Next question comes from Katie Wilson. Your line is open.

Katie Wilson: Hi. This is Katie Wilson. I'm from the Copeland Center for Wellness and Recovery and I wanted to ask a little bit more in depth about some of the Internet resources that you're putting together particularly if you're going to be developing a social network platform for people who are joining the 10x10 program of if you're going to try to integrate it into already existing programs.

And I also wanted to let you know about a great paper that came out from the Pew Internet and American Life Project, which is on chronic disease in the Internet, so.

Leslie Brenowitz: Great. Thanks Katie. This is Leslie Brenowitz from Vanguard and the 10x10 Campaign. For the time being we're sort of have an interim, you know, Web resource up where we—people can access some information and reach us. But the plan ultimately is to build a comprehensive website for the 10x10 Wellness Campaign.

And while, you know, the specific direction of social networking activities hasn't been decided, there's definitely interest in integrating that. And, you know, I think we'll want to look at whether it makes more sense, you know, whether we'll reach more people and serve more people by kind of striking out on our own and developing a platform versus working through existing social networking platforms or doing both.

But there's certainly interest there. And for now while this isn't exactly social networking, it's at least a back and forth mechanism, people can sign up for the 10x10 campaign list serve by going to http://www.10x10.samhsa.gov. But Katie, if you all have interest and experience in, you know, working with social networking on this topic, we'd love to talk to you offline about learning from your experiences.

Katie Wilson: Great. Thank you.

Leslie Brenowitz: Next question.

Coordinator: Next question comes from Peggy. Your line is open.

Peggy: Yes. Hi. This has been a wonderful discussion. I just in thinking about the three different presentations, I'd just like to see what you think about—is it you think that screening tests are a must to reduce mortality and co-morbidity rather than just, you know, obesity and smoking cessation and exercise?

Dr. Joseph Parks: This is Joe Parks. I'll take that question. Yes. I think that people with severe mental illness just like the whole general population should all (could) be recommended screenings by the American Academy of Family Practitioners or by the CDC Preventive Care Task Force.

Now one good news is in the healthcare reform legislation just passed, all that's going to be covered as healthcare reform comes in over the next several years.

With respect to people with severe mental illness in particular, particularly anybody taking anti psychotic medication, it's clearly the standard of practice. If you take an anti psychotic medication, you should be getting checked on a regular basis for your blood pressure, for your glucose tolerance with either a fasting glucose level or a hemoglobin A1C, for your cholesterol and for your blood lipids as well as your level of obesity.

And all those should happen at least annually for anybody taking any anti psychotic medication.

Peggy: Thanks so much.

Lauren Spiro: This is Lauren. I just want to jump in. You know, it's hard to get treatment for a condition when you don't know you have it. So I think it's really important to, you know, get check-ups, you know, from practitioners of your choice, you know and I'm not saying of course if you're in mental health treatment somewhere to go along with that treatment. But, you know, separate from that or in collaboration with that, you might want to work with peers, with family members and with others to just get screenings for—to make sure that you're in good health.

Dr. Joseph Parks: And I'd like to give the listeners a tip on how to get your doctors to take action. I'm a practicing physician. I have some knowledge of what I'm like and what my colleagues are like and you're more likely to get a particular action out if you ask for a particular thing.

If you come in and ask me how you're doing in general, I may not find the particular thing you're concerned about. If you come in and say, you know, Dr. Parks, they told me my blood pressure's high. I'm worried that I need treatment for high blood pressure. Could you take a look at that?

If you ask about a particular thing, you're much more likely to get action on a particular thing. That's why screening is good. You know, if it's done in your community health center, it may not be done by a physician but it gives you a piece of information to go to that next visit and say, ah, it's my cholesterol. Look at my cholesterol.

Peggy Swarbrick: And our screenings were good evidence of that because we've done these screenings and I've had a number of people come see me later on or follow up where they've said that they—because we give them the information.

We give them the numbers and they're going back to their primary—they're either connecting with a primary healthcare provider or finding or connecting with who they have. And people are saying, you know, I've been talking to them about, you know, and have them change my medications, lowered it, taken me off this.

