Patrick Kennedy, "Profiles in Mental Health Courage"

Hi, and welcome to the Q&A podcast.

I'm your host, Peter Slen.

Thanks for listening.

This week, it's former representative Patrick Kennedy discussing his book, Profiles in Mental

Health Courage, where he details his and his family's issues and policy suggestions in

dealing with mental health.

That podcast begins in a moment.

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All Patrick needs is a good, swift kick in the ass, Senator Ted Kennedy used to say about

his son Patrick.

But in his book, Profiles in Mental Health Courage,

former Representative Kennedy talks about his specific mental health diagnoses,

his family's issues with mental health,

and how he thinks policies should be changed

to help the estimated 84 million Americans who have mental health issues.

The interview with Patrick Kennedy begins now.

Congressman Patrick Kennedy, author of the new book, Profiles in Mental Health Courage.

That's a rather purposeful title, isn't it?

It is. It is, obviously.

President Kennedy's famous book, Profiles in Courage, what a great title.

He wrote his book to illustrate acts of courage in politics,

where people really put their own political careers in jeopardy

because they stood for the national interests, not the local parochial interests.

And in this book, we're seeing 12 people who put their reputations,

their careers, their...

lives, really, out front so that Americans can benefit from understanding

how mental illness and addiction is a very complex issue

and really can appreciate the nature of these illnesses

and understand those who have them as separate from the illnesses themselves.

And I think when people read this book, they'll see that we often conflate the person,

with the disease which is really what shames so many people and keeps them from seeking help which

is really detrimental in fact the biggest barrier that we have in this country to people getting

help is people just asking for help and with stigma still strong today as you know people

are much more open about revealing that they have a diagnosis but they still are not comfortable

talking about what it is actually like living with a mental illness or addiction and these 12

stories go such a long way to breaking that mystery of what it's actually like to live day to day

with a mental illness and addiction and i really include other people in the story which often

doesn't happen in these narratives about mental health and addiction where the person tells a

happy ever after story because they're never comfortable telling a story and

not uh kind of closing with everything's okay well the reality is not everything's okay these

are chronic illnesses but in this story we include family members co-workers friends

and that's a perspective that's often left out of these stories which i think is really important

because you think of the numbers peter of the americans who suffer from these illnesses now

take that and look at all the family members of

individuals all the friends of those individuals the co-workers and frankly

this is a one-in-one situation everybody in America is affected by mental

illness and addiction but we're still looking at it kind of with some distance

because we're afraid of really tackling and understanding the true nature of

this because it's fear based and it's people don't know if they can wrap their

arms around how to treat these illnesses and and they think that it's someone's

personal issue and that they're not supposed to you know intrude all of

these misconceptions I think we help address in the course of telling these

twelve stories and just like President Kennedy told the stories of senators who

were profiles in in political courage he did that to advance the national

interest to highlight

the

characteristics the environment that made these people courageous and in this

book I am highlighting what it is to be courageous in not only continuing in

spite of the difficulty to get help fail come back get more help try another type

of therapy fight with your insurance company to get it covered deal with a

family member who doesn't approve and won't talk to you negotiate the

relationship with your employer if you still have a job all of these things are

the true stories of mental health and and these people really put themselves

out there I mean that when people read this they will their jaw will drop to

just how honest and transparent these profiles are and in a way I think that

will take some of the sting for others when it comes to them telling their own

stories because they'll see that it's not

some salacious kind of scandalous being to have one of these illnesses and of

course that's usually the you know model of which these illnesses get covered that

it's very much an illness very much a brain illness and it's you can easily

see that when you read these stories before we leave your uncle John's book

profiles and courage you take some of the people he profiled some of the

senators and talk about their mental illness John Quinn and several others

John Quincy Adams, Daniel Webster.

Well John Quincy Adams' father, President Adams, suffered huge depression.

And John Quincy had a child die of suicide.

He had a brother die of alcoholism.

You know, Sam Houston, another one of John F. Kennedy's profiles, was personally shamed

for being an alcoholic.

He was called the big drunk.

I mean, Sam Houston was the first president of Texas and then a U.S. Senator, a tremendous

profile in political courage, but he also had to endure the shame that still exists

in many respects today on those that cast judgment on you because of your illness.

And of course, Lucius Lamar saw his father come into the house, write a note saying goodbye

to everyone, walk out and take his life with a pistol.

Right in front of their house.

And then, you know, in other stories, Daniel Webster, one of my dad's all-time political

heroes, died of cirrhosis of the liver.

I mean, this is not a new issue, obviously.

We pretend because of COVID that all of a sudden we're in a new day and, oh, COVID created

all these problems.

Frankly, these problems were here before COVID.

Thankfully, COVID helped sensitize more people.

I mean, we're in a new era.

We're in a new era.

I mean, just zap.

nghĩ, is that we're all going to die until nine years or one year or something like

that.

Mm hmm.

So at the present particular period of COVID, you're talking about around 80 percent of

people total death, which is going to make back from us all runny devil's insgesamt

elongatedalling loss of the brain.

