Paul Gionfriddo, CEO and President of Mental Health America has been advocating for improved mental health support across the US since 1979. From his earlier career in the Connecticut State Legislature to his role with one of the most influential mental health non-profits in the country, Paul is arguably one of the leading voices impacting positive mental health reform in America today.
After working with Paul when he was a speaker at Make a Difference US in October, I was fortunate to catch up with him for a follow up conversation, post election results. He shared ways in which America’s mental health system has the chance to improve for the better in years to come and his firm beliefs on where that needs to start.
You’ve had a long career advocating for improved mental health across America. What have been some of the biggest achievements you’ve seen happen to date?
We’ve had crisis after crisis over my career but what I consider the biggest success is helping people understand that serious mental illness doesn’t begin in adulthood. It usually begins during childhood and unfolds over years before someone reaches crisis.
In each generation there’s been less stigma. Young people today are incredibly open about mental health. More than in my generation or that of my parents. This is helping reduce stigma, but stigma and discrimination haven’t gone away. They still exist in many aspects of society.
What would you consider your own key achievements?
Coining #B4Stage4 (Before Stage Four). It’s a way of talking about early intervention using a chronic disease model versus thinking of it as a public safety issue. With psychologists, the medical community, social services, media, and the public – this framing really helps people understand this. And breaking it down into a hashtag has also really made a difference in awareness raising.
Also developing the Bell Seal for Workplace Mental Health, which is our certification program at Mental Health America (MHA) which recognizes employers who are committed to creating mentally healthy workplaces. It came out just before the COVID-19 crisis—at just the right time.
The timing really has been a silver lining in a deep dark cloud of a pandemic, that we had something ready to go literally 3 weeks before COVID hit. And we think it may offer ways and incentives to support the mental health of the hybrid workforce for years.
Where are some key areas where you think are still falling short on serving the mental health needs of Americans?
In the criminal justice system. Too many people continue to talk about mental health as a public safety issue. We see sheriffs getting involved with people in crisis far too often. And people in crisis are too often not seen as people who need treatment – they’re seen as people who are dangerous. The worst outcomes for people with mental health problems often occur when they hit the criminal justice system.
Forty years ago, we thought of homelessness as being about moms and kids on the streets. Now we understand better that chronic homelessness usually happens because people have chronic behavioral illnesses and we lack the full array of treatments and resources they need.
We are also still failing kids with early stages of mental health conditions by not supporting them in schools. It isn’t just that when we don’t support them, they drop out or are expelled and then go on to lead productive lives anyway. More often, we start them on pathways to homelessness, jail, and in the most tragic cases death – from suicide, other injury, or other untreated chronic diseases.
Half of mental illnesses – serious diseases – emerge by age 14. By ignoring and not treating them when they do emerge during childhood—this is our greatest failing right now.
You’re part of a group of CEOs who are looking at how to influence positive mental health policy change in the US – is there anything you can share about what kind of changes you as a group are seeking to influence?
In spring this year, fourteen CEOs started coming together to elevate the discourse on mental health as we were dealing with the pandemic. The group includes former US Representative and founder of The Kennedy Forum, Patrick J. Kennedy, leaders from NAMI, the National Council on Behavioral Health, Wellbeing Trust, both APAs, and others representing a historically diverse group of perspectives. But we all recognized the immediate damage the pandemic was doing to mental health and wanted Congress and the Administration to address this as aggressively as they were addressing the damage being done to our physical health.
This has led to some strong advocacy in Congress. While we didn’t make it into earlier stimulus packages, in the House HEROES proposal, more than $8 billion was dedicated to mental health. Senate leadership also included more than $5 billion for mental health in its summertime proposals. So, we’re making bipartisan progress, even though we’re still waiting for dollars to be approved.
But that isn’t going to deter the leaders of our groups. We’re building consensus around principles and proposals that would re-imagine an improved mental health delivery system. And these are being built as much around the needs of people as they are around the traditional wishes of advocates or providers – as we all think they should be.
We believe in a number of things. That we must focus on prevention and early intervention. That workplace mental health is a public health imperative. That racism and bigotry in current systems must be overcome. That school-based services for kids are necessities. That we must cover mental health on par with physical health in terms of both public and private third-party payment. That our behavioral health workforce must be expanded. And that we must get people who are mistakenly in the criminal justice system into care services.
I think we need to get people to understand the racism and bigotry which have been built into the behavioral health system. We need to recognize that people who come from marginalized populations are often disenfranchised because of the color of their skin or their mental health condition. We need to see that it is about time they have the chance to live their lives on an even playing field.
As the coming weeks unfold, we hope it won’t just be the fourteen of us saying all this. I hope that scores more advocates will sign onto the principles, even as they offer their own additional proposals. The bottom line is this: if we can show the country that our group with its range of perspectives can come to a consensus on how the system should be rebuilt, federal and state elected officials should be able to as well.
Based on this experience, is there any message you’d want to share with American workers about hope for the future of mental health in the workplace?
I expect that all employers will be more sensitive and accommodating to workers’ mental health needs in the future. And if one isn’t, I think there will be a competitive employer who is offering this support. People will leave the one who isn’t and go work for the one who is. Asking for support will be a strength in the future, not a weakness.
What constitutes productivity has changed this year. The so-called 80-hour work week that once upon a time was treated almost a mythical optimal productivity standard is changing. Work/life balance is becoming increasingly important to people and that means balancing those 40 hours of work with 40 hours of relaxation and recreation is going to be more important than ever. It’s almost easier to be all-consumed at home when working remotely than it is to spend extra hours in the office. People realize this now more than ever.
