Mental health expert Dr. Lloyd Sederer

Sederer, author of The Family Guide to Mental Health Care, discusses the mental health crisis in the U.S.

A leading voice on quality care in mental health, Dr. Lloyd Sederer is medical director of the New York State Office of Mental Health, the largest state mental health system in the United States. He's also adjunct professor at the Columbia/Mailman School of Public Health and has served as a faculty member at Harvard Medical School. Sederer has published seven books, two through multiple editions, and more than 350 professional articles and reports. His most recent text, The Family Guide to Mental Health Care, is a comprehensive print resource for the millions of people who have loved ones suffering from some kind of mental illness.


Tavis: One in four adults in this country will experience a mental illness at one time in their lives; one in 10 kids and adolescents will have serious problems that will derail their educational and social development. Eighty percent of Americans with treatable mental disorders do not receive proper diagnosis and effective treatment – 80 percent.

Obviously, this is a serious problem in our nation, and one that Dr. Lloyd Sederer, the medical director of New York State’s Office of Mental Health seeks to address in his new book, titled “The Family Guide to Mental Health Care.” Dr. Sederer, an honor, sir, to have you on this program.

Dr. Lloyd Sederer: Well, thank you for having me.

Tavis: I just tried to give some sense of how bad this problem is. Fill that in for me a bit.

Sederer: What makes the problem particularly bad is that the treatments for mental disorders are highly effective. They’re just as effective as the treatments for heart disease or diabetes or asthma, and not enough people are going to treatment, getting treatment that could work.

That’s what causes that 80 percent. Too many people who have treatable conditions are not getting the treatment they need.

Tavis: How can mental health be such a serious issue and yet politically, socially, economically, and certainly culturally, be an afterthought?

Sederer: That’s been a question that has been asked for hundreds, if not thousands, of years. There’s a great deal of stigma about mental illness, and there’s not a sense that these are medical conditions that are treatable conditions and that need to be part of standard medical practice.

Not just going to a psychiatrist or a psychologist, but a part of primary care, where depression is identified, where anxiety disorders are identified, where alcohol and drug problems are identified. We don’t have that even as a part of our standard medical care, yet those conditions are more common than asthma or diabetes.

Tavis: That leads to the obvious question, at least to my mind, which is how this issue will be impacted or not, as it were, by the affordable healthcare act – Obamacare, as it’s known.

Sederer: Obamacare stands to do a lot of good things, three in particular. One, a lot more people are going to have health insurance, which means they’re more apt to get care.

The second thing is that in the essential benefits, there are a set of 10 essential benefits in affordable care, and one of them is mental health and substance abuse treatment. So you are required to do that.

The third is that there’s an element that says if you provide mental health treatment, you have to provide treatment at the same rates, under the same conditions as you do for medical care. That’s called parity, which means you can’t shortchange people with mental illness, you can’t give them less.

If you’re giving the care, you have to give it as if it was a heart disease or diabetes. So three things are apt to improve with the Affordable Care Act.

Tavis: This audience knows, I’ve expressed it on more than one occasion, my just – I’m trying to find the right word. I don’t want to go into commentary tonight, but disdain and disgust that nothing happened on the legislation that would have led to background checks for handguns. That’s another conversation for another night.

I raise that only because if there is – to my mind, you tell me if I’m reading this right – if there’s a silver lining in that dark cloud of nothing happening on the handgun legislation, one of the things that has gotten some traction, and even the opponents of the background checks were arguing that a person with mental illness will not be stopped by a background check.

So now I know there are a number of senators who have been, some of who were already on this issue, but others who are at the very least now trying to advance a serious conversation about that aspect of these shootings that we’re all sick and tired of seeing happening – that is to say, the notion of mental health.

How have you been reading this, and is it your sense that even if for the wrong reasons, there might be some conversation in the U.S. Senate, on the Hill, about what to do about mental health if we’re not going to do something about background checks or assault weapons. Does that make sense?

Sederer: That indeed would be the silver lining.

Tavis: Okay.

Sederer: If we could figure out better ways, we know better ways of identifying these problems in teenagers and young adults. Half of people who are going to become mentally ill become ill by the time they’re 14, three-quarters by the time they’re 24. The diseases are starting to appear.

They can be detected in family doctors’ offices and pediatricians’ offices and schools. If we identify the illness and if we provide care, help families feel comfortable about getting care, we can intervene early.

There’s nothing like intervening early to prevent the progression of a disease, and it’s the progression of a disease that leads to severe states where people not only hurt other people, they hurt themselves.

Tavis: You’re the guy that runs this program, of course, in the state of New York. I wonder if in New York or some other place there is an example, or there’s a best practice, for lack of a better word, a best practice for who his handling these kinds of issues best in the nation.

Give me some sense who that is and what we ought to be emulating in scaling up that they’re doing.

Sederer: Well, it depends on whether you’re asking about primary care, which is where most people with mental illnesses go, or in specialty care, which is in these psychiatric clinics, mental health clinics, psychiatric hospitals.