So the more we can even get people to do this, you know, things can change. But as Lauren said, if you don't know, you know. We have many people who really were clearly diabetic and needed to practically bring them to the emergency room after the screening. I mean they were so—they're—so it really is important that we encourage people to get these screenings as much as possible.

Lauren Spiro: And I'll just add with the shared decision making toolkit that's coming out, and I'm not an expert in it but I've been to some presentations, I think we'll get a lot more tools and information on how to do this. But one thing I think that they include in there in the shared decision making is, you know, thinking in advance of - and perhaps even taking notes about, you know, your specific questions. What you want to ask. Your specific symptoms.

And again, you might want to bring an advocate, a friend, a peer along with you for support or in case you forget to ask a couple things or maybe based on the results you get, you know, just having someone there with you, you know, as a support person I think is really important. I've done it in my own life and it helps a lot.

Leslie Brenowitz: Thanks for that question. Do we have another question on the line?

Coordinator: Yes. The next question comes from (Bob White). Your line is open.

(Bob White): Yeah. The question I have is—and I'm, you know, I just—I don't know. It's—we're trying to get back to what we had in the 70s. You know. We weren't dying as young in the 70s as we are right now.

The major, major thing I see—I mean we smoked back in the 70s more than we smoke now. We drank more. We ate more. We did all of that because we didn't know about our health as much as we do now. The major thing that I see different is the drugs that we're taking and some of the side effects from the drugs that we're taking.

And I'm glad to hear that you're talking about it. But is there - is the drug companies, are they—is the light coming on saying hey, we're causing sugar diabetes in people. We're cover - there's high blood pressure and all the rest of that stuff?

Dr. Joseph Parks: Yes. Yeah, I'll take that. Yes, the drug companies are much more active and sensitive on the general health issue than they've been in the past. Some of the newer medications do have a great—are associated with more weight increase than many of the older medications.

But, you know, some of that tipping point is also people that are on medication even back in the 70s were somewhat heavier than the general population. But we've all packed on another 20 pounds since the 1970s both the general population and the mentally ill population who are all somewhat heavier and it's kind of like passing the tipping point earlier.

That said, among the medications there are certainly some more weight neutral choices out there that can - that are less likely to pack on the pounds and there's good studies showing going from a high-risk weight medication to a lower one can help you shed some pounds. So, you know, something to talk with the doc about.

Leslie Brenowitz: And this is Leslie. I'll add that it is likely that in one of these training teleconferences this year we'll be looking more specifically at the issue of safe medication use and the connection between the side effects of some of the atypical anti psychotics and metabolic syndrome, etc., as well as developing some education materials about that.

I also refer people to the FDA Office of Women's Health Web site that Lauren mentioned earlier and there are many useful publications there including about safe medication use, et cetera. But I think, you know, part of the job of this campaign in to make sure that consumers and providers alike are well educated and well aware of the connection between some of the medications being prescribed and their side effects and impact on wellness. So it is an important point that we're going to continue to talk about.

Dr. Joseph Parks: I think one of the—one of the big culprits too is just the larger amounts we all eat. I mean 1970, nobody asked you to super size it. The only fries you could get were the little dollar fries, remember. Remember when all the fries were the size of the dollar fries? Hard to get them now.

Leslie Brenowitz: And we were all full after we ate them. Imagine that. Thank you. Do we have—sorry Lauren. Go ahead.

Lauren Spiro: Yes Joe, I know I'm certainly larger than I was back then. I just really—I just really appreciate (Bob)'s question because, you know, I just see so many people that gain weight very quickly from particular psych drugs. And just I think we need to be mindful about not only the medical impact but the emotional impact that this can lead to and often does lead to, you know more social isolation.

It's harder for people to get out. It's harder for them to exercise. And, you know, they just—it's hard for them to, you know, emotionally go out because of the—and I'm talking about some people I know have gained huge amounts of weight. I mean we're not, you know, 20, 40...

Dr. Joseph Parks: Oh, it's like double discrimination. You can be discriminated against...

Lauren Spiro: Exactly.

Dr. Joseph Parks: ...due to your weight and due to your mental illness. It is —and it's a double burden.

Leslie Brenowitz: That's an excellent point. Thank you. Do we have another question?

