This is the second installment of our ‘Five Question Fridays’ interview series. The goal of this interview series is to talk to the brightest minds in the Health and Human Services about everything from technology to policy. Last week, we spoke to the CEO of Mental Health America, Paul Gionfriddo, about the recent increase in demand for Mental Health services and the impact of digital strategies.
This week, we welcome Dr. Glenda Wrenn, a well-respected speaker and mental health advocate. Glenda also sits as the Director of Behavioral Health for the Kennedy-Satcher Center for Mental Health Equity, where she fights to ensure that all people have equitable access to behavioral health care and the opportunity to achieve optimal health outcomes. Glenda continues to move conversations about mental health forward through her numerous publications, speeches, and extensive research.
Check out our ‘Five Question Fridays’ interview with Glenda Wrenn below:
You’re currently the Director of Behavioral Health for the Satcher Health Leadership Institute. Could you shed some light on some of the recent projects you’ve been working on?
Sure. As of July 1, our division is now the Kennedy-Satcher Center for Mental Health Equity. This is an exciting time of transition due to a generous endowment gift from Former Congressman Patrick J. Kennedy matched by our institutional NIH endowment. The Center will allow us to continue to do the great leadership development work though our Smart and Secure Children Parent Leadership Program and our Integrated Care Leadership Program; but it will also support further innovation and effectiveness on projects that are focused on advancing mental health equity.
One example of that is our work on behavioral health crisis systems. We had already led a successful initiative in partnership with Grady Health System to improve and transform their delivery of crisis services in their Emergency Care Center and expanded that to the Grady Emergency Medical System. But our team remained concerned with the lagging pace of national progress despite recent federal legislation designed to help individuals and families in mental health crisis. We believed that there was more that state and local policymakers, advocates, and health leaders could do if armed with the right information and roadmap. Support from the Center has allowed us to advance that scope of work in partnership with several key stakeholders, and we are excited about the next year and the progress we will help advance.
In 2016, you spoke at National Council’s NatCon Conference in Las Vegas. How would you say that the Mental Health industry has changed since you attended that conference over a year ago?
First, let me just say that I am a big fan of the National Council. They have earned my respect and admiration by their relentless advocacy and exceptional quality of their programs and initiatives. With that disclaimer aside, quite a bit has changed since 2016.
We have a new President for one, and new leadership at the Department of Health and Human Services in Secretary Tom Price. The “Helping Families in Mental Health Crisis Act” is now law, and as we speak the debate on health care reform rages on. In Las Vegas, one of the conference themes was addressing racial and ethnic disparities. The summer of 2016 brought racial tensions to the forefront of everyone’s focus with several shootings on unarmed black men by police. The fall of 2016 brought the voice of the working white class to our attention, and collectively, I think these social events are very relevant to the mental health industry.
We know that single, white middle aged men are perishing at alarming rates too due to suicide and opioid overdose, and represent a health disparity population in that regard. At the same time, many in the mental health industry including myself, are concerned that inclusion of mental health as an essential health benefit and other hard fought reforms that were included in the Affordable Care Act may be lost in the current legislative process to enact reforms via budget reconciliation. Now more than ever, the mental health industry and stakeholders, such as myself and our organization, are motivated to work together toward a directionally common outcome. Unfortunately, due to the devastating escalation of the opioid epidemic, behavioral health remains a priority issue for all Americans.
Our 2017 State of Workforce Management survey report revealed that 53% of Health and Human Services has experienced compliance issues over the past year. What advice do you have for organizations to maintain compliance with changing policies and regulations?
Well, this is not surprising to hear, as policies and regulations are rapidly changing. There are important changes that need to be made, and health and human services is not the most agile and responsive industry. So, there is a role for policy and regulation, along with innovation and market forces to ensure outcomes, equity, and efficiency. That said, and I am not expert on these matters, I think that organizations need to dedicate resources specifically to compliance and adopt compliance as part of operational excellence within their culture.