You said about the 50 percent of all people killed during the covid era.

And when people die, how many deaths are there?

Well, we are at 213 percent of people we have been killed.

plead some sense on these numbers.

Yeah.

And, of course, it's just the young people who 유

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But part of the paradigm we need to shift is the idea that these are new problems. If there is anything truly new about them, it is how much incrementally worse they have gotten because we have not done enough as a society to address them.

You know, when I got to Congress, I had already been outed because a guy that I was in drug treatment with at 17 wrote about being in drug treatment with me and sold it to the National Enquirer. My face is on the cover of the National Enquirer.

So I had no choice about whether I became public. These people in this book chose to become public. And by the way, they use their own names. You know, there's no pseudonyms. No one's hiding behind it.

They are.

When I got to Congress, I had the freedom to support mental health bills because I didn't have to worry about a reporter saying, oh, are you supporting the Mental Health Parity and Addiction Equity Act because you have a personal connection to these issues?

That was already a story that was written. And thankfully, my constituents in Rhode Island still elected me. The freedom it gave me, Peter, is that I got to be the first name on the Mental Health Parity and Addiction Equity Act.

I was the youngest member of Congress from the smallest state in the country, Rhode Island, and in the minority party, as you recall, when Newt Gingrich was speaker.

In a popular bill, as you recall, with my dad being chairman of labor, senior senator there for 40 plus years, he got his name number one on a lot of bills, you know, but in a lot of my colleagues on the House, same story, because a popular bill.

Everybody won.

Everybody wants their name on it. And it's reserved for those with a lot of gray hair or no hair at all. That's who gets to sponsor.

So here I am, 27, I am the sponsor of a bill that says that the brain is part of the body and insurance companies can't discriminate in the reimbursement of illnesses of the brain any more so than they would any other illness of the body.

I had no business being the primary sponsor of that bill.

It tells you a lot.

It tells you a lot about stigma that the youngest member of small state, the lowest guy on the total poll, got to put his name first.

So my point is, is that stigma still ranks really big in all of this.

And and as a result, we haven't made the progress we need to as a nation still.

Now, when HIV AIDS hit, we were losing 53 million Americans a year.

We, within a year or two of the ACT UP and AIDS activists coming all over the country and demanding change, Congress was appropriating $24 billion a year to tackle this illness.

Addiction, opioid overdose and other overdoses account for $112,000.

You add the $350,000 to die of AIDS.

alcoholism, which of course no one acknowledges is a major public health issue.

And then you add the 50,000 who take their lives successfully with suicide.

And the total amount of money that we all get combined to deal with this crisis is a fourth of what we got with HIV AIDS.

I mean, we've done more now for mental health and addiction than any other time,

President Biden, certified community behavioral health centers, $11 billion, all good.

But next to the challenge is my point.

We have not mobilized.

Congress passed a trillion dollar infrastructure bill.

Great.

New roads, bridges, everything.

We need an infrastructure in our health care system to deal with mental health and addiction

because it affects not just the illness, those suffering with a primary diagnosis of mental

illness and addiction.

It affects people with oncology, cardiovascular disease, diabetes, and the whole medical system,

Peter, is ignorant for the most part.

And they don't treat mental health and addiction.

They say, oh, that's for the psychiatrist to treat.

And why I make that point is that we all think we've read the headlines.

You're seeing more money spent.

Oh, we must be addressing this.

And I'm just telling you, if we were truly mobilized and we weren't just taking whatever

we were given, we would be demanding much more and, by the way, getting much more for

this illness.

I hate to make it a per capita spend.

But if you look at what we spend on cancer and HIV, AIDS and cardiovascular disease and

diabetes versus what we spend on bipolar, depression, schizophrenia.

Alcoholism, we're still far, far away from even parity, which is just give us the same

as we would get if we had another illness.

And I just want to clarify something you said.

I think you meant 53,000 we lost, not 53 million to HIV.

Yeah, I just wanted to clarify that.

Congressman, what's your diagnosis?

I have bipolar 2, which is often referred to as manic depression.

It's a mood disorder.

I also have addiction.

I'm addicted to anything and everything.

A lot of people think, oh, you're an opioid addict.

Well, I was that.

But I also was addicted to benzodiazepines.

I was addicted to stimulants like Adderall.

I was addicted to anything that would change my mood.

And, you know, that's the nature of addiction.

We often get that confused.

We think, oh, it's the opioid.

You say, oh, it's the methamphetamine.

I can tell you 90% of the people I know who have an addiction, they have other addictions

because the disease of addiction, you know, in alcoholism, you could easily have it in,

you know, chemicals.

And now, as we're learning from the gambling addiction, we're learning from, you know,

other forms of addiction that it can be ubiquitous.

Like there's this great psychiatrist from Stanford talks about dopamine nation, which

means, you know, thanks to social media and everything, there's all types of addictions.

So we have to have much better understanding and literacy about that.

I go, I get a help from a psychiatrist who's trained in addiction.