As a result, we’re starting to ask more questions about what, exactly, is productivity. What really improves the bottom line and what doesn’t? Pushing people to exhaustion is no longer the way to do that. Employers and employees are both really starting to realize this.
As a father of a son with mental illness who ‘the system failed’, as you’ve said, is there anything that you think could make a big difference for the futures of children with mental health problems?
We should screen every child for mental illness, like we do with vision screening and accommodation. Providing mental health support for our youth should be the same as getting glasses for a child. Giving simple support to kids at an early stage helps with expression, emotional wellbeing that can benefit that child for the rest of their life. Based on a comparison of data published by NIMH and US DOE, today we only catch 1 in every 30 kids in school who currently need mental health support. We need to be reaching the other 29.
We need Special Education to be working for these young people. We need to fix Special Ed by funding it fully and giving every child in need the individualized programs to which they are entitled under the law.
With an investment of $10-$15 billion, we could support the other 29 kids. We’d see less suspensions and expulsions, and it would be a lot less expensive than providing them life-long “services” in jails, prisons, hospitals, homeless shelters, and subsidized housing. It makes far more sense to give them the educational supports they need, versus being set up to fail. I could continue to talk about the ‘other 29,’ but I wrote a book about the 1, my son, after we’d actually caught that he had schizophrenia when he was ten years old and got him into special education. And that wasn’t really a success, either. But it would take too long here to explain why, and how we could have made things work. You’ll just have to read the book!
What would you say effective screening support should look like?
Even though it should be offered to every school child (and adult), screening doesn’t have to be offered directly within schools. Community providers could do it – it’s easy. The screening tools (such as the PHQ-9 for depression and the GAD-7 for anxiety) are widely available, and MHA offers them for free and anonymously online to everyone. And people, especially young people, aren’t shy about taking screenings – we get about 10,000 per day right now, around 4000 of whom are teenagers. The screening is very easy, not like some people imagine using Rorschach tests or things like that.
In terms of workplaces, what should improved mental health support look like?
At MHA we’ve been advocating that the Center for Disease Control (CDC) should add skills and expertise in the area of workplace mental health. And we are excited that this is going to be happening in the next year. So, we’re making progress on this front! It’s good that people in the government are seeing this as a standard occupational health issue. As a result of the pandemic we’ve been able to see this as really important, not just for frontline workers—but for all workers.
For individual workplaces, if this is about productivity within our capitalist system, then employers need to understand how much productivity is attached to worker emotional wellbeing. Employers need to be promoting EAPs much better and proactively offering time off to overstressed and overworked employees for their mental health. And there needs to be more peer support formally promoted in workplaces.
Leadership also needs to be talking openly about mental health. CEOs need to be speaking about it—this can have a hugely positive impact in setting the tone and culture of a workplace. This is just one example of many mental health interventions in workplaces that don’t have a big price tag attached.
We have a new administration coming into office in January. What are your hopes for what this can mean for positive policy change?
Joe Biden understands grieving, loss and the tremendous need for health and mental health reform. The sensitivity of the new administration will be different than with the last administration.
Donald Trump talked sometimes about his older brother who died of a substance disorder. From what he said, he seemed to grow up believing this was a weakness. And I think that perspective – that people with serious mental illnesses are “weaker” than the rest of us – has guided the policy response of the government over the past four years on mental health and substance use.
Going ahead I think the Biden/Harris Administration will see things differently. We can expect to see a greater emphasis on prevention and early intervention and seeking help as a strength not as a sign of weakness. I think we’ll see realistic and moderate policies going forward. We can and should dream for all we need and would like to have, but we also must be realistic. A lot of people have mental health needs, and we must do the best we can for them— even knowing at the start that we cannot save every life. But at the very least we must try.
I also think there will be a greater emphasis on recovery—something Joe Biden has exemplified though his life with all that he has been through personally. Biden also talked about mental health on the campaign trail, that we were facing community crises with not enough mental health professionals available, so I think the Administration will be helpful with that, too.
But we’re at a fortunate moment in history where we have bipartisan support for mental health, with both Democratic and Republican advocates, so I believe there are areas where good policy can and will be drafted. Leaders in both parties have made this a priority and we will have that backed up by a president who will make it a priority.
With your retirement from Mental Health America planned for next June, if there was one thing you’d like to accomplish alongside your team before then what would it be?
I got into this space when I was 25 years old in the Connecticut state legislature. I was assigned to a sub-committee on health because no one else wanted to do it. I was the youngest and least experienced, the last pick. This is how I got into behavioral health —by chance as I sat on a joint appropriations committee. Now more than forty years has passed.
If we could accomplish one more thing in the next few months, I’d like to see something more happen for kids. There must be more attention paid to early intervention for our young people.
What we can do is to get more services to kids as fast as we can, with the health pandemic as a platform.
People often ask me what they can do for my son, Tim, who is 35 and lives with schizophrenia. What I say to them is there’s not a lot we can do right now because he’s not asking us for all that much. It’s what we could have done for him when he was 5 years old that could have made a difference.
I’d like one more shot at making that difference for some other five-year-old out there.
About the author
Heather Kelly is the founder of Aura Wellbeing, a consultancy providing workplace wellness strategy, coaching and training services to employers. She was Content Director for the launch Make a Difference Summit US and Launch Online Editor for Make a Difference News. Heather led the development and operation of the Workplace Wellbeing Index, during her time working for the UK’s largest mental health charity, Mind. In her earlier career in the US she worked as a photographer, a journalist and a senior manager in the insurance industry. She’s passionate about inspiring more empathy and awareness in workplaces toward normalising mental health and in her spare time Heather teaches photography to teens as part of a charity projects in London and Spain, she’s an avid runner and experimental chef for recipes promoting healthy minds.