Coordinator: Yes. We have quite a few more.

Leslie Brenowitz: Okay. Next question.

Coordinator: Next question comes from (Stephanie Lucas). Your line is open.

(Stephanie Lucas): Hi. I'm (Stephanie Lucas). I'm from (Magellan). I'm a peer support specialist and I was wondering what things a peer support specialist can start and stop and continue doing in the wellness program.

Leslie Brenowitz: So in case anyone couldn't hear, (Stephanie) is a peer support specialist and she was asking about practices that peer support specialists could engage in or not engage in to support the wellness of the people they're working with. Peggy, do you have any...

Peggy Swarbrick: Yeah, I would—so in terms of the different initiatives that I outlined from the three states, some of—if you want to look at some of the ways they're doing training around helping the peers in terms of wellness.

I think the biggest thing they're doing is using the framework of wellness as we've kind of outlined it here and start to look at - and start to look at this more holistically and use—as we've been using is a coaching model which is a little different than the traditional model of working with people of like trying to work where the person's at and going with that and helping them and being guided by the person rather than telling them what to do.

So I think one of the things that's easy to go and start doing a lot of lessons on how to read a label, how to buy carrot sticks. You know, like it gets all—it's very narrowly focused on like what we think should be done or some prescriptive way.

But from a peer to peer model using a wellness framework and a coaching framework, it's learning how to sit back, listen and help the person to come up with what they've identified as they—you know, what's the path they're going to do to potentially - if it is the goal is to potentially like lose weight, get more active, to start to work from more of a strength based perspective with the person.

And, you know, I think the other thing is—I'm not sure if this—I do think that sometimes people will - I think the key also is just to be out there trying to help, you know, support people and role model with people.

So I think that's another area. Some things we can—you know—there's been some controversy over this one. But a lot of it is like there's, you know, sometimes you sit— people are out there smoking with each—with other people. You know what I mean?

And so sometimes looking at some of those kinds of behaviors of how we're role modeling some of those things. So it might feel comfortable around people but it might not be helpful to be doing that with people.

(Stephanie Lucas): Okay. Thank you. I know in Pennsylvania we're doing the self-directed program with (Chris) and that was very helpful. Thank you.

Lauren Spiro: I also—I wanted to mention—this is Lauren. I wanted to mention that I—you know, trauma is a huge issue and I'm hearing more and more about people that are afraid to go to doctors.

Peggy Swarbrick: Oh yes.

Lauren Spiro: That that's very re-traumatizing. So I think that's one—just one of many areas where a peer can be useful.

Peggy Swarbrick: Yes. And also as we developed our peer wellness curriculum, we actually did extensive focus groups to inform the curriculum with families with, you know, with peers. And that was—that's a big part of our curriculum is training peers to help people work through the fears as well as maybe be advocates or mentors for them because that—and that was an—that came up as an issue.

So that's one of the roles that the peer wellness coach is also doing is trying to be an advocate with the person as well as helping them to work through some of that - the fears of going to different types of medical specialties or even just going to doctors.

And I did notice on, you know, scanning the question and answers we might not get to but that actually is a question that I'm noticing in there is the stigma that people do face which is another thing that we've really worked on in terms of our curriculum is helping—trying to start working with other medical providers or healthcare providers to try to—actually they've gotten involved in our training.

We're at a University of—at the Medicine and Dentistry and so we've been able to fortunately have other medical professionals be part of our training curriculum to sort of sensitize them and you'd see in the report out of the Wellness Summit that was some of the recommendations. We have to start working on educating other professionals.

So a peer is great to be able to be an advocate as well as a role model as well as a mentor to maybe go along with people or help them work through making those appointments and going to them as well as maybe being an educator of the healthcare providers that need to be educated not to be afraid of people.

(Stephanie Lucas): Thank you.

Leslie Brenowitz: Thanks. Thanks Peggy and thanks for the question. I just want to—in being mindful that we've got a number of folks who want to ask questions and of the time I'll just ask folks if you can be somewhat brief in your question and then as we answer we'll try to be brief yet complete. So—and you can follow up with us if you don't—if you're not satisfied and, you know, you haven't gotten a full answer. We want to make sure we answer everyone's question.