You know, a lot of mental health treatment, the providers do not know how to treat addiction.

So I have a.

An ASAM certified doctor, and I also go to 12 step recovery, and I thank God for 12 step

recovery.

I took medication assisted treatment, which means that I was taking buprenorphine for

a period of time while I was still here in Congress to deal with my opioid addiction.

Since I left Congress, I've been able to really spend my full time getting my own recovery

on a solid plane.

Which has allowed me to taper off of MAT, but that is an important, you know, mechanism

to help people as well as, and there's other forms of medication for other types of illnesses.

The point I make in this book is that there are evidence based forms of intervention and

we are not deploying them.

That's the bottom line with the previous statistic is there's a lot that we know what to do about,

but we don't do it.

We don't pay for it.

And we don't insist that the provision of mental health be consistent with evidence

based models of care.

So kind of behavioral therapy, which is changing the way you act as a way of changing the way

you think, is the standard of care for every type of addiction and even mental illness.

There's different types of it.

That is still not trained.

In 60 years.

It's not.

50% of the mental health providers in this country do not know how to treat the eating

disorder, the mood disorder, the particular addiction with that particular type of evidence

based intervention.

So you know, we have so much to do and it just is about political urgency.

And if we did it, I think obviously a lot more people, I was lucky, I was able to get

to the other side.

Be in recovery.

A lot of people aren't obviously that lucky because they don't have the resources I have.

And that's why, you know, I fought so hard for the Mental Health Parity and Addiction

Equity Act.

And I've spent my last dozen years having left Congress back in 2011, really trying

to enforce the Mental Health Parity and Addiction Equity Act, which I was honored to sponsor

when I was in Congress.

Because it's not so much.

Just.

You have to write the bill.

You have to get the bill enforced.

And unfortunately the insurance industry has a very strong political lobby, as you know.

And it's been very difficult getting that law fully implemented.

And as you know, most people still have so many barriers in getting their care paid for.

Pre-authorization, concurrent review, retroactive review, all different types of care, primary,

secondary, tertiary levels of care, in-network, out-of-network, inpatient, outpatient, pharmacy

benefits.

They all have step therapy where they never would imagine doing that, Peter, if it were

cancer.

You know, even CMS, they would bless any new expensive drug for any other illness.

But for mental health, God, you've got to fail first on these five generics before you

get help.

They won't even pay for your ability to get.

To know what kind of psychopharmacology will help you direct you to the right kind of medication.

They'll say, oh, you have to, you know, go in intoxicated before you get any care.

Or you have to wait a week before you get into care.

I mean, we need care on demand.

My own experience, if you don't intervene when people are ready for treatment, you've

missed the golden opportunity.

And the problem with these illnesses, Peter, is that people often don't have insight.

In fact, that's the big characteristic of these illnesses is when you have one, you

don't know you have one.

Like for me, I did a book on my own struggle years after I left Congress.

And I was amazed, Peter, when I went around, interviewed a lot of folks that I worked with.

They told me, oh, Patrick, you were in real trouble.

But I didn't know.

But the irony is, Peter, none of them told me that at the time.

And of course, as is the case of most people with these illnesses, you're the last one

to know you have these illnesses.

And that's true, not just with addiction, but obviously with people with schizophrenia

and bipolar.

And so when you get an opportunity to treat someone, you've got to take that opportunity.

And when insurance companies place too many barriers between.

. . .

You're looking for help and getting help, finding a doctor, inadequate networks, phantom

networks.

Thank you, Chairman Wyden and Senator Crapo for your leadership on the finance committee.

We need to raise these issues up because it's pressure, Peter, that's going to bring change.

If you don't break the current system up and come up with a new model, we're going to be

stuck in that same position.

that same merry-go-round where people really are not getting the care they need.

Patrick Kennedy, tell us about February 22nd, 2011.

Yes, so I had been sober.

That's my survival.

That's my sobriety date.

So, you know, a big problem we have politically in this country is there's over 30 million

Americans in long-term recovery.

All of them are in church basements, anonymous.

I don't say what 12-step group and program I work.

I just say I'm in 12-step recovery.

That's not a violation of the 11th tradition on anonymity.

I'm saying that for your viewers.

It's okay to say you're in recovery.

I say I'm a person in long-term recovery.

Which means for me, I've not had to drink, drug, or use any mood or mind-altering substance,

pills, pot, or powder since February 22nd, 2011.

If we could mobilize that 30 million Americans who know these illnesses, know how devastating,

and have made it to the other side, we could change.

I don't pretend that we're going to change and we shouldn't change anonymity, but that

doesn't mean people have to change.

I don't pretend that we're going to change and we shouldn't change anonymity, but that doesn't mean people have to change.

And it's just a general standard.

I don't think that the people who are in the 2020s that are in 12-step recovery can sign

their political activism and their being a potential advocate to the corner.

Bill W., founder of AA, Bill Wilson testified in front of Congress.

Most people don't really focus on that.

