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>> so here i am, 27, looking at a bill that says the brain is part of the body and insurance companies cannot discriminate in the reimbursement of illnesses to the brain any more so than they would any other illness of the body. i have no business being the primary sponsor of that bill. it tells you a lot about stigma. that the longest member -- the youngest member, lois died on the totem pole, got to put it in so my point is stigma still ranks big in all of this and as a result we have not made the progress we need as a nation, still. when hiv-aids, we were losing 53

million americans a year. within one or two years of the aids activists coming all over the country and demanding change, congress was appropriating $24 million a year to tackle this illness. addiction, opioid overdose and other overdoses, account for 112,000. you add the 300 50,000 people who die of alcoholism, which of course no one really acknowledges as a major public health issue. then you add the 50,000 who successfully take their lives via suicide. the total amount of money we all get combined to deal with this crisis is one quarter of what we got with hiv/aids. we have done more now for mental

health addiction than any other time, president biden, to certified health centers, $11 billion. congress passed a $1 trillion infrastructure bill. great. we need infrastructure in our health care system to deal with mental health and addiction because it affects not just those suffering with a primary diagnosis, it impacts people throughout the medical system and they are ignorant for the most part and they do not treat mental health and addiction, they say it is for psychologists -- psychiatrists to treat. so we think, you have read the headlines, you see more money being spent, we must be addressing this.

but if we were truly mobilized and not just taking what we were given, we would be demanding much more and getting much more for this illness. i hate to make it a per capita spent but if you look at what we spend on cancer and hiv and cardiovascular, diabetes versus what we spend on bipolar, depression, schizophrenia, alcoholism, we are still far away from even parity, which is give us the same as what we would get if we had another illness. peter: i want to clarify, 53,000 we lost. what is your diagnosis? patrick: bipolar ii, which is often referred to as manic depression. it is a mood disorder. i also have addiction.

i am addicted to anything and everything. a lot of people think, you are an opioid addict. and i was, but i was also addicted to stimulants like adderall. i was addicted to anything that would change my mood. that is the nature of addiction. we often get that is confused. oh, it is the opioids, it is the methamphetamines. 90% of the people i know who have addiction have other addictions because the disease of addiction, in alcoholism you could easily have it in chemicals and now as we are learning from gambling addiction, we are learning from other forms of addiction, that it can be ubiquitous. there is a great stanford

psychiatrist talking about dopamine nation, which means thanks to social media and everything there is all types of addiction so we have to have a much better understanding of literacy about it. i get help from a psychiatrist who is trained in addiction. a lot of the mental health treatment, providers do not know how to treat addiction. so i have a certified doctor and also go to 12 step recovery and thank god for that, i took medication assisted treatment, which means i was taking medication to deal with opioid addiction when i was in congress. since i have left congress i have been able to spend more time getting my own recovery on a solid plane which has allowed me to taper off of the medication but that is an

important mechanism to help people as well and there are other forms of medication for other types of illnesses. the point i make in the book is that there are evidence-based forms of intervention that we are not deploying. that's the bottom line with the previous statistic is that there is a lot we know what to do about that we don't do it. we don't pay for it and we do not insist that the provision mental health be consistent with evidence-based models of care. so behavioral therapy, which is changing the way you act, is a way of changing the way you think, is that standard of care for every type of addiction and mental illness. there are different types of it. that is still not trained. in 60% of mental health providers in the country, they do not know how to treat eating

disorders, mood disorders, particular addiction with that particular type of evidence-based intervention. we have so much to do and it just is about political urgency. i was lucky, i was able to get to the other side and be in recovery. a lot of people are not that lucky because they do not have the resources i had. that is why i fought so hard for the equity and parity act and why i spent a dozen years in congress trying to enforce that mental health equity and parity addiction act because it is not just writing the bill, it is getting it enforced and the insurance industry has a very

strong political lobby unfortunately and it has been very difficult getting that law fully implemented and as you know, most people still have so many barriers in getting care paid for. preauthorization, current review, retroactive review, all different types of care, primary, secondary, tertiary, and network -- a network come out of network, out-of-network, inpatient, outpatient, pharmacy. they would never imagine doing this if it was cancer. even cms, they would bless any new expensive drug for any other illness but mental health, you have to fail first on these five generics before you get help. they will not even pay -- they

