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An Interview with Linda Rosenberg, MSW, President and CEO of The National Council for Community Behavioral Healthcare

In our continuing efforts to keep our readers informed of important issues on the advocacy and political scene, Mental Health News spoke with Linda Rosenberg, MSW, President and CEO of The National Council for Community Behavioral Healthcare. In the interview that follows, Linda Rosenberg gives us a look at The National Council and some of the issues they are advocating for on behalf of the mental health community in Washington.

Q: Tell us about the National Council for Community Behavioral Healthcare.

A: The National Council began in the early 1960’s during the nation’s transformation to community mental health care. New community-based mental health centers that were mandated by the federal government were being created and the CEO’s of these centers came together and formed the National Council as a place where they could share information, education, and learn from each other about the many challenges they faced during the early years of the community mental health care movement.

Community mental health was a new concept that envisioned mental health centers throughout the country that would serve as a resource in communities that everyone could be involved with and take advantage of – from serious mental illnesses to families whose children were having difficulties in school. In addition, prevention and treatment was to be included in the mission of these centers from the very beginning. Throughout the years that followed, these centers developed and dramatically changed to meet the needs of society and the political climate of the day.

The National Council is a nationwide membership organization that began with about 800 members and today has over 1700 members. We are the largest national membership organization of the mental health and substance abuse national associations. All of our members provide mental health or substance abuse treatment services, with many of the agencies providing both services. Many treat both adults and children while some focus just on either adults or children.

The National Council also leads members in the delivery of high-quality care through practice based on the best-available evidence. We know that high quality care is that which is personalized, prevention-oriented, and based on evidence about the benefits, costs, and the desires of each person. We believe that quality care requires a focus on integrated physical and mental health; the pursuit of clinical excellence; workforce development; and investment in information technologies.

What brings everyone together is a commitment to provide effective mental health and substance abuse services. Almost all of the services are provided in the community, although we do have members that have inpatient units or may have a crisis stabilization program. We also have members who are some of the larger peer-run organizations that provide a whole range of services. A great majority of our members provide supportive housing where consumers are provided a safe living environment as well as other supportive services to assist them in being successful in their recovery and to become a part of the community around them.

Q: Do any of your member organizations provide services to the autism community?

A: Yes, many do. Some of our member organizations have specialized treatment programs, special schools, and programs for families of children on the autism spectrum.

Q: What are some of the benefits that the National Council offers to its members?

A: What attracts organizations to the National Council is that we are voice for them here in Washington. More and more initiatives affecting the mental health and substance abuse community are taking place at the federal level. So many mental health and substance use organizations are dependent on Medicaid and Medicare funding. That has become the mainstay for organizations that provide services as opposed to 20 years ago when these organizations received their funding primarily from contracts from their state and local communities. What goes on here in Washington has become increasingly important, and people want to be a part of an organization that they know is representing the interests of the consumers that they serve. I think we do that, and I think we do it very well.

Q: So, the National Council is a public policy advocate for its members.

A: Yes, that is our major role. We are a voice for consumers and families and for the organizations that provide services to them. There is a big difference between having government benefits available to consumers and families, then to actually have access to services that would enable them to utilize those benefits.

Q: What are some of the leading issues in Washington that the National Council is spearheading?

A: During the Bush administration, we were leading the charge to stop cuts to Medicaid, particularly the “rehab option” and targeted case management. The National Council formed a coalition of many advocacy groups to fight against those cuts. We have a public policy staff and we also have lobbyists under contract with the National Council. We nurture friends in both The House of Representatives and in The Senate, who will help us and become champions for people with mental illness and addictions. Our big victory in the above-mentioned campaign was to secure a moratorium that prevented the Bush administration from really gutting the rehab option and targeted case management.

Now, with the new and more progressive Obama administration we see a different vision about healthcare. Currently there are two big pieces of work at hand for the National Council. One was to get mental health parity passed at the federal level – and it was passed. However, that was just the start. The real agenda now is what will the new Parity regulations actually look like? You see, you can have parity laws as we do in many states. However, they don’t matter very much because for the most part they consist of a very narrow benefit where people can perhaps get a few days of inpatient care, a few outpatient visits, and that’s about it. People often need other forms of services such as case management, assertive community treatment, children’s services, and other home and community-based services. Our fight has been to make sure that the parity regulations are as broad and as strong as we can get them to be.

Q: So, when we all heard that Parity legislation had passed, that was only part of the story?

A: Yes. When a piece of legislation passes, that is just a very broad outline, and then the regulations for the legislation are written by the federal government. These regulations tell the whole story about what that piece of legislation is really going to mean to the public. We have been putting a lot of pressure on the Administration to make sure the parity regulations are as robust as they can possibly be. There are many components that go into the process before a piece of legislation becoming enacted into law. Even when legislation is passed by both Houses and is signed by the President, that piece of legislation requires regulations that have to be written. These regulations tell you what the legislation is really going to do and how it will be implemented on the state and community level. The real work of for the National Council over the past several months has been to keep the pressure on Congress so that when they implement this legislation we are sure that people with mental illness and addiction disorders have a full range of services that are available to them in their communities. Parity legislation’s regulations have to include meaningful benefits. We expect the regulations to be released in January and expect them to go into effect sometime in July.