But we need to build a political constituency.

When I was in Congress, Peter, I knew I could get whatever number of bricklayers the day

after tomorrow.

tomorrow, just call the local or laborers or sheet metal workers or, you know, Teamsters or

NEA or AFT members like they turn out, they have lists, they have members, they organize,

they donate, they participate. In our movement, mental health and addiction, there is no list

serve. There's no environmental lists like League of League of Conservation Voters, where, you know,

everyone in this district, whether state reps or congressional, cares about this.

And that is where we should start. Then we should get all of the advocate groups and get their list

and add that to the list so that anyone running for office immediately knows that they've got

a better part of their constituency cares about these issues. And if they do that,

we're going to get the money that we need. We're going to get the change in regulations.

That we need. We're going to get the infrastructure for information technology and

and data sharing to help us really manage these illnesses and know how they are getting better or

not that we need. We're going to get the social supports, clubhouse models, which are the most

evidence form of treatment for schizophrenia. We're going to get the proper sober housing

facilities, which we know works beautifully, but which are not paid for.

We'll get all of that. But we need people in the way this town works and the way our country works through

democratic participation. But if we're all silent, Peter, we're not going to get what we need because

politicians are not going to see us. And so we need to build a modern day political movement. Frankly, Peter,

we need an AFL-CIO of mental health and addiction. We need to get the psychiatrist, psychologist, social workers,

you know, clinical marriage, family,

counselors, everybody together. And we need to get, you know, people with depression, bipolar,

schizophrenia, addiction, alcohol, opioid use disorder. They're all in it together. We have 99

percent the same agenda, but we all operate often in our silos. So it reduces the impact that we

could have collectively if we were to organize.

Mental health in America. Statistics reported from HHS in your book.

Eighty four.

Million Americans have one or more disorders. Thirty four million have one or more substance use disorders.

Thirty one million depressive disorder. Twenty million Americans anxiety disorder. Thirteen million alcohol use

disorder. Eleven million mental and substance use disorder. Seven point seven million cannabis use disorder.

Three point seven million schizophrenic.

Sixty one percent.

Of those that we listed above have received mental health treatment. Only twelve percent have received substance treatment.

Yes.

It's the statistics are jarring because it shows we would never imagine cancer. Twelve percent of the people with cancer getting treatment. I mean, so we have a program, you know, I helped start this advocacy, which we have in a Q.R.

Code in the back of the book.

Alignment for progress also can be found at the Kennedy forum. We have a ninety, ninety, ninety by twenty thirty three and ninety percent screen in this country. Ninety percent given evidence based intervention and ninety percent achieving and being supported in recovery. So ninety percent screen. We screen that for cancer and HIV AIDS and cardiovascular disease. Why can't we do with mental health and addiction?

90% getting evidence-based treatment.

We do that in other illnesses.

Why can't we do it in mental health and addiction?

And 90% in recovery.

We know, as I just mentioned, these social supports account for so much of the total impact of good care.

We're not paying for those things.

So we have a very specific agenda, not only the 90-90-90, but in the book is a QR code for our strategy.alignmentforprogress.

And that is a curation by committee of all the issues that that committee can do in Congress.

So if it's any other, if it's a Chamber of Commerce or an AFL-CIO or the environment, the advocates have delineated by every committee in Congress what you can do in that committee to help advance the cause.

Take, for example, I was on Armed Services Committee.

My labor friends came in and said, Patrick.

I said, sorry, fellas, I'm Army, Navy, Air Force, Marines.

I can't help you.

They said, no, no, Patrick, you can help us a lot.

We have prevailing wage issues with the Department of Defense.

I said, oh.

And the environmentalists came in.

I said, sorry, guys, Army, Navy, Air Force, Marines.

What does this have to do with the environment?

They said, Patrick, did you know the Department of Defense has a bigger environmental budget than even the Environmental Protection Agency?

I said, I had no idea.

My point.

My point being, Peter, is that in mental health and addiction, we need every committee in Congress to be doing something.

I guarantee you many of my colleagues on the Housing Committee don't recognize they are perhaps on the most important committee in Congress to address the mental health and addiction crisis.

Because if you don't have stable housing, none of the rest of it will work.

But how many of our mental health and addiction advocacy groups have focused on the HUD committee?

How many have focused on the Labor Committee?

What's Labor got to do with it?

That's where we regulate ERISA plans.

We enforce the parity law.

That's where we get supportive employment so we can reorganize the way we have the workplace set up so people in recovery can be supported in their work environment.

My point, Peter, is that we're just not organized to meet this huge public health crisis that we have as a nation.

We don't have our issues.

Issues mapped out.

I mean, I've tried to do this.

I put a 1.0 together, but I'm working on really filling it in.

We don't have our vision.

I'm trying to put something forward with this 90-90-90 by 2033.

By the way, I stole that from HIV-AIDS.

That was their agenda.

I guarantee a lot of people say, God, 90%?

How are we going to screen 90%?

What, you know, evidence-based treatment for 90%?