will say you have to go in intoxicated before you get any care or you have to wait one week before you can get care. we need care on demand. my own experience, if you do not intervene when people are ready for prude -- ready for treatment, you have missed a golden opportunity and the problem with these illnesses is that people often not -- do not have insight. when you have one, you don't know you have one. for me, i did a book on my own struggles years after leaving congress and i was amazed when i went around, interviewed a lot of folks i worked with, they told me, patrick, you are in real trouble. but the irony is no one told me that at the time. and of course as is the case

with most people of these illnesses, you are the last person to know you have them. that is not true just with addiction, but also people with schizophrenia and bipolar. so when you get an opportunity to treat someone, you have to take that opportunity and when insurance companies place to many barriers between you asking for help in getting help, finding a doctor, inadequate networks, phantom networks, thank you chairman widen for your leadership on the finance committee, we need to raise these issues up because it is pressure that will bring change. if you do not bring the current system up and come up with a new model, we will be stuck in that same merry-go-round where people really are not getting the care they need.

peter: tell us about february 22, 2011. patrick: that is my sobriety day. the big problem we have politically in the country as there are over 30 million americans and long-term recovery. all of them are insurance based anonymous. i do not say what twelve-step program i work, i just say i am in twelve-step recovery. it is ok to say you are in recovery. i say i am a person and long-term recovery who has not used anything since fairbury 22nd, two thousand 11. if we can mobilize those people have these illnesses and they know how devastating they are, we could change.

we should not change anonymity but that does not mean people have to consign political activism and being a potential advocate to the corner. bill wilson, founder of aa, testified in front of congress. we need to build a political constituency. when i was in congress, i knew i could get whatever number of bricklayers that day after tomorrow or laborers or sheet metal workers were teamsters. they turn out. they have less, members -- they have lists, members, donate, participate. in mental health and addiction, there is no listserv, no environmental list where you

know everyone in this district, state reps or congressional, cares about this. and that is where we should start. then we should get all the advocate groups and get their list and add it so that anyone running for office immediately knows they have a better part of their constituency cares about these issues. if we do that, we will get that money we need, the change in regulation we need, we will get the infrastructure for information technology and data sharing to help us manage these illnesses so we really know if we are getting better or not. we will get the social sport -- social support. we will get the proper sober housing facilities which we know work beautifully but which are not paid for.

we will get all of that. we will get people through democratic participation but if we are all silent we will not get what we need because politicians will not see us and so we need to build a modern-day political movement. we need an afl-cio of mental health addiction. psychiatrists, clinical marriage family counselors, everyone together and we need to get people with depression, bipolar, schizophrenia, addiction, alcoholism, get them altogether. we have 99% the same agenda but we operate in our individual silos so need to organize. peter: mental health in america statiscs reported in your

book,4 million americans have one or more disorders. 44 million have one or more substanc use disorders. 31 million, just press a disorder. 20 million americans, anxiety disorder. 18 million, alcohol use disorder. 11 million, mental and substance use disorder. 7.7 billion, cannabis use disorder. 3.7 million, schizophrenia. 61% of those listed above have received mental health treatment. only 12% have received substance treatment. patrick: yes. the statistics are jarring. they show we would never imagine cancer, 12% of people with cancer get treatment? we have a program, i helped start and advocacy and there is

a qr code at the back of the book, alignment for progress,, we want 90% screens, 90% given intervention, 90% achieving and being supported in recovery by 2033. we screened that for cancer, hiv , aids, cardiovascular disease. why can't we do it for mental health? 90% getting treatment. we do it in other illnesses, why not mental health? 90% recovery, we know social support accounts for so much of the total impact of good care. we are not paying for those things. so we have a very specific agenda.

we have a qr code in the book for the strategy for progress and that is a cure ration by committee of all of the issues that committee can do in congress though if is a chamber of commerce or afl-cio or environment, the advocates have delineated by every committee in congress what you can do in that community -- committee to help advance the cause. i was on armed services committee. my labor friends came in. i said sorry, i am army, navy, air force, marines, i can't help you. they said we can help you -- you can help us a lot. we have prevailing wage issues with the department of defense. environment came in. i said what does army navy air force marines has to do with it? the department of defense has a bigger environmental budget than the epa. i had no idea.