Now, our big piece of work is centered on Healthcare Reform. It appears that there will be a piece of legislation in early 2010 that the President will sign. That will begin years of work to enact that legislation. If you look at either the House or the Senate Bill, you’ll see that certain things will be phased-in over the next several years. In spite of the fact that this will not be a quick process, we believe Healthcare Reform will have a profound effect on the nation and on people with mental health and substance use disorders. In fact, we believe it will have more of an effect on people with substance use disorders as most of these individuals do not have insurance and are not covered currently by Medicaid or commercial insurance. Now they will have coverage.

Over the next few years, almost every American will have some form of insurance coverage. That is going to change how people get care, and it is also going to mean that providers of services have to change as well. For one thing, providers will now have to get used to dealing with insurance companies.

Q: Won’t that be a daunting process for service providers?

A: Yes, it is going to be a daunting process. We are likely going to see the re-emergence of HMO’s and managed behavioral healthcare organizations in many states. I believe that states alone will not want to manage all of these new insurance benefits and will bring in intermediaries. I think we will see continued erosion of state grant funding and county and local funding. The argument will be that everyone now has an insurance card, so what do we need state general fund dollars or county dollars to support individual healthcare? We know that insurance often isn’t as flexible as it needs to be, so I suspect that this will require a lot of work in the coming years.

Q: Do you see this as a positive or a negative step for community healthcare?

A: I think it’s a mixed bag. On a personal level, and from the perspective of the National Council and the almost quarter of a million staff that work for our member organizations, we would say that everyone should have health insurance. I think what people are less clear about and less ready for are the changes in how we are going to have to do business with everyone now having insurance.

There are things we have to be careful to watch for with this sweeping new legislation. When there is change – even though it is a change for the good of the nation – there often are unintended consequences. We can’t predict how the new healthcare reform will affect people. Having a group such as the National Council and others on the state and local level monitoring the process is very important. When Massachusetts implemented its statewide healthcare insurance initiative, they soon realized that they there weren’t enough primary care physicians to adequately service the people of that state. I think there will be workforce problems associated with national healthcare.

For the mental health and substance abuse community we now going to be a part of general healthcare, yet we are not funded the same way and we don’t have many of the same tools that general healthcare already has in place. A prime example is our community’s lack of experience with information technology. We have limited electronic health records, or registries for chronic illnesses, or other technologies that can help ensure better care. We will have to fight hard to make sure the mental health and substance abuse communities will receive help in getting and implementing those needed technologies.

Q: Sounds like the job description for agency CEO’s will be changing significantly in the coming years.

A: I think it will. The mental health and substance abuse organization CEO of the future will primarily need to be good business people. They will now be dealing with insurance companies, technology companies, and also banks, because they will have to maintain lines of credit to balance the ebb and flow of expenditures and reimbursements from the insurance companies. I think the CEO of tomorrow will have to either be knowledgeable about the new business of mental health and substance abuse care, or will have to have a lot of talented people around them. They will need a team of people who are knowledgeable in all those business and technology areas. I think the organization of tomorrow will also have to be big enough to weather the new changes that are coming. Some believe that many small organizations will struggle under National Healthcare because they will not benefit by “economy of scale” factors.

Q: What is the National Council doing to prepare its members for the new face of healthcare in America.

A: We do a lot of work in the areas of streamlining and business efficiencies. We are starting a new “CEO University” project which will begin next year for new CEO’s to learn from each other and from specialists we will be bringing into the project. We have a similar project for Medical Directors that started last year. We do a conference that is heavily focused on leadership and on what folks need to know and do to prepare for the future. We do a whole host of activities from keeping our members current on what is going on “on the Hill,” to better organization management, and to improved clinical expertise for the therapeutic missions of their organization. In addition, we have newsletters, webinars and many other learning opportunities that provide essential tools for organizations to stay abreast in these changing times.

In closing, I would like to thank Mental Health News for providing me with this opportunity to introduce the National Council to its readers, and would like to invite your readers to visit our website at www.thenationalcouncil.org to learn more about us and to find out how they can become a member.

With more than 30 years of distinguished service in mental health policy, services and system reform, Ms. Rosenberg is one of the nation’s leading mental health experts. In 2004, Ms. Rosenberg was named President and CEO of the National Council for Community Behavioral Healthcare, a not-for-profit advocacy and educational association of 1,600 organizations that provide treatment services to 6 million adults and children with mental illnesses and addictions. Prior to joining the National Council in August of 2004, Ms. Rosenberg served as the Senior Deputy Commissioner for the New York State Office of Mental Health with an annual budget of nearly 4 billion dollars. Ms. Rosenberg had responsibility for New York’s adult and child psychiatric hospitals as well as the states forensic hospitals and services. She tripled New York’s assertive community treatment capacity; expanded children’s community-based services; developed an extensive array of housing options for people with mental illnesses and addictions; implemented a network of jail diversion programs including New York’s first mental health court; and promoted the adoption of evidence based practices and consumer and family programs. A certified social worker, as well as a trained family therapist and psychiatric rehabilitation practitioner, Ms. Rosenberg has extensive experience in the design, implementation, and management of hospital and community psychiatric treatment and rehabilitation programs. Ms. Rosenberg has held faculty appointments at a number of Schools of Social Work, serves on numerous agency and editorial boards, and writes and presents extensively on the need for community services and the impact of organizational, financing, and service delivery strategies on continuity of care and consumer outcomes.

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