Mental Health and the Role Prevention Plays – An Interview with former Congressman Patrick J. Kennedy

What is brain health, and how does it impact mental health? Brain health encompasses the well-being and optimal functioning of the brain and is a critical aspect of overall well-being and quality of life. The intricate network of our brains plays a fundamental role in shaping our cognitive abilities, emotional resilience, and mental health. Understanding and prioritizing brain health is vital for fostering healthy individuals, families, and communities. Recognizing the importance of brain health and how it is intertwined with mental health, Prevention Action Alliance (PAA) is excited to host the Honorable Patrick J. Kennedy, former U.S. Congressman, founder of The Kennedy Forum, and prominent advocate for mental health and addiction treatment, as the keynote speaker during the Your Role in Prevention luncheon on August 16, 2023.

We recently had the opportunity to sit down with former Congressman Kennedy and discuss his involvement in the field of brain and mental health. During the interview, former Congressman Kennedy shared his personal journey, highlighting how he became an advocate in this critical field. He also provided insights on the present landscape of brain and mental health, emphasizing how prevention is key for healthcare in solving the mental health and addiction crisis.

How did you first become involved with brain health?

I started working on these issue areas while on the House Appropriations Committee – I was the point guy for National Institutes on Drug Abuse, Mental Health, Neurological Disorders, Child and Human Development, Alcoholism, and Aging – those are all brain focused. To tackle understanding the brain and where the therapeutic targets are, you can’t research the brain based on diagnosis; you need to research the brain. We need a whole new approach to research that doesn’t isolate brain research by diagnosis. These are heterogeneous illnesses, meaning that they involve multi-genetic/genomic information. You need a systems analysis approach which is what we hope to accomplish in the field of brain health. We launched an effort on the anniversary of President Kennedy’s[1] moon-shot speech; I brought all the NIH Directors to the JFK Library to celebrate his mission to space; it is a great analogy for what we need for the race to unlock the mysteries of the mind, to unlock therapeutics for all brain-related illnesses.

So, what was the turning point? What made you decide to become an advocate and have a voice?

I was brought up to be silent about these topics, to keep them secret. But I come from a very well-known family, and when I went to drug rehab at the age of 17, the person I was roommates with sold his story to the National Inquirer about being in drug rehab with a Kennedy. I was front-page news. Today I thank God for that. It didn’t solve the fact that I had a chronic illness. I had three DWIs and went to rehab six times between when the National Inquirer story ran, and I got a permanent sobriety date. What that meant, though, was that when I got elected to Congress, I was the sponsor of many of these bills, the most important of which was the Mental Health Parity and Addiction Equity Act.

No one else wanted to sponsor it because the words in the bill included mental and addiction. This was back in the 90s and early 2000s. I know many of my colleagues in Congress, like me, weren’t exempt from suffering from these illnesses – either themselves or their families, but none of them could put their name on the top of the bill because they had not been publicly exposed like I had. They were worried that if they sponsored these bills, the press would ask them if they had a personal connection to the subject matter. No politician wanted to go down that rabbit hole. Then they would have had to answer whether they had ever been in rehab or taken antidepressants. It is not a good line of questioning for a public figure. I ended up being the sponsor of the bills by default.

Can you tell me more about the Mental Health Parity and Addiction Equity Act and its impact on destigmatizing and promoting mental health wellness?

So, my bill, the 2008 Mental Health Parity and Addiction Equity Act, which I cosponsored with my Republican colleague, the late former Congressman Jim Ramstad, said that you had to cover all brain-related illnesses, both biologically based, which at the time was schizophrenia and bipolar, and affective disorders. Affective disorders are all addictions and other mental illnesses in the DSM [Diagnostic and Statistical Manual of Mental Disorders]. We ultimately got the bill passed in 2008, which is fortunate because, in 2010, the Affordable Care Act was passed. Since the Federal Parity Act was passed before that, it became an essential health benefit (EHB) and had to be covered under the Affordable Care Act.

The Federal Parity Act requires that payers not impose any higher treatment thresholds for accessing treatment for addiction and other mental illnesses, very specifically in-patient in-network, out-patient in-network, in-patient out-of-network, out-patient out-of-network, pharmacy, and ER. This is a big advancement from when you had to pay higher copays, deductibles, and premiums and had low lifetime caps. That meant that you quickly ran out of money if you had any of these illnesses. We have made great progress, but the problem is that there is so much left to do.