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 did not recognize they are perhaps on the most important committee in congress to address the mental health and addiction crisis because if you do not have stable housing, none of the rest of it works. but how many mental health and addiction advocacy groups have focused on hud? on the labor committee? what does labor have to do with it? that is where we get support of employment so we can reorganize the way we have the workplace set up so people in recovery can be supported at work. we are not organized to meet the huge public health crisis we have as a nation. we do not have our issues mapped

out, i tried to do this, i put a 1.0 together but i am working on filling it in. we do not have our vision. that is what i am trying to do with the 90-90-90 by 2033. i stole that from hiv/aids. if we had someone with cancer, broken arm, we would expect to get 90% screened, 90% evidence-based intervention. it is unfathomable that we would not expect that. yet we just accept that people will not get care for these illnesses. that is a hangover from generations of stigma and shame. the 12 people in the new book i just wrote with my co-author really break the mold and say

these are treatable illnesses, they are complex, they involve getting coworkers, family, friends involved, they also necessitate both the medication, mental health treatment, and social support. it is three-pronged. just because it is complex does not mean we cannot wrap our arms around. when he data. debt -- we need data. we subsidize medical records for every other medical condition except mental health and addiction. so 90% of behavioral health providers in this country are not on electric health records. peter: what about hippo? -- hiop -- hippa.

patrick: that is being changed. whatever your issue is physically, it is all on your medical. but you are telling me my medical record will not show i am on been the draw and if i was unconscious and had a car accident and the real me into a local emergency room, they could kill me if they didn't know it and it wasn't in my medical record. we need to change the system. in the book, at the end all of them did this because they want to advance better policy and we have links to all that public policy in the back of the book. peter: you use the term substance use disorder rather than substance abuse. is that purposeful? patrick: yes.

we are changing nomenclature all the time. a lot of mental illnesses today are called neurodivergent permit brain illnesses. people are still behavioral health, mental health, there are all kinds of connotations. certainly the words abuse can note that it is willful, bad moral character. no one chooses to get out for the day and alienate their friends, potentially risk losing their job if they have one, risk going to jail because when you have these illnesses you do all kinds of things that jeopardize not only your life but that of others. the fact of the matter is if you actually think it is up to someone to choose these things, you are absolutely wrong. no one would ever choose to be

alienated by their friends, to be pitied and ridiculed, to lose your economic wherewithal, to be separated from your family. choice for me is not giving up. i have 13 years of continuous sobriety but i have to make sure i do not pick up that first substance. that is my moral responsibility. no one gets a get out of jail free card in terms of their responsibilities but we have to understand when people are hostage to their illnesses promote people are living on the streets not far from where we are taping this, the schneider homeless shelter, they are prisoners of their brain

illness. we ought to be going in and setting them free. the notion that we leave people to languish and die on our streets around the country is shocking to me. and we have this libertarian position, we do not want to interfere with their civil liberties, they choose to live that way. no. no one chooses to live that way. governor newsom has started in california care reports, where we aggressively go after people who are on the streets, dying on the streets, saving them from themselves. in my own case with my mother, my brother and sister and i had to get guardianship over my ther. we saved her life so she could be around for our kids.

they never met my father, obviously, who died before they were born, but they got to meet my mom and it is 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. in this system today, we do not allow families to get involved in helping their loved ones, we do not make it a very simple process so that people can get the care they need, and there can be all kinds of safeguards for people's rights. we are not dealing in a situation of 50 years ago where people were just consigned to asylums without having any rights. we could have the best of medical assessments, mental health courts today know how to do this, it is just shocking

that we as a nation continue to let this languish. peter: in your book you write about the impact on families. i have be tough it myself during many of those years teens, 20's, when my dad would say to my brother, all patrick ed is -- needs is a good swift kick in thess, and my mother also was sometimes treated dismissively, especially when her drinking was socially or politically inconvenient, we were not always as kind as we could or should have been. patrick kennedy, families get worn out, don't they? patrick: big time. it is a challenge. because you want to isolate yourself from everyone if you have that disease and everyone wants to isolate themselves from you. it is mutually assured isolation.

people with illnesses thrive in isolation. the more we isolate people, the more their illness gross. that said, we do not even intervene in these illnesses until it is stage four. my mother's mother died of alcoholism at 61 and was not found for a week. she died alone in her little apartment in florida. and 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 is screened and treated early could have resulted in a completely different trajectory for life. if a doctor was assessing me with my family history, alcoholism on both sides, they

would have said, do you have a history of stroke? yes, my grandfather had a stroke, cardiovascular disease, everyone my family has had cancer, they know what to do. screen you, treat you, the best treatment is prevention. but with these illnesses, we wait until you are at death's door before treating. so no wonder people feel so worn out. because these illnesses are never treated early enough to make them manageable illnesses. lots of people get better, but a lot more people would survive and would not suffer as much if we had a public health model that was intense on helping people at stage one like we do with cancer and there would be no stigma around it. you would not have to go to a mental health professional, your

regular pediatrician or physician would know that you are at high risk, you have also had trauma, i am not going to prescribe benzodiazepine, i will see that you get hooked up with a group of peers that are in similar situations and we will get you certain vacations that might be useful or certain things you should be aware of that you can do on your own to help build coping mechanism development that will keep you stronger and less susceptible to becoming a victim of these horrible illnesses that devastate so many lives. family also do not know what to do. so part of the stories in this book illustrate that they are all red is -- reticence to involve.

