NAMI Convention: A Discussion with Mike Fitzpatrick, Executive Director
This is number two in a series of seven blogs made possible by the encouragement and financial support of The Health Central Network. All represent interviews with senior officers of NAMI [National Alliance on Mental Illness] or other luminaries that attended the NAMI 2007 annual convention. These interviews cover a wide range of topics that should be of interest to everyone that is involved in one fashion or another with mental health issues.
Mike Fitzpatrick, MSW, is the Executive Director of the National Alliance on Mental Illness (NAMI). Previously, he served as the Director of NAMI's Policy Research Institute and as NAMI's National Director of Policy. Prior to joining NAMI in 1999, Mike held senior management positions in state government, with non-profit agencies, and in the private sector. He served in the Maine State Legislature (his home state) and was House Chair of the Health and Human Services Committee from 1994 - 1996. Over the years, he has developed successful education, employment, housing, outreach, and rehabilitation programs.
RC: There have been so many changes in NAMI over the last few years. I'd like you to take a few minutes and review the highlights.
MF: We're a large, sprawling organization with 1,100 affiliates around the country. We do a variety of programs. We have a number of signature education programs. Thousands of people around America are involved with them daily... from peer programs like "Peer-to-Peer" and "In Our Own Voice" to "Family-to-Family" (which is focused on family members), and provider education programs. Partially because of our partnership with HealthCentral and partially through our association with other sites, we're a very large source of on-line information. Our web site (http://www.nami.org/) now gets over half a million unduplicated visitors every month from people who are looking for basic information on major mental illness.
And our political advocacy is certainly something that we're known for. In every state capital, the District of Columbia and Puerto Rico, we're involved with state legislators as well as county and local governments, trying to change mental health systems and build a mental health system we can be proud of. We're certainly very visible on capitol hill.
There is a lot of work in front of us. We produced and sent out our innovative "Grading the States" report, where we graded all 50 states on the adult system of care and their investment in services. We gave America a "D". It was a well earned "D". By using the report [card] format, if your state got an F, there were some things they did well, but there are remedial things they need to improve. We've had the opportunity to work with mental health authorities, commissioners, and legislators around the country who took our report very seriously and have been working with us on how to change their systems. We're gearing up to do another report for 2008. That's going to be a major undertaking.
We're in the process of rolling out our NAMI Connection Program, which will be in every large urban area in America - it's a recovery support group. They are free and held a couple of nights a week. People with mental illness can simply walk into those groups. They're run by peers who were trained by us. We're in the beginnings of that roll out. This year we will be in 15 states and in 16 more states next year.
RC: NAMI has been trying to gain entry to the inner city of Trenton. What got us started was one person from NAMI who was a member of a congregation there.
MF; One of the things we do well is that we have a lot of electronic publications that are beyond Beginnings, Avanzamos, and NAMI Advocate, which are hard print publications. One of our more popular ones is FaithNet [http://www.faithnet.nami.org/], which is focused on the faith community realizing that many people, when they experience mental illness in their family or in their lives, turn to the clergy first.
RC: When I first got sick, that's where my mother took me.
MF: What we know is that most people, when they become sick, don't go to the mental health system first. There are at least two or three other stops along the way. It's incumbent on us to make sure that, in terms of self care, people understand what health care is and that the larger community understands...teachers, or the faith community, or general practitioners, which are all places where people tend to turn first.
RC: I was diagnosed with schizophrenia in 1956. There was only one medication. The choice was going to the state hospital or staying in the upstairs bedroom. I've seen the whole spectrum of change over the years.
MF: I think the lives of people who get ill today are so different. And there are challenges. One of the problems we have in this country today is the small number of people with serious mental illness who are able to return to work. Also, there are a large number of people on the waiting list for housing. We need affordable, permanent housing. And we really need a third generation of medications. The second generation hasn't really met the promise. We need to be working very hard for a cure...I think the work on genomics holds great promise, but it's 10 years out, maybe more. But in the end, I think what we'll have is individualized medication. That's where we need to be.
RC: I'm interested in education of the provider.