If we had someone with a cancer, broken arm, we would expect that you would.

We would get 90% screened, get 90% evidence-based intervention.

It's unfathomable that we wouldn't expect it.

And yet we just accept that people are not going to get care for these illnesses.

And that is a hangover from generations of stigma and shame.

And these 12 people in the new book that I just helped write with my co-author, Stephen Freed,

really break.

Make them old and say, these are treatable illnesses.

They're complex illnesses.

They involve getting the co-workers, family members, friends involved.

They also necessitate, you know, both the medication, they necessitate mental health

treatment, and they necessitate social supports because it's a three-pronged stool, biopsychosocial

illnesses.

Just because it's complex doesn't mean we can't wrap our arms around them.

And that's why we need data.

But does COVID?

Does Congress ever fund electronic health records for people with mental health?

No.

If you can believe it, you know, we subsidize medical records for every other medical condition

except for mental health and addiction.

So 90% of the behavioral health providers in this country are not on electronic health

record.

Isn't there a HIPAA, a privacy aspect of that?

That's been changed.

Thankfully, that's being changed.

But that was a holdover of past.

Shame, too.

I mean, we have got, whether you have a sexually transmitted disease, you've got HIV, you've

got whatever your issue is physically, all that stuff's on your medical record.

But you mean to tell me my medical record will not, you know, know whether I'm on Vivitrol,

which I've been on, and if I were unconscious and had a car accident and was wheeled into

a local emergency room, they could kill me if they did not know that.

And it's not on my medical record.

So we need to change the system.

And the book, these profiles are great.

But at the end, all of them did this because they want to advance better public policy.

And we have links to all that public policy in the back of the book.

I noted that you used the term substance use disorder rather than substance abuse.

Is that purposeful?

Sure it is.

I mean, we're changing.

We're changing the nomenclature all the time.

A lot of mental illnesses today are called neurodivergent.

You know, we, they're brain illnesses.

You know, people are still behavioral health, mental health.

You know, there's all kinds of connotations, but certainly the words abuse connote that

it's willful, you're, you know, it's bad moral character.

No one chooses, Peter.

To get up in the day and alienate their friends through their disease, potentially risk losing

their job if they have a job, um, risk going to jail because when you have these illnesses,

you do all kinds of things that, uh, jeopardize not only your own life, but that of others.

Um, you know, the fact of the matter is if you actually think it's up to someone to choose

these things, you're out.

You're absolutely wrong.

No one would ever choose to be alienated by their friends, to be pitied and ridiculed,

um, to lose your economic wherewithal, to be, you know, separated from your family.

I mean, there is now choice for me is not picking up.

So I go to 12 step recovery.

I'm active in recovery.

I've got a 13 years of continuous sobriety.

But I have to make sure.

I don't pick up that first mood or mind altering substance.

I got to stay on that.

And that's my moral responsibility.

I, I get no, no one gets to get out of jail free card in terms of, um, their responsibilities,

but we have to understand when people are hostage to their illness, the people are living

on the streets, not far from where we're taping this, um, recording, you know, the Mitch Schneider

homeless shelter.

Those people are.

Prisoners of their brain illness.

We ought to be going in there and setting them free.

The notion that we're leaving people to languish and die on our streets around this country.

It is shocking to me.

And in, and it's because we had this civil libertarian position that, oh, we don't want

to interfere with their civil.

They choose to live that way.

No, Peter.

No.

No one chooses to live that way.

We need to have what, you know, uh, governor Newsome has started to do in California.

And that is care courts where we aggressively go after people who are on the streets, um,

dying on the streets and saving them from themselves.

In my own case with my mother, my brother and sister and I had to get guardianship over

my mother.

We saved her life so she could be around with my kids.

My, my kids never met my father obviously who died before they were born, but they got

to meet my mom and they got to meet my mom because my brother and sister and I went to

court to get guardianship over our mother to keep her from killing herself.

She was so happy at the time she wasn't happy, but she ended up being so grateful that she

was able to make it to the other side because we intervened.

Yeah.

And in this system today, we don't allow families to get involved in helping their loved ones.

We don't make it, um, a very simple process to make it so that people can get the care

they need.

And there can be all kinds of safeguards for people's rights.

There's nothing, we're not dealing in the situation of 50 years ago where people were

just consigned to asylums without any, um, kind of rights at all.

We could have the best medical assessments.

We have.

We have courts today.

They know how to do this.

It's just shocking.

We as a nation just continue to let this languish.

Well, in your book profiles and mental health courage, you write about the impact

on families.

I had been through it myself during many of those years, teens and twenties when my dad

would say to my brother, all Patrick needs is a good swift kick in the ass.

And my mother during the many recurrences of her lifelong alcohol use disorder was also

sometimes treated dismissively, especially when her drinking was the most socially or

politically inconvenient.

We were not always as kind as we could and should have been.

But Patrick Kennedy, families get worn out.

Don't they?

Oh, big time.