that is a personal decision, i cannot get involved in their business. we write that yes, people should feel they need to be involved. there is just no literacy, no understanding of how these illnesses should be treated, what it entails, there is just a question of do they go away for rehab, should we send them to detox, should we commit them? we don't know about helping our kids not succumb to depression and anxiety and give them social supports and training them to self modulate. does anyone even know what self modulate, does the country know they have the opportunity in this toxic world where everyone is fighting each other to understand their reactive brain

and use their prefrontal cortex to interrupt counterproductive thinking patterns? to push pause when they know they are about to act out in a compulsive way, in a reactionary way? frankly, we do not have that understanding and we all suffer as a result. i am fortunate i am in the 12 step recovery program, i get access to a new way of life if i follow the steps. as part of education we ought to be helping our kids get more learning, training the brain -- the green berets have more mental health per green beret than any other branch of the service. green berets don't need mental health, they swim out of -- they

jump out of airplanes and they swim underwater for five miles without breathing and they take out their targets. they don't need mental health, no. green berets see mental health as a critical part of leveraging all the money we spend on training to make them the best so that they do not have intrusive thoughts while they are in the field. so when they are going after osama bin laden and they need to know where the rest of their team is, they cannot be thinking about what is going back at home, they cannot be ruminating about what is not going well in their lives. they have to be focused on the mission and today we could be

trading the people in this country to have the ability to lot -- to not let their reactive brain sabotage them. our country today is at war with itself because we are all stressed, it's a toxic environment, we are in reactive mode. if i meet someone i totally disagree with, i know that internally i am reacting to them, i don't. i take it down a notch. i engage. because i've been given the tools to do it. peter: one of your profiles in your book is someone named harry mcmurray. who was he? >> my cousin mark's son who died by suicide. harry was a wonderful young man. my first cousins on my mom's

side we would often spend summers together, we grew up together. most people know the kennedy side of my family, but my mom's side, many of the illnesses that affected me are from my mom's side. 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 history -- his son, harry, who died at age 19 and it is the first time mark talked to anyone about this, which is not uncharacteristic of people who lose a loved one to suicide. they want to put it behind them and move on. what he so courageously did is that not only did he speak to me, but harry's brother also spoke to me and also harry's

college roommate. what ended up happening is each of them told their own story about what they thought led up to harry's suicide. the interesting thing is that his dad, mark, did not know everything his brother gail. -- his brother knew. his brother didn't know everything the father knew. the college roommate new things the others didn't know. because they all wanted to keep it secret. or they thought it was not their business to share. which is a natural reaction. if there was more communication about these illnesses, i think a lot more could be done about

people intervening earlier in the treatment. peter: what did you find out about your cousin's son, harry? patrick: he had a severe concussion. we think about these in terms of football players but it is ubiquitous and a major part of someone's risk for mental health and addiction. a lot of people with mood disorders, some of it is precipitated by a concussion. he had a concussion and the mental illness and addiction both occurred kind of together. in many cases it was not a case of harry just needed to treat -- treatment for alcoholism disorder, he had this mood disorder and in this country we do not distinguish between them, or we just -- distinguish too

much and do not integrate that treatment so what i learned is that communication could have meant a lot because if the roommate had taught to the brother had talked to the dad, if they had talked to him, they might have been able to put peace together -- 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, my cousin mark said patrick, i know you are mr. mental health, but i never thought it was that serious. how many times do we say, i just didn't think it was that serious? and that is part of our culture's thinking, we have to

wait until illnesses become crises before we intervene. that is the big change in the country. if we really treated this as seriously as we do cancer and other illnesses, we would be spending a lot more money on sinking better neuroscience but also seeking the implementation of better evidence-based training and treatment and access to care and payment of that care. peter: another one of your profiles is active on social media. we want to show you a little bit of her. >> i kind of decided that i was just going to use all 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, fighting a way to become ok had to be my priority, not my dreams. peter: you write that she did not outwardly have any visible disability. patrick: how courageous is she? she is helping so many through that and through this book. she is courageous. she is brilliant. she was afraid to tell anybody, even her doctors, because she wanted to be an astronaut. you see this repeated over and over for people who are first

