Q and A With Mental Health America’s Paul Gionfriddo: The B4Stage4 Initiative


mental health america

(7-10-17) I recently asked Paul Gionfriddo, the President and CEO of Mental Health America, if he would answer a series of questions for me. Thankfully, he agreed.)

Question 1: People sense a new vitality at Mental Health America. Tell us what made you agree to take charge of MHA?

Mental Health America is an amazing place to work, with incredibly gifted and energetic staff people and affiliates across the nation who are making a real difference. Four years ago, I was happily working from home, writing my policy memoir (Losing Tim) and taking occasional consulting jobs to help pay the bills. My wife, Pam, who was and still is the CEO of MHA of Palm Beach County, came home each night, and listened to my stories about how I’d fix the mental health system that had failed Tim so badly. When the MHA position came along, she said, “you’d be perfect for this.” David Shern (former MHA CEO) also strongly encouraged me to apply. When I talked to the search committee and Board, I told them that there were other organizations working in the deep-end space, but that we needed a national advocacy organization to do more upstream – early identification, early intervention, and health/behavioral health/education/workplace integration. My story – and I’m sticking to it – is that they had 100 qualified candidates for the position, and only got to me after first considering the other 99. But ultimately this approach made sense for them and for me, and so here we are.


Question 2. You describe your family’s struggles with your son, Tim, in your article, How I Helped Create A Flawed Mental Health System That’s Failed Millions (which I will post Tuesday.) What can you tell us today about your relationship with your son?

Like so many others, Tim went through a lot – in school and afterwards – as someone living with a serious mental illness that emerged during early childhood. I love Tim deeply, as I love all my children. I am constantly amazed by his resilience in the face of schizophrenia. I am in awe of his patience in dealing with the challenges and roadblocks to independence and recovery that have been put in his way during this past quarter century and trapped him in the revolving door of occasional hospitalization, frequent incarceration, and chronic homelessness. He and I share a sense of humor, and have always had a good relationship during our most troubling times. Of course, he calls far too infrequently, and worries me far too frequently. When I tell him this, he just laughs, and says “I’m fine, Dad.” Typical 32-year-old.

Question 3. What is B4Stage4 and what is it? What is MHA doing to promote it?

As a matter of public policy, by using a non-clinical standard of “danger to self or others” as a trigger to treatment, we have made mental illnesses the only chronic diseases that we wait until Stage 4 to treat, and then often inappropriately only through incarceration. That’s why MHA launched and trademarked our B4Stage4 initiative. It has been embraced by many others to move our thinking around serious mental illnesses upstream and focus it on health, not public safety. We have made it a part of our overall communications, marketing, policy, and program agendas. Our most visible B4Stage4 initiative, our online mental health screening program, www.mhascreening.org, has proven wildly popular. Approximately 3000 screenings are completed each day, and we have screened 2.3 million since its inception. Our soon-to-be-launched screening-to-supports (S2S) program will build on this effort.

Question 4. MHA was started by Clifford Beers, who was abused in an institution. It always has been seen as an organization for persons with lived experiences. The National Alliance on Mental Illness was started by parents and traditionally seen as a parent organization. Do you see a blurring of lines between the two groups? If so, what makes MHA unique?

Clifford Beers was the father of modern mental health advocacy, and we all trace our roots to him and his work. His earliest policy agenda – to screen children for mental health and focus on their needs, to end incarceration of people with mental illnesses, and to integrate health and behavioral health services – still animates our work at MHA today. Our focus on prevention, early identification and intervention, services integration, and recovery is consistent with his vision and unique to us – and our new national peer certification program is very much a part of our tradition to promote the work and elevate the perspectives of people with lived experience. But we also walk pathways with many other organizations, like NAMI, that share similar values and missions. Although our perspectives and focus may differ, I’d say we are united in most of our goals. I also believe – from many years of policy experience – that advocates either all stand together, or all fall apart.

Question 5. One lightening rod always has been a clear difference between MHA and NAMI is that NAMI supports Assisted Outpatient Treatment for individuals such as your son. Your thoughts?

Neither AOT nor ACT (the most widely advocated alternative) helped my son, so neither is my personal top priority. But both are evidence-based programs, which means that they have helped many others. My view is that if we invest more in upstream interventions, we will need AOT and ACT a lot less. But what we need to do for either AOT or ACT to work best is to invest in all the services people need to survive and recover, to make these services available to everyone who needs and wants them, and to stop pinching pennies and spend what it takes to get them done right.

Question 6. As a parent and the leader of a national mental health organization what advice can you offer parents such as me? What helps you during the toughest of times?

We need to remember that there’s always hope. During the toughest of times, we must hang on to this. At the same time, we must recognize that this is really hard for parents. We need to be comfortable drawing whatever lines we need to draw to maintain our own mental health. This also means becoming comfortable treating our children as grown-ups once they become legal adults (even if they don’t call home or ask our advice when we want them to), especially when they make mistakes. Throughout, we should never blame ourselves – or allow others to blame us – for the illnesses our children happen to have or the decisions that we make in their best interests. And those who would judge us have no standing or right to do so. They do not walk in our shoes.

Question: 7.  Is there reason to be optimistic about what is happening today in mental health – given the threat of major cuts to Medicaid and recent statistics that show increased numbers of persons with mental illnesses in our jails and prisons? Do you see any positive changes being made?

We have got to stop sending nonviolent people with serious mental illnesses to jail for custodial care. That’s a positive change we haven’t made yet. And cutting Medicaid as deeply as some have proposed will do real harm to people with behavioral illnesses. On the plus side, the mental health reforms included in the 21st Century Cures Act laid an important foundation