Yeah, no, I, uh, it is a challenge because you want to isolate yourself from everyone

if you have the disease and everyone wants to isolate themselves from you.

It's mutually assured isolation, separation, people's illnesses thrive in isolation, which

means the more we isolate people, the more their illness, um, pathologizes.

That said, we don't even intervene in these illnesses, Peter.

So it's stage four.

So my mother's mother died of alcoholism at 61 and she wasn't found for a week.

She died alone in a little apartment.

In Cocoa Beach, Florida.

And she, my mother and her sister both suffered from alcoholism.

I can guarantee you she knew and everyone around her knew she had a problem much earlier

in her life that if, if screened and treated early could have resulted in a totally completely

different trajectory in her life.

If, if a doctor was assessing me, um, with my family.

History with alcoholism on both sides of my family, they would have said, well, first

of all, um, do you have a history of stroke in your family?

I said, yeah, my grandfather had a stroke and cardiovascular disease.

Yes, we have this.

How about cancer?

Yup.

Every one of my family's had cancer.

Oh, they know what to do.

They know to screen you.

They know to treat you, you know, the, the best treatment is prevention.

But in these illnesses, we wait till you're at death's door before we treat them.

So no wonder people feel so worn out because they, these illnesses are never treated early

enough to make them kind of manageable illnesses.

Now lots of people get better.

Um, that's the story.

But you know what?

A lot more people would survive and a lot more people wouldn't suffer as much.

If we had a public health model that really was intent on meeting people at stage one,

like we do with cancer.

Um.

And, and there'll be no stigma around it and you wouldn't have to go to a mental health

professional.

Your regular pediatrician or cardiologist or oncologist would know, okay, you're at

high risk here.

Now you also had trauma.

These two things make you at high.

I'm not going to prescribe that benzodiazepine.

In fact, I'm going to see to it that you get a hooked up with a group of peers that are

in similar situations.

So you can.

They're going to get you some, uh, certain medications that might be useful or certain

things that you should be aware of that you can do on your own to help build that stress

management, that coping mechanism development that will keep you stronger and less susceptible

to becoming a victim of these horrible illnesses that, um, you know, devastate so many, uh,

lives.

Family members also don't know what to do.

So part of the stories in this book illustrate that.

They all like are very reticent to involve themselves because they say, oh, that's someone's

personal decision.

I cannot get involved in their business.

We, we, I write in there with all these stories that sure, people should feel like they, they

need to be involved because, uh, and gives them a kind of examples of where people can

be more involved.

There's in other words, there's just no literacy.

There's no understanding of how these illnesses should be treated.

There's just no literacy.

There's no understanding of what should be treated, what is entailed.

Um, it's just a question, oh, do they go away for rehab?

Do they go to detox?

You know, should we commitment them?

I mean, that's all we know about mental health in this country.

We don't know about helping our kids not succumb to depression, anxiety by giving them those

social supports.

There's a, um, training them to how to self modulate.

Like does anyone even know what self modulate?

Like does, does the country know that they have the opportunity?

Uh, in this toxic world where everybody's like fighting each other to understand their

reactive brain, to use their prefrontal cortex, to interrupt counterproductive thinking patterns,

you know, to push the pause button when they know they're about to act out in a compulsive

way, um, to act out in a reactionary way.

Um, frankly, we don't have that understanding Peter.

Yeah.

We still suffer as a result.

I mean, I'm fortunate.

I'm in a 12 step recovery program.

I get it.

That's the reason I'm grateful to be an alcoholic because I get the access to the new way of

life that can be made available to me.

If I follow these steps, um, we ought to be as a part of education, helping our kids get

social emotional learning, um, training and brain fitness, the, the green berets, Peter

have more mental health.

Per green.

Beret than any other branch of the service, like these green berets don't need mental health.

They jump out of airplanes, swim underwater for five miles without breathing.

They, they hit the beach, they speak six languages.

They take out their target, their home at night reading to their kids.

I mean, green berets don't need mental health now.

Green berets see mental health as a critical part of leveraging all those dollars we spend

on training.

They need mental health to make them the best so that they don't have intrusive thoughts

while they're in the field.

So when they're going after Osama bin Laden and they need to have their six, which means

they have to know where all their, uh, fellow, uh, green berets or special forces, Navy SEALs,

where they are, they can't be thinking about what's going on back at home.

They can't be ruminating about what's going on that's not going well in their lives.

They have to be on mission focused.

Okay.

And today we could be training people in this country to really have the ability not to

let their reactive brains sabotage them.

I mean, our country today is totally at war with itself because we're all stressed.

It's a toxic environment.

We're in the reactive mode.

I meet someone who I totally disagree with.

I do not, I know if internally I feel, oh my God, um, I'm reacting to them.

I don't.

I take it down a notch.

I engage because I've been given the tools to do that.

So…

Patrick Kennedy, one of your profiles in Mental Health Courage is somebody named

Harry McMurray.

Who was he?

Harry McMurray is my cousin Mark's son who died by suicide.

He died in a car accident.

Harry was a wonderful young man.