So operator, on to the next question please.

Coordinator: Next question comes from (Jenny Daly). Your line is open.

(Jenny Daly): Hi. This is (Jenny Daly) and I work with a group of 23 counties in North Central Pennsylvania. I facilitate the recovery workgroup and one of our recommendations is to improve the health and wellness focus of - for persons with serious mental illness.

And some of this has been addressed in part. But we had a long discussion about how to engage and educate PCPs around this issue especially in regards to, you know, the time it takes and they don't have a lot of time. And we talked about having, you know, creating a resource toolkit at least so that PCPs have the information to make referrals out about health and wellness initiatives for, you know, individuals that they see.

So I guess my question is how to best engage the primary care providers in this.

Dr. Joseph Parks: This is Joe Parks. I think you're on the right track with choosing—with coaching people on what they want the primary care person to do and then trying to get in there with the information the primary care doctor will need to take action on that.

But the more people can bring a written list of their past medical treatments or their past medications or a lab value may have gotten from screening at your community mental health center, your blood pressure, your sugar, that also reduces discrimination.

You know, if you go in and say, you know, I'm feeling tired and I don't want to get out of bed, they may say oh that's your depression but if you come in with a slip of paper that shows that you were screened as having oh, you know, high blood sugar at your communal health center then they'll believe a number where they may be skeptical of the symptom.

So coming in with written notes helps a lot in terms of getting the most you can out of the little bit of primary care time that is available.

Leslie Brenowitz: Certainly over the five year course of the 10x10 Wellness Campaign there will be a concerted effort to both, you know, educate and empower consumers and reach primary care physicians and perhaps allied health professionals in working, you know, from that angle to get people to recognize there is a problem and there is a lot that can be done. And of course the impact of health reform on all this will continue to play out hopefully for the better. Thank you. Next question.

Coordinator: As a reminder, if you would like to ask a question on the phone, please press star 1. If your question has been answered already, please press star 2. One moment.

Next question comes from Leslie Saunders. Your line is open.

Leslie Saunders: Yes. Hello. My name is Leslie Saunders, Heritage Clinic, Escondido. I wondered if you would amplify a little bit on peer support specialists designing or helping to deliver models of whole health; perhaps some more specific examples.

Peggy Swarbrick: In the terms of the Georgia, the Michigan, or New Jersey model?

Leslie Saunders: Yes. Exactly.

Peggy Swarbrick: Right. So peer—it's pretty much the focus is that peers are being trained to work around whole health issues trying to help people understand lifestyles, the impact of lifestyles and then helping to support them around making lifestyle changes, perhaps smoking cessation, diet and exercise, perhaps going back to work and helping them to set up goals that relate to their health and wellness and then help supporting them around those goals whether it's they need the skills in that area, they need some linkages.

Maybe it might be helping them to navigate getting medical checkups around these different areas. So it's helping, you know, using peers to help peers around health and wellness goals.

Leslie Saunders: Thank you.

Dr. Joseph Parks: In Missouri we provided our peer specialists with a couple different manualized treatment curriculums for smoking cessation and for also for diabetes and nutritional education. And so they get a ring binder that has lesson plans and they can - and they are able to take those and adapt them in a consumer-oriented manner.

But it does give them a framework to work within and material to apply the consumer orientation too and has the impact of providing a level of standardization while still being something that can be adapted.

Leslie Saunders: Thank you.

Dr. Joseph Parks: And then they build that as a usual PSR, psycho social rehab activity, and it's reimbursed like any other communal health center psycho social rehab activity. It's just delivered by the peer specialist...

Leslie Saunders: Do you have anything that addresses morbid obesity specifically?

Dr. Joseph Parks: There are a couple of different manualized treatments available in the obesity technical paper on the website and many of those you don't have to be a licensed healthcare professional to do them. A trained layperson such as a peer specialist could deliver some of those.

Leslie Saunders: Alright. Thanks very much.

Leslie Brenowitz: Next question.

Coordinator: Next question comes from (Randy Hack). Your line is open.