Can you share your insights on the current state of mental health and what is impacting it?

Post-pandemic, we are in a whole new league of challenges, and unfortunately, we have a new addiction-for-profit industry known as marijuana. It’s unbelievable that we’re introducing this new addictive industry when kids suffer from record anxiety levels. And now they don’t have to worry about someone smelling the smoke from inhaling marijuana; they can eat gummy bears with THC in them, brownies with THC in them, and all the other products, including elixirs which are basically grape soda with THC in them. The THC in edibles, elixirs, and other products is very potent and is nothing akin to anything we understand as the marijuana of 30 years ago, which had 1 or 2% THC. Now you can find products at 99% THC. That creates a whole new neuro-circuitry in the brain, especially for the young person who is at risk for psychosis. This is a deadly mix. As we know, we have too many people who are homeless and suffering from psychosis, and the last thing we need to do is add to it.

Speaking of kids, what are your biggest concerns for this generation’s youth regarding mental health and brain health?

Kids have to run a gauntlet of addiction. When I was growing up, my father had me set the fireplace during the winter. He would tell me to get the kindling – the highly flammable little pieces of wood you put underneath the big logs to get the fire going. As we expose our children’s developing brains to all these addictive industries, we are setting up the next generation to become addicted. You have social media; powerful sexual imagery in pornography sites; this notion of sports betting (you see it on every sporting event that there is); the new commercial addiction-for-profit industry of marijuana; and we have not regulated the alcohol industry in the last 40 years in terms of adding new taxes which we know reduces consumption and access. How is any kid with the pressures of the world, with the impact of Covid, with all that is going on with social media [expected] to make it through this gauntlet? [There are] so many addictive industries hitting their developing brain in such powerful ways as to tripwire the kindling in the brain. With further consumption, this becomes full-on fire in a way that it wouldn’t if we waited for when their brain was fully developed at the age of 27 and their pre-frontal cortex could have enough mediating power to tamp down on the amygdala compulsion. Now with the pre-frontal cortex not fully developed and these assaults on the brain from an addictive point of view, kids’ brains become hardwired for addiction. The point is that they could get addicted to any number of things, and then the disease of addiction takes hold. Most people don’t understand that addiction, is addiction, is addiction. It doesn’t matter whether it’s opioid, meth, porn, gambling, or tobacco; it’s the addictive disease underpinning that. As someone in recovery, you come in for alcohol addiction. Then, if you are not careful, you become addicted to any other chemical or process addiction because your brain is already wired for the addictive process. The brain gets hijacked by addiction – that is what we do when we assault them with all these things.

What role does prevention play in your mental health advocacy work?

It’s the number one priority for me. We treat every other illness in stage one. We screen people – doctors ask us about our family history of cardiovascular disease, who had a heart attack, who had a stroke, is there any history of cancer in your family, and so on. But when it comes to addiction and mental illness, even up until the last year or two, you didn’t have a primary care doctor or ER doctor asking you about your depression level or risk of suicidal ideation; now they kind of do because we have made some progress, but by and large we are well behind the rest of medicine which is focused on going upstream. The irony is that going upstream for us is the best chance to solve this most meaningfully. We cannot treat our way out of these illnesses. We are already underwater regarding our inability to meet the need. We are already at capacity, and with stigma, only a small percentage of people seek care because so many self-stigmatize. So, imagine if you were successful in any real anti-stigma effort and everyone felt like they could ask for help. It [providing care] would be an even bigger problem because, as I said earlier, we are overstretched as it is. Prevention is really the only major game-changing solution we can deploy these days with the nature of this pandemic of mental health and addiction.

“We cannot treat our way out of these illnesses.”

Are there any misconceptions or myths surrounding brain health that you believe need to be addressed? What are some common misunderstandings people may have about this topic?