Work has to be done in both places. Best practices need to be identified in both places. In primary care, that’s about introducing screening for depression, for substance abuse, just like you and I get screened for blood pressure and diabetes.

In specialty care, what we’ve got to do is insist, by creating standards I think are standards of care, and that’s what we’re trying to do in New York and there are some other states that are doing this as well, that say this is the best practice.

It’s not just medications, it’s not just therapy. It’s combining this. It’s enabling people to stay in treatment, because if people stay in treatment, they’re going to get better.

So it depends on which setting, and those are the two principle settings where people go for care.

Tavis: I want to spend some time just kind of running through these eight guideposts. You call them eight guideposts to navigating mental health care in this country. In no particular order, let me just throw them out at you and get you to top-line them, and we’ll invite people to pick up your book and read more about this.

But it gives a good framework for what the book lays out, these eight guideposts to navigating the mental health care system. Number one, analyze the behavior.

Sederer: Yes. That means you’re seeing something, jot it down, because you’re going to need to remember it, you’re going to doubt what you see, and then you need some facts in talking to your loved one.

Tavis: Guidepost number two, remember it’s not your fault.

Sederer: For longtime families who are blamed for the problems that their kids and their loved ones had. It’s not – mental illness is a disease. It’s no more a family’s fault that a child has diabetes than he has depression.

Tavis: Trust yourself.

Sederer: That’s a really hard one, because people doubt what they see. They don’t want to believe it, they’re afraid of what’s going on. That’s why I suggest that people write some things down and talk to somebody else.

Don’t go it alone is another one of the principles, because alone, you’re going to doubt, you’re going to lose your confidence. Write some things down, write what you observe, talk to other people about it, and then you’ve got something to talk to your loved one about. It’s not just that you felt this or you thought this, but here’s what I observed.

Tavis: You’ve already hit don’t go it alone, so seek help as soon as possible.

Sederer: Well, that’s always the best advice for any kind of condition. But I just, if I could top off, if you will, a word or two about don’t go it alone, that’s really the hardest thing for people to do if they feel ashamed or if they feel hopeless.

But because these are such common conditions, it means that you’re not alone. That people in your extended family, friends, coworkers, doctors, clergy, it’s all, this is ubiquitous as a condition.

So you don’t have to go it alone. There are people and places and organizations you can turn to that help you not go it alone.

Tavis: There are some things, some diseases and illnesses that you know, being a physician, are treatable. If you have a mental condition, seeking help as soon as possible does what? If the condition is there, it already exists, does it not?

Sederer: But conditions can progress.

Tavis: Okay.

Sederer: They can get worse, and they can disable people. This is particularly true of serious mental illness in adolescents. We know that what’s called the duration of untreated illness, the longer an adolescent with a serious illness like a psychotic illness goes untreated, the more likely that adolescent is going to become disabled, as the young adult, as an adult.

There’s something going on in the brain. There’s a progression of the disease in the brain. That’s what we’re trying to prevent.

Tavis: Don’t get into fights.

Sederer: That’s the hardest prescription of all, because when you see something, you try to reason with your loved one. They say no, nothing’s the matter with me; you’re the fault, et cetera, et cetera.

You want to dig in, you want to fight back, and fighting doesn’t work. It just doesn’t work. There are other ways to do this that have to do with observing, listening, and leverage.

Families have leverage. They give, and being part of a family is a two-way street – you give and you get, and families can make change, but not by fighting.

Tavis: Families have leverage, but they also have agency, and one of your eight guideposts is to learn how to bend the mental health care system to fit your needs.

Sederer: Yes, yes. So one example I like to use is this privacy law called HIPAA, which says a healthcare provider or hospital can’t talk to you without signed consent, and that often is a big wall that comes up between a family who wants to provide necessary information and the doctor or the hospital.

What families can learn, how they can bend that rule, because if they persist, they can get a doctor on the phone. They can say, “I know you can’t talk to me, but you can listen to me. You need to listen, because my son’s not going to tell you that he’s smoking all this dope.

“My son’s not going to tell you that he’s collecting knives in his room. I know this. He’s not going to tell you. You can listen to me. There’s no law against that.”

Tavis: Finally, you say settle in for the siege and don’t give up.

Sederer: Yeah. Most mental illnesses are a marathon, they’re not a sprint, and that’s true of most persistent illnesses. It’s true of asthma, diabetes, Parkinson’s. You have to think you’re on the long road, and you have to marshal your resources carefully.

You can’t spend them all at once, whether it’s emotions or money. You have to be careful and think you’re on a long road, because you are, and sooner or later, that’ll work for you.

Tavis: His name is Dr. Lloyd I. Sederer, M.D. The book is called “The Family Guide to Mental Health Care: Advice on Helping Your Loved Ones.” I should mention this book has a wonderful forward written by the wonderful actress Glenn Close.

Dr. Sederer, good to have you on the program. Most importantly, thank you for your work, sir.

Sederer: Thank you so much.

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Last modified: June 4, 2013 at 2:29 pm