(Randy Hack): Hello. I'm (Randy Hack) from Hawaii. We have a large instance of diabetes in our 64 percent Asian American Pacific island population. In your causes of death, Joe, do you have secondary because I suspect diabetes is a lot more prevalent? And have you teased out that from your data?

Dr. Joseph Parks: Yes. I think my first—I don't know if my first slide had diabetes but a lot of the—it depends on how you coat it. Often diabetes is the next bad cause of death because that's what caused the kidney failure and that's what caused the heart disease.

The diabetes is a very large effect on it. I thought you were going to ask me about have we divided it out by race and ethnic issues.

(Randy Hack): That would be a good question. Go ahead.

Dr. Joseph Parks: That was—that's what we hope to do in the next date run. We actually have some approved funding from SAMHSA to repeat the study and we hope to be able to proceed with that in the coming fall at the beginning of the next federal funding year. Because it's been 10 years and it's time to look at this data again and see if things are improving or getting worse or at least holding even.

And we really appreciate SAMHSA granting that funding last year and look forward to starting the study in October.

(Randy Hack): Mahalo. Thank you.

Leslie Brenowitz: Thanks so much. Next question.

Coordinator: Next question comes from (Kim Williams). Your line is open.

(Kim Williams): Yes. Thank you. My question has to do with life expectancy. It seems that the life expectancy of people with serious mental illness continues to decrease. There's previous research that shows that 10 years and now we're talking 25 years.

So my question is why is the gap increasing? Is it because the life expectancy of the general population has been increasing and/or that the health conditions of people with serious mental illness have just gotten worse over time?

Dr. Joseph Parks: I think it's that the general population has increased modestly and the severely mentally ill population actually I think their situation has gotten worse. In particular we see bigger drops in smoking in the general population whereas the smoking rates and holding even in the severely mentally ill. They're not going up but they're not going down in particular.

And I—the people with severe mental illness were somewhat overweight and we've all become more overweight. And if you started out a little ahead of the pack, now you're even further in the level of being overweight that has a medical impact.

I think third is just getting healthcare has become significantly more complicated in the last 10 to 15 years. It's hard enough to get healthcare in this country, you know, if you're not having any illness that interferes with your concentration, your memory and your motivation. It's a tough system out there.

(Kim Williams): Thank you.

Leslie Brenowitz: Next question.

Coordinator: Next question comes from (Suzanne). Your line is open.

(Suzanne): Yes. I'm wondering about looking at screening for those with serious mental illness. Are there recommendations in terms of starting that screening process earlier as far as blood pressure, lipids and so on?

Dr. Joseph Parks: Yes. There are current—the current firm recommendation is anybody that is going to be started on an anti psychotic medication in particular should be screened for all those things before they're started and then at least annually thereafter and for some of the indicators somewhat more frequently.

In Missouri we're actually—we'll be—have implemented screening for all the people in our community mental health centers on an annual basis. Most I think will be doing it around the time when their annual treatment plan gets updated.

(Suzanne): Okay. Thank you.

Leslie Brenowitz: Thanks Joe. Operator, do we have more questions on the line?

Coordinator: We have quite a few more questions, yes.

Leslie Brenowitz: Okay. Next question.

Coordinator: Next question comes from (Robert). Your line is open.

(Robert): Yes. This is (Robert) (unintelligible). I'm from the Western (New York) (unintelligible) Program. And I have a very specific question. We have very similar data and barriers as you mentioned. I want to talk specifically about two of them, the hopelessness and the poverty rates.

And my question is given that this is a Medicaid population, is there anything in the foreseeable future that might offer something like a healthy rewards similar to HMOs and private insurance to encourage folks to possibly engage in those healthy activities? And could that possibly even come from a health insurance reform?

Lauren Spiro: Well I think with health insurance reform we're certainly going to see more people having access. The 5.2 million people with mental illness today who are currently uninsured will have access to insurance. So hopefully people will feel more hopeful about, you know, having access to care.

In terms of, you know, actual stipulations in the new legislation with regard to incentives for engaging in wellness supporting activities let's say and I'm not sure—I haven't looked into that and in fact something we talked about at the campaign is perhaps looking to develop some sort of article or other publication related to the potential impact of health reform on this topic.