MF: One of the things we know is that there are huge work force issues in this country. And they're really in two parts. One is that much of the care that people tend to get is provided by people who don't stay in their jobs very long. In some states, because of the wages, we compete with fast food or mall jobs. And those are sort of the front line workers. And then, when you're talking about psychiatrists, social workers, and psychologists, it's really important to keep them up to speed so they understand what best practices are...what are evidence-based services, what are the best medications. And focusing on general practitioners... except for perhaps schizophrenia, virtually all other treatment is predominantly prescribed by general practitioners. There are some states, for example, particularly rural states, where there are counties where they've never seen psychiatrists and probably never will. And so what you do is end up dealing with telemedicine and training health care clinic staffs.
RC: NAMI was around for many years before I ever heard of it. I struggled for 10 years with my daughter, who has bipolar and anxiety, without knowing about NAMI as a resource.
MF: One of the interesting things is that our new strategic plan deals directly with that. What we know is that in the mental health community that talks about serious mental illness, NAMI has fairly high visibility. But in the community at large, in many communities, we have no or very little visibility. What we aspire to do is become more visible. You know what AARP is and we all know what AARP does. We know what the Red Cross does. We want to have the same in time visibility in the community so that a consumer or family member knows what NAMI does and how to turn to us. I said earlier that our web site gets about half a million unduplicated visitors per month. About 70% of those don't go in through our home page. So they aren't looking for NAMI information. What they're looking for is basic information. And what we want to do is to reduce that percentage so that people start looking for us instead of looking for "schizophrenia" or "Zyprexa".
RC: It's a big challenge.
MF: It's a huge challenge. But it's something we can do over time. We can sort of chip away at it and learn from what other associations have done.
RC: I had a choice to join a lot of mental health organizations when I was looking for help for my daughter. I didn't know that NAMI started as an organization for family members. Then I heard that someone had stood up and said..."but the consumer is part of the family". Now NAMI is the only organization of any significance that works with both family members and consumers.
MF: No question. Over time, NAMI has morphed into the largest consumer organization in America. Just in terms of sheer numbers of members and our base and our history, it was certainly a family organization. Certainly the NAMI Connection rollout increases our role and the presence of consumers. If you look at my staff of 80 at the NAMI national office, a significant number of them have personal experience with mental illness. We're more diverse, younger, and better reflect our community than we have in the past. We're open to absolutely everyone regardless of age, race, and what have you... I've been in this role as executive director for three and a half years. I have a great staff, great volunteers, and a very supportive board. We're in a very good space. And there's a lot to do, a lot of challenges.
RC: How do you get the word out?
MF: It's really branding. It's the same thing that any company would look at. How do you brand NAMI? We've just finished doing a promotion with the Fox television program "House". They reached out to us and said, "We've done work with the heart association and other health groups. We want to do something with mental illness because we feel that not enough attention is paid to mental illness. And we want to use our visibility." They have 27 million viewers every week. It's the highest rated scripted show on television. But what it did, it gave us a venue in the entertainment press that mental illness rarely gets in a positive way. So we get to talk to Access Hollywood, the E channel, and other venues like that. We need to do more of that. We need to get more outside of our comfort zone and outside the mental health system and talk to the popular press.
RC: My theory is that as long as mental health remains a special interest group, they'll get only a little piece of the dollars appropriated by legislators.
MF: As a recovered politician, what I can tell you is that a lot of times politicians vote on things when they know there is a large constituency watching them. It doesn't mean it's good or bad. People who run for office try to do the best they can - they try to do good.
RC: That's the way the country was designed originally. They were supposed to represent their constituency.
MF: Yes. So if they know the mental health community is organized and votes, and that family members of mental health consumers and providers all vote and are watching very closely what policy makers are doing... Particularly with the "Grading the States" report, it put us in contact with a whole lot of state officials and it has been a fascinating experience. We've been able to turn the barge in a few states. You're kind of undoing 30 or 35 or 40 years of systems.
RC: I know what you mean. I used to be in the shipping business. With large tankers, it took 6 miles to stop and about 10 miles to turn them. In a sense, since this is a grass roots organization, you've got the foundation to build on.
MF: Oh, sure. Our power is really in our grass roots. Politicians on capitol hill know that we represent a whole lot of people back home.
RC: And that's what it takes.