ATLANTA – Mental health care and its role in the larger, evolving health care system emerged as a recurring theme last week at the annual conference of the Association of Health Care Journalists.
Starting with former President Jimmy and first lady Rosalynn Carter -- who set the tone on the first day by zeroing in on the persistent lack of parity between the coverage of physical and mental problems -- mental health care issues rose to the fore in several workshops and presentations, including annual journalism awards for health coverage.
Although the fate of the Affordable Care Act was not necessarily a focus at the conference, the Supreme Court's hearing of legal challenges to national reform and its anticipated ruling found their way into most conversations.
"The Tea Party and some Republicans have misled the American people," Jimmy Carter said. "If the facts were known, people would support health care reform."
Carter said he would prefer "a single-pay[er] plan, taking what Medicare does now and expanding it."
Rosalynn Carter, an advocate for mental health coverage even before the Carters were in the White House, said she is distressed that despite the passage of the Mental Health Parity Act of 1996, "we still have not implemented the legislation. We have to make mental health care on a par with everything else."
Signed into law by President Clinton, the mental health parity law was one of several legislative attempts to require health insurers to provide equal coverage for mental and physical ailments. The law has been modified several times, most notably in 2008 with the Mental Health Parity and Addiction Equality Act.
"But the White House has not followed up on it," Rosalynn Carter said. Both Carters said politics and a powerful insurance industry are keeping parity at bay.
The Carters also discussed their work with the Carter Center, a world health organization they founded with Emory University in Atlanta after leaving the White House.
"We are very close to eradicating guinea worm from the face of the earth," Jimmy Carter said, adding, "And we're very proud of that."
Guinea worm, thought by some to be the historic source of the twining critters in the international medical symbol caduceus, is a parasite that has invaded, sickened and killed humans for thousands of years through unfiltered water.
The Carter Center has worked in 73 countries on projects as varied as building latrines to treating river blindness. The center spends about 85% of its time and $100 million annual budget on health care.
Behavioral, Mental Health Moving Into Primary Care
From a workshop devoted to exploring efforts to include mental health as a routine part of primary care to the use of artificial intelligence to research and even diagnose mental illness, mental health issues were pervasive over the four-day conference.
"Primary care and integrated behavioral care really should be the future of health care in this country," said John Bartlett, senior project adviser for the Primary Care Initiative, a project of the Carter Center Mental Health Program. "I really don't see a down side for moving in that direction and there are lots of advantages," Bartlett said.
Bartlett predicted including mental health screenings and behavioral health counseling will become routine parts of primary care, partly because it's the right thing to do for patients and partly for financial reasons.
"ACA has tons of dollars for prevention and [I] think that's going to help move behavioral and mental health into primary care offices," Bartlett said.
Future Includes Artificial Intelligence
Michael Covington, associate director of the Institute for Artificial Intelligence at the University of Georgia, said a significant part of the institute's work involves health care -- including mental health research now and perhaps diagnosis in the future.
"Things like idea density in language -- how much actual information is contained in what people say -- is sometimes a marker of mental health issues," Covington said. "Idea density can be recognized and measured by artificial intelligence," Covington said.
He also pointed out that people with certain kinds of schizophrenia use the muscles in their faces differently from most people. "That also can be screened with artificial intelligence. These kinds of things work well with Mrs. Carter's statements about bringing mental health into the big picture of health care," Covington said.
The session on artificial intelligence applications in health care featured Watson, IBM's super computer that defeated the best humans in Jeopardy! Watson is now being steered toward decision support in health care.
Fred Trotter, founder of the Cautious Patient Foundation who calls himself a "hacktivist," said health care's late arrival and slow uptake in digital recordkeeping will hamper artificial intelligence's potential.
"A doctor is a diagnosis machine, primarily," Trotter said.
"There are other privileges we assign to those people, but their core job is to diagnose. Eventually, Watson or machines like Watson will do a better job diagnosing health issues than doctors. That day is coming, but I am afraid Watson will be ready to diagnose on his own before we have the data to give him. That should bother everybody in the room," Trotter said.
Mental Health Story Wins Award
Mental health issues also were represented in annual awards presented during the conference. The top award for health policy journalism in 2011 went to the Milwaukee Journal Sentinel for "Imminent Danger," a story exploring the challenges in getting help for people with mental illnesses who may pose a danger to themselves or others.