But I think that, you know, it's going to—there's going to be a lot of unraveling now of what it'll all mean and what did those thousands of pages of legislation really mean and then the implementation what will it look like for various populations.

Dr. Joseph Parks: There is buried in it a couple different requirements for setting up wellness programs and there is specific grant funding for wellness programs. They are not particularly targeted at people with severe mental illness but are for the whole general Medicaid, Medicare and for the insurance exchanges.

There's also a requirement that preventive care be covered and that smoking cessation be covered for pregnant women and that any future recommendations for preventive care out of several government bodies be covered.

So I think the thing closest to what you're talking about are the new federal grants are going to come out for wellness programs. Who gets those, how much? I don't know how much money is in them. That's probably set in legislation. But how those grants are given probably remains to be determined and hasn't been laid out yet.

(Robert): (Great. I'll look into that). Thank you.

Leslie Brenowitz: I think we have time for maybe a couple of more questions. I know there's probably more on the queue with questions and if we don't get to your question, I apologize. We appreciate all of the interest.

If we don't get to your question, please feel free to send us an email at 10x10@ - sorry I'm forgetting my email address 10x10@samhsa.hss.gov and we will be happy to respond or to forward your questions and get input from the speakers because we have a finite amount of time. But let's go ahead and take the next question.

Coordinator: The next question comes from (Carl Kovacs). Your line is open.

(Carl Kovacs): Well thank you. I appreciate the presentations today. I just wondered if your work includes any focus on people with substance use disorders or the developmentally disabled or children with serious, you know, mental illness problems.

Dr. Joseph Parks: You know, the data we've given you today all relates to adults with serious mental illness. That said, there is research out there regarding populations with substance abuse problems and developmentally disabled. In the substance abuse - for people with substance abuse problems, they have premature death also.

It's more around the 10 or 15-year level. And there's—a lot of the increased risk is related to infectious diseases. For developmentally disabled, they're actually almost more of a good news case. Their life expectancy has increased over the last 20 to 30 years. It's still less than the general population but they in general are on an upward trend as opposed to a downward trend. At least the recent data I've seen.

(Carl Kovacs): Great. Thank you.

Leslie Brenowitz: Next question.

Coordinator: Next question comes from (Maria Nolan). Your line is open.

(Maria Nolan): Hello. My name is (Maria Nolan). I'm from the Friendship Clubhouse in San Diego, California. I am diagnosed with bipolar disorder and I at this time are not prescribed any medications nor have been for three years. I would like to know if there's ever been a comparison study between those of us that are prescribed medications and those that aren't prescribed medications with regard to mortality and progression and life. That's all.

Dr. Joseph Parks: Yes. There's no formal study in any of the recent years. There is some very old literature around mortality and people with severe mental illness prior to medications being widely used beginning in the 50s and in those very old studies people with severe mental illness did have some premature mortality we found around the 10, 15-year level.

But, you know, that's 40, 50-year-old data. And I'm unaware and that would be an excellent piece of information to have but it's simply not available at this point in time.

Leslie Brenowitz: Fascinating. Again, my apologies to anyone with questions that we did not get to this afternoon. Please do contact us and be assured that we will respond.

So we've come to the end of our time. Joe, Peggy, and Lauren, I want to thank you so much for your work on this subject and for your insights and sharing them today. Thanks also to all of our listeners and viewers for caring about the topic, for taking time out of your afternoon to learn more. And we hope you'll continue to engage with the campaign by signing up for our list serve, visiting our Web site, participating in our training teleconferences.

This conference has been recorded and the audio recording and transcription will be available by around mid-April on the SAMHSA 10x10 Campaign Web site; that's http://www.10x10.samhsa.gov.

Tomorrow you will receive an email request to participate in a short anonymous online survey about today's training, which should take no more than five minutes to complete. I strongly encourage and request that you take the survey to share your feedback with us. We will read all the answers and look for your input in helping to shape the campaign and select topics and speakers for future training events.

Thanks again everyone for joining us and thank you in advance for completing the survey. Thanks very much. Good afternoon.

Coordinator: Thank you so much for participating in today's conference call. You may disconnect your lines at this time. Thank you and have a great day (Not in audio recording)