responders, who serve in the military, they do not want to get help. they worry that it will interfere with security clearances or their careers. her story is indicative of a lot of peoples, which is, if i say anything, if i get help, it could realistically really impact my career. she came to terms with that. she is an enormously successful but she knew she could be as successful in the world as possible but still struggling inside and that could wipe away all of her success if she took her life, obviously, and she got health, and to her credit she

has spoken out because i think a lot of people who are barely holding it together so that they can seem together on the outside, the -- that can jeopardize their lives because if they do not get the help they need, we are at a really terrible situation. peter: how were you able to meet the people you profile? patrick: i shared my book with all these people. i made the deal with them that they could pull out of the book at the 11th hour if they were not comfortable with the way their stories were portrayed. because my uncle was president kennedy, because my family has been active in policy, because i am another person with experience, i was able to reach

them because they wanted to make a difference. that was my one real value in getting these stories was that they were talking to a kennedy and they were being asked to do something for their country. basically. [laughter] the bottom line was they wanted to help others and i got to be the conduit to have them help their fellows. not only because i am working on policy change and they know that and appreciate it but they also know i have had similar kind of experience does come really with the shame of having these illnesses on the perceptions created when you are someone with -- someone who is well known to have these problems. but i have an incredible network of people in the mental health

and addiction world. so i put the call out to all of my friends to help me find stories. and i basically called the leaders of the nih to study these illnesses, leaders of major psychiatric departments and big medical centers, i called all these people and they said if you have any stories that you think would be illustrative of the complexity of these stories, would you mind sharing my letter of invitation to? be part of the book? ? they said, i will let you know, i will share your letter and if they are interested, i will put them in touch with you. h so there were no issues ofi -- no issues of hippa, all of these people were contacted by their

clinician. peter: you wrote that the book was inspired by simone biles. patrick: people were like, why can't she get on that balance beam, why can't she do her tremendous athletic prowess? she is admired throughout the world. she said, i have a mental health issue that prevents me from doing that. and people were critical at the time. we just don't get it, you are an olympian, you know how to do this, perform, please. what i thought it indicated was that people do not have an appreciation for these illnesses and in her case, as in most cases, people say they have a mental health condition, and that is all they say. they do not say anymore about it because of the shame. so the american public does not have a really nuanced

understanding about what goes into having one of these illnesses. so this book i think brings a little greater insight and transparency into what it is like for people with these illnesses. i think each of these profiles sheds light on that. peter: every year c-span sponsors studentcam where students send in videos. one of the winners on a public policy issue this year was on mental health. we want to show you some of it. >> all mental health challenges begin by age 14. you deserve access to mental health care and i believe the solution lies in schools. 10 years from now mental health education should be part of the curriculum in a grade across the u.s. so students are ready.

it would offer training, discuss different challenges, and include discussions about topics like academic stress, social comparison, and how to work with appear in crisis. if we require other types of education, why not mental health education? >> one thing i think is important is helping young people identify mental health issues in their friends, classmates. >> it needs to incorporate lived experience and realize each of us is resilient and vulnerable. it is not us versus them. patrick: that's beautiful. i'm glad they got the recognition. 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 tools to self manage, to understand, identify, to know how to have coping mechanisms and problem-solving skills to address the stress they are living with. it is critical. 20 years ago we added stem education because the world was worried americans would not compete with japan, china, other countries so chambers of commerce, everyone said we have to do this math and science. today i guarantee you if you asked any business roundtable member, any chamber will tell you having employees that know how to manage stress, problem solve, who are resilient, they are the employees they are looking for. it is not enough to teach kids

history and literacy. we need to also prepare them with life skills. for political reasons i do not know how, what nomenclature you want to use, social learning is conflated with liberalism, just [indiscernible] take the green beret analogy i used earlier. this is about us living optimal lies when we have so many obstacles thrown in our way. how do we manage them? that is good mental health. so that we do not have to get down the road of mental illness and spend all her time trying to course correct thinking and patterns of behavior when they are too far down the track of pathology. peter: you have one minute to

tell us about your co-author, stephen friede. patrick: he teaches journalism at columbia. 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 write with me on my own autobiography. i had to get him to help me with this because he is so good at narrative, connecting the dots, and that is what this whole story is, it is about weaving this complex story into a narrative people can wrap their arms around. that is certainly a challenge in this space, one that he really helped us do. peter: "profiles in mental health courage" is the name of the book. our guest has been patrick kennedy. thank you. patrick: thank you, peter.

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