A big misconception is treating these illnesses as a choice instead of a chronic illness that they are. In the past, we bifurcated brain research from neurological to affective. In the public mind, they view Parkinson’s, Alzheimer’s, and autism as neurological, yet they don’t see anxiety, depression, addiction, and trauma as neurological. Today, everybody understands the neurological components of addiction. However, there is still implicit bias in the medical community against patients with depression, anxiety, addiction, and trauma because it’s still seen as a choice. There is still difficulty translating the disease of addiction as a brain-based illness. There are genetic components to understanding your illness, which is the main component of any mental illness, including addiction. That is a biological underpinning of addiction; it is genetic and biological. You think it is just psychological, but there is a built-in inability for people with these illnesses to reflect on their behavior, which is why it becomes a progressive illness. They can’t stop even though all the indicators are that this is a progressive illness and will worsen. This is at the heart of it; the inability to understand the progressive nature of the disease of addiction. People with these illnesses can’t understand that, and that is why they don’t seek help in a timely manner and why it doesn’t stick. This is why 12-step recovery works. It is a repetitive cognitive behavioral therapy approach, using constant repetition to break the denial that accompanies these illnesses constantly. All of this is brain-based. When you refer to it as abuse and behavioral, there is a connotation that there is a choice. But if you suffer from one of these illnesses, the choice is taken out of it because the disease has hijacked your brain. No one willingly wakes up and decides today that I will jeopardize my relationship with my family, risk losing my job, getting arrested, and overdosing. That is not the human condition. The human condition is that I want to connect with others, feel appreciated and loved, and want to be “a part of.”

Another dangerous myth is the thought of youth experimentation which is being perpetuated by the older generation who were able to experiment back in the day. This has traditionally been thought of as a part of youthful discretions, part of adolescence, and part of growing up. With the new synthetic drugs – fentanyl and fentanyl analogs and amphetamine analogs, this is fatal before you even enter the addiction space. When I was active in addiction, I could relapse, and I did for years, and it did not kill me. Thankfully, I have been in long-term recovery for over 12 years and got out at the perfect time. I got out right before the stuff that I used to buy on the street was laced with fentanyl. There was a young girl, 16, from a neighboring community to where I live. She [fatally] overdosed the first time she ever tried drugs. She was a successful student, athletic, and overdosed at a party. This is a fatal illness now. Yes, it is also a chronic illness that is progressive and can kill you or get you incarcerated or institutionalized in a mental health hospital at some point, but now, there are no second chances.

As someone active in the mental health advocacy world, my phone is ringing off the hook with parents at their wit’s end as to how they help their young person, their kid, get help. It’s a real crisis.

What prevention practices do you use, or what do you recommend other parents use?

I am a person in recovery. I go to meetings daily. All my five kids know that. My solution is to give them lots of hugs, kiss them madly, and tell them how they are all blessings in my life. I put down my phone when I am with them. Like everyone else, I think I need to respond to that email or text, but we don’t need to. I am very intentional; that’s what recovery has given me, the insight that I need to be very intentional about how I act or behave in front of my kids. There is no bigger model for my kid’s development than my wife and I as their parents. We all know that we “become our parents” whether we like it or not. So, I do my part to break the cycle of addiction in my family by remaining sober myself. I tell them how to mediate and self-modulate—learning to deal with their emotions. I get down to their level when they are crying or having a meltdown. I try and give them guidance on how to navigate those feelings. They need to know how to navigate negative emotions so they don’t self-medicate over negative emotions. We’re very active in sports and music. I teach them how to swim, play tennis, and ski. We are fortunate to be able to do those things. I try to connect them to nature – I take them outside all the time, and we go to the forest near us and build forts. What my wife and I model is also key. We don’t have big screaming matches. My wife is in Al-Anon. She is very insightful about the illness because it is a family illness. We are pulling out all the stops to give our kids the best shot, but there are no guarantees. I have all eyes on these kids. I pay attention to their behavior and mood to see if there are deviations. And my kids know I do my advocacy; they’re always overhearing me talk. I bring them to events I am at. I’m trying to tackle this at every level. It’s a mission for me.

To hear more from former Congressman Patrick J. Kennedy or to join us in our journey of preventing mental health and substance misuse disorder, purchase your ticket(s) for the Your Role in Prevention Luncheon taking place at noon on August 16, 2023, at The Columbus Convention Center. We look forward to seeing you there!

[1] Patrick J. Kennedy is the son of the late Senator Ted Kennedy and nephew of former U.S. President John F. Kennedy. He is a former congressman. Patrick Kennedy is not running for President.