http://www.cfha.net/forum_thread.php?t=59Recent posts in Ben Miller: Mental health: Come out, come out wherever you arehttp://www.cfha.net/forum_thread.php?t=59#post108pJeff you make a valid point regarding how family medicine educators may have a particular influence on the practice of collaboration. My recent dissertation 209 examined the referral practices of family physicians with a national survey of AAFPs national research network. The participants voiced what they consider a void in optimal mental health services for their patients. The results suggest family physicians unfamiliarity with the various psychotherapists available to their patients counselors family therapists social workers psychologists and psychiatrists. Further studies need to be done exploring the depth of understanding that family practice residents and medical students are given regarding the services of different talk therapists. Without completely appreciating the unique expertise of various psychotherapists it is not surprising that collaboration would be limited.phttp://www.cfha.net/forum_thread.php?t=59#post98pJeff thank you first for your post and second for all the work you have done to advance mental health. You are right that we need to take advantage of any and all opportunities to advance mental health anyway we can. My post and your response both highlight the need for large scale read national change in a fragmented and flawed system. In todays senate finance committee bill Chairmans Mark - Baucus there is mention of mental health and required coverage of mental health and substance use. I honestly need more time to get to what this means but it is at least a start. Lets continue to collaborate on this issue as often as we can. Good points and great discussion. nbsp nbspphttp://www.cfha.net/forum_thread.php?t=59#post95pMy name is Jeff Goldsmith and I wanted to respond to several points.nbsp I am a psychiatrist and an addiction expert with the American Society of Addiction Medicine Board.nbsp We have been pushing hard for several years to get Parity for mental health and addictions and were thrilled to get it last year.nbsp I have chaired a symposium about Parity two years ago and they indicated that anti-parity folks continue to fight parity for years and Vermont had to pass three parity laws to get things moving in parity for their state.nbsp While i am not political in general I thought this issue was crucial for the moment.nbsp We need a national system that supports Parity in principle and we dont have it yet.nbsp So keep an eye pealed and this Fall is the time for guidelines to come out for Parity.nbsp So far the Presidents cabinet members havent come out with guidelines.nbspppSecond your organizational name includes Collaboration which i wholeheartedly support.nbsp Collaboration is crucial for primary care and family health care.nbsp Half of mental healthcare is done by primary care providers and not psychiatrists.nbsp So we all need to collaborate with each other to provide the best care.nbsp I wish that Congress would collaborate more too.nbsp Medical Educators have not taught collaboration well in the past and I hope we do a better job in the future.nbsp Collaboration is not consultation nor referral.nbsp It is working together and you know that well in your position.nbspphttp://www.cfha.net/forum_thread.php?t=59#post91pSo as I mentioned above parity in and of itself is not sufficient. Please read the a hrefhttpcontent.healthaffairs.orgcgicontentabstract283w490 targetblankCunningham Health Affairs aarticle for more info on his take. It is great that the President is aware of the mental health community. If we want to transform the healthcare system we need more than just awareness - we need creativity and vision to end the fragmentation that plagues our healthcare system. Could vision come through our a hrefforumthread.phpt53 targetblankpublicationsa a hrefforumthread.phpt55 targetblankresearch networksa or even our a hrefforumthread.phpt61 targetblanksocial networksa Now is our time to make our voice heard nbspphttp://www.cfha.net/forum_thread.php?t=59#post88pDescartes has proven to be more of an issue that I originally thoughtnbspBack in August President Obama visited the seacoast area and I wasfortunate enough to attend.nbsp One of the audience members asked thePresident about the role of mental health in the reform efforts.nbsp Hisresponse was positive in that he confirmed his support for parity ofmental health in the reform process.nbsp That being said after readingthe Parity Act Im not that optimistic about the governmentsoperational definition of parity.phttp://www.cfha.net/forum_thread.php?t=59#post86pBen I share your frustration with the void of mental health discussion in the healthcare debate.nbsp I attribute this to a number of causespulThe bodymind split that typifies the healthcare lobby.nbsp The mental health lobby is mostly agnostic to the larger healthcare debate because it doesnt really involve their funds.nbsp In this they are short-sighted because I believe that designated funds and carve-outs for mental health will eventually disappear and then we will be more under-funded than now. ululCollaborative Care has yet to make a strong case for the need to integrate behavioral specialists in primary care.nbsp The IMPACT research probably makes the best financial case for care coordination but they use extended-duty nursing staff rather than mental health professionals for care coordination and problem-solving therapy.nbsp Their findings might actually undermine rather than reinforce our case. ululLegislation requires bumper sticker messages that people can write on posters and yell at congressional meetings.nbsp Integrated care is a nuanced model that is difficult to simmer down. ulpI do think that Twitter is a way to reach a broad audience with bumper sticker tweets that connect them with more information.nbsp Thanks for taking the lead on this.phttp://www.cfha.net/forum_thread.php?t=59#post84pAs the health reform debate rages so many numbers names and theories are thrown around we have to ask ourselves the question where is mental health You see being a mental health professional committed to seeing the divide between mental health and physical health erased I want to know that the next version of health care comprehensively addresses the needs of the whole person. So I always make sure to try and see where mental health sits within any discussion on healthcare. To this end I follow blogs check certain websites read bills etc. to get a better sense if the artificial divide between systems will be erased.ppnbspppMy findings mental health is notnbsp part of the larger health reform discussion that I can see - if we are talking HEALTH REFORM shouldnt we include all aspects of healthppnbspppNow here me on this one I know the mental health community is actively engaged in advocacy around parity a hrefhttpcontent.healthaffairs.orgcgicontentabstract283w490 targetblankbut is this sufficientappnbspppWatching the Presidents speech to Congress two nights ago I kept wanting to hear something about mental health - that is too much to hope for. I follow a hrefhttptwitter.com targetblankTwitter ato see what other thought leaders yes they are on Twitter have to say on healthreform a Twitter technique etc. I see brilliant articles discussions ideas but none include mental health. Being a Twitter amateur I try to push for integrating mental health into the discussion as often as possible but this is not going to get the message that now is the time to end the separate histories of mental and physical health and defragment healthcare. Still I try and use any and all any means necessary to bring attention to this issue. If you are feeling adventurous you can follow me on Twitter - a hrefhttptwitter.commiller7 targetblankmiller7a nbspppnbspppAm I off base herep