Patient safety and quality improvement are natural homes for this in the health sector. Just as patient safety has been prioritized across the health industry (thanks in large part to the IOM report “To Err is Human” and the efforts of many advocates), in my view, “compliance” might be due for a reframe because it really speaks to enabling transparency and accountability which benefits all stakeholders in the long-run. As a clinician, I know full well that the current way of ensuring compliance is not optimized. I practice a small percentage of the time, but am required to fulfill 100% of the certification, compliance, training, and regulatory standards within my field.
I think there is a better way, and I would hope that organizations work to be pro-active in innovating solutions that minimize the burden while achieving the outcomes of demonstrated accountability. The analogy I like to use for this is math. We must show our work, and no longer will we get credit for just getting the answers right or a pass because we’re a good student. It’s just the reality of our times and something we should view as a shared responsibility.
You’ve had the chance to speak with many Mental Health executives over the course of your impressive career. From these encounters, what are the most common problems or challenges that you hear the most?
Depending on the context where mental health executives and leaders are working, the challenges and pain point varies. Also, I’m likely biased based on the type of work that I do which is very much grounded in the communities served by mental health services. I commonly hear concerns about sustainability and managing the pressure to increase revenue while reimbursements are flat lined or decreasing. This usually comes up when discussing barriers to innovation. It’s very hard for leaders to be creative when they are trying to keep the lights on.
Another issue I hear often is concerns about an inadequate behavioral health workforce. This is a complex problem, but supply and demand is not adequate (and unlikely to be so anytime soon) and we really need to find a way to task shift and deliver care that aligns resources with need. That is the essence of equity in my view, the ability to align resources with need, providing the right amount, to the right individual, at the right time, in the most efficient and effective manner possible.
As a specialty behavioral health provider, I understand the temptation to move into “turf protection” mode, but we really need our leaders to inspire and require us to transcend those short-sighted perspectives in order to actualize a future that has moved beyond those poorly constructed defenses. I certainly could go on about problems, but I usually spend most of my time focusing on solutions, so I will leave it at those two.
You’ve spoken at countless events and conferences, been involved in multiple panel discussions, and contributed to a long list of publications covering a variety of Mental Health topics. What continues to drive your passion for Mental Health issues and policies?
Well, this is a personal question if I am to answer this honestly. I have a deeply held love of my country and its potential as a force for unity and freedom. I also practice a personal Faith that calls me to service, and leveraging my time, gifts, and talents to elevate the basic human dignity of others. I would not have chosen mental health as “my issue” were it not for a series of events and experiences that chose me.
The first patient I ever saw with a mental health problem was a veteran with severe schizophrenia. I was a medical student, and not on a path anywhere close to psychiatry. He was so disorganized he could not form a sentence that made any sense. We call that “word salad.” I had heard that he was an exceptional chess player in a famous park in Philadelphia where people come to play. I was incredulous. He was threatening, unfriendly, and paranoid, with complex delusions seemingly involving a loose connection to his military service but at this point involving implanted devices and such.
Over the next month, I saw him improve in a way I can only describe as miraculous. I never knew people could become sick in that way and recover so completely. But, my favorite part of this story happened a year later when I ran into him at another hospital where he was likely coming for an outpatient visit. He had gained around 30 pounds but I recognized him instantly. I asked if he remembered me from the other hospital and he smiled and said “yes.” After some brief niceties, I asked if his appearance was from medication side effects and he said “yes.”. He then looked at me and said with a smile, “Looks like you’ve gained some weight too,” to which I burst out laughing. I was 7 months pregnant. The joy we shared in that moment is what drives me. It represents the promise of healing and recovery, and the conviction that those of us with the power to change our systems for the better have a duty to do so with integrity and excellence.
We’d like to thank Glenda for her participation and incredible insight. Make sure to follow Glenda and the Kennedy-Satcher Center on Twitter for more updates. If you’re interested in participating in our interview series, send an email to firstname.lastname@example.org. This DATIS blog may not be shared or repurposed without permission.