My first cousins on my mom's side we'd often spend summers together, we grew up together.

Most of people know the Kennedy side of my family on my mom's side.

As I said, many of these illnesses that affected me and my mom affected her sister and her

family.

So Mark, my first cousin.

I went to talk to him.

for the book because I wanted to see whether he would tell his story about losing his son

Harry who died at 19.

And it's the first time Mark ever talked to anyone really about this, which is not

uncharacteristic of most people who lose a loved one to suicide.

They want to put it behind them.

They want to move on.

But what was really instructive and what he so courageously did in this is that not only

did he speak to me but Harry's brother Belton spoke to me and Stephen Freed.

And also Harry's roommate in college.

So what ended up happening is each of them told their own story about what they thought

led up to Harry's suicide.

And an interesting thing is dad, Mark, didn't know everything that

Belton knew.

Belton didn't know everything that Mark knew.

And neither Mark nor Belton knew everything that Clay at school that was Harry's roommate

that he knew.

And so because they all wanted to keep it secret or they thought it wasn't their business

to share it.

Which is a natural reaction.

Like.

So..

You know.

It's interesting.

more communication about these illnesses I think there's a lot that could be done where people

could intervene earlier in their treatment. What did you find out about your cousin Harry?

He had a severe concussion. We totally by the way underplay the impact of concussions in this

country. We think about it in terms of football players but it's obviously ubiquitous and it's

a major part of someone's risk for mental health and addiction. A lot of people with mood disorders

some of that is precipitated by a concussion. Anyway he had a concussion and the mental

illness and addiction both occurred kind of together. So in many cases it wasn't a case where

Harry needed just to get some treatment for his alcohol use disorder. He also had this mood

disorder. He had a concussion. He had a concussion. He had a concussion. He had a concussion. He had a

concussion. He had a concussion. He had a concussion. And we in this country do not

distinguish between the two or we distinguish too much and we don't integrate that treatment.

And so what I learned was that again communication could have meant a lot because if the roommate had

talked to Harry's brother, had talked to Harry's dad, if they had talked to him they might have been able

to piece together a picture that would have more accurately described where Harry really was

and what his vulnerabilities were. When I went to the funeral for Harry my cousin Mark said you know

Patrick I know you're Mr. Mental Health but I never thought it was that serious. How many times do we say,

well it just didn't, I just didn't think it was that serious. And that's part of our culture's

thinking is that we have to wait till these illnesses become crises before we intervene.

That's the big change in our country and in the lives of people like my cousin Mark. And

if we really treated this as serious as we did do cancer and

other illnesses. We would be spending a lot more money on seeking

better neuroscience but also seeking the implementation of better evidence-based training

and treatment, and access to care. And payment of that care.

Patrick Kennedy another one of your profilers, or your profiles,

is active on social media. We want to show you a little bit of her.

And I kind of decided that I was just going to

use all the resources I had.

the resources that were available to me to stay here because bottom line if I am not alive

I cannot be an astronaut if I am not here I cannot reach my dreams so being here having peace

finding a way to become okay it had to be my priority not my dreams. Butler Craig you write

that she didn't have any outwardly visible disability yeah how courageous is she she is

helping so many people through that and so many more through this book she is courageous she

she's brilliant and Naya is someone also tells the the larger story that she was afraid

Pray to tell anybody, even her doctors.

Because she wanted to be an astronaut.

And you see this constantly repeated over and over for people who are first responders,

people who serve in our military, don't want to get help.

They're worried it's going to interfere with their security clearance or interfere

with their trajectory and their careers.

Her story is really indicative of a lot of people's, which is, if I say anything, if

I get help, it could, realistically, it could really impact my career.

And she came to terms with it.

She enormously successful, but she knew she could be as successful in the world as possible,

but still.

She was struggling inside and that could wipe away all of her success if she took her

life, obviously.

And she got help and to her credit, she's spoken out because I think there are a lot

of people who are barely holding it together so that they can appear together on the outside.

But that could jeopardize their lives because if they don't get the help they need, then

it's…

Then we're at a really terrible situation.

Film Courage How were you able to meet Naya or meet Justin

Maffet up in New York or the couple from Nashville, etc.?

How did you find them?

Dr. First of all, like my book, A Common Struggle, I shared my book with all

of these people.

I made the deal with them that they could pull out of this book at the 11th hour if

they weren't comfortable with the way their stories were portrayed.

Because my uncle is President Kennedy, because my family has been active in policy, because

I'm another person with lived experience, I was able to reach them because they wanted

to make a difference.

That was my one real value add in getting these stories is that they were talking to

a Kennedy and they were being asked to do something for their country.

Film Courage That's big.

Dr. The bottom line is that they want to help others.

I got to be the conduit to have them help their fellows.

Not only because I'm working on policy change and they know that and appreciate it, but

they also know I've had similar kind of experiences with the shame of having these illnesses and

the perceptions that are created.

Film Courage How did you find them?

Dr. Well, first of all, I think it's a good question.

Film Courage How did you find them?

Dr. I think it's a good question.

I think it's a good question.

When you are someone who's well-known to have these problems.

I have an incredible network of people in the mental health and addiction world.

I put the call out to all of my friends to help me find stories.

Basically I called the leaders of the NIH.

who study these illnesses, the leaders of major psychiatric, you know, departments and big medical

centers. I called all those people and I said, if you've got any stories that you think would be

illustrative of the complexity of these illnesses, would you mind sharing my letter of invitation to

be part of this book? And they said, I'll let you know. I'll share your letter. And if they are

interested, I will put you in touch with them. So there was no issues of HIPAA or anything like

that. All of these people were contacted through their mental health clinician in 90% plus of the

cases here. You write that the book was inspired by Simone Biles. Well, as you know, Simone,

people were like, oh, why can't she get on that balance beam? Why can't she do her tremendous

athletic prowess? And, you know, she's just admired throughout the world. And she said,

well, I have a mental health issue that prevents me from doing that. And people were critical at

the time. They're like, we just don't get it. You're an Olympian. You know how to do this stuff.

Perform, please. And what I thought it indicated was that people don't have an appreciation for

these illnesses. And in Simone's case,

as in most people's case today, who say they have a mental health condition, that's all they say.

They don't say any more about it because of the shame. And so the American public doesn't have a

really nuanced understanding of what goes into having one of these illnesses. So this book,

I think, brings a little bit greater insight and transparency into

what it's like for people with these illnesses. And I think each of those profiles sheds light on

that. Every year, C-SPAN sponsors a contest called Student Camp, and students send in videos.

One of our winners this year on a public policy issue was on mental health. We want to show you

part of it. Half of all lifetime mental health challenges begin by age 14. Yet the average delay

between the onset of a mental health condition and the onset of a mental health condition is

10 years. Youth deserve access to mental health care, and I believe the solution lies in schools.

20 years from now, mental health education should be part of the curriculum in eighth grade across

the US before they enter the realm of high school, so students are ready. The curriculum would offer

digital citizenship training, discuss the different mental health challenges to debunk false information

online, and include peer-to-peer discussions about topics such as social comparison, academic stress,

how to get access to care, and how to work with a peer in crisis. We require physical health

education. Why not mental health education? Simply put, schools are a gateway to needed

services that otherwise might be inaccessible to many young people. One of the things I think

is important is just helping young people identify mental health issues in their friends,

their classmates, their peers. And it needs to incorporate the lived experience and realize

each of us is one of the most important people in the world. And I think it's important to

recognize that each of us is resilient, and each of us is vulnerable, so as to not perpetuate its us

versus them. Beautiful. I'm glad they won the recognition. It's right on. We cannot treat our

way out of this problem. We have to do a much better job at prevention. And one of the best

ways to prevent this epidemic is to give kids the tools to self-manage, to understand, identify,

to know how they have the

coping mechanisms and problem-solving skills to address the stress that they're living with.

That's critical. You know, 20 years ago, we had STEM education, science, technology,

engineering, and math, because the world was worried that Americans would not compete with

Japan and China and other countries. So the chambers of commerce, everyone said,

we got to do this, math and science. Today, I guarantee you, if you asked any,

business roundtable member, any chamber, Fortune 100, they would tell you having employees that

know how to manage stress, problem-solve, are resilient. Those are the employees they're

looking for. So it's not enough to teach kids numeracy and history and literacy. We need to

also prepare them with these life skills. And I don't, you know, for political reasons,

forcing them into a situation where you don't know how you want to, you, what nomenclature

you want to use this social emotional learning as conflated with liberalism. Okay, just

use brain fitness. I mean, take the green beret analogy I used earlier and use that

because, you know, this is about us living our optimal lives when we're having so many

obstacles thrown in our way. How do we manage them?

And

that is good mental health.

So we don't have to get down the road of mental illness and spend all of our time trying to course correct people's thinking and patterns of behavior when they go too far down the track of pathology.

You have one minute to tell us about your co-author, Stephen Freed.

Stephen's a brilliant journalist, teaches journalism at Columbia.

He's written extensively about mental health issues throughout his career.

I was fortunate to get to know him when he did a magazine article on me on mental health.

I loved his writing.

I asked him to work with me on my own autobiography, and I had to get him to help me with this because he's so good at narrative, connecting the dots.

And that's what this whole story of mental health and addiction is.

It's about we.

Weaving this very complex story into a narrative that people can wrap their arms around.

That's certainly our challenge in this space, one that Stephen Freed really helped us do.

Profiles in Mental Health Courage is the name of the book.

Our guest has been Patrick Kennedy.

Thank you.

Thank you, Peter.

And we appreciate your joining us on this Q&A podcast.

Next week, we talk with Steve Ford.

He is the son of Gerald and Betty Ford.

Some of the things we talk about include his father.

His mother's presidency, which began 50 years ago, the Nixon resignation and pardon, and

what it's like to be the offspring of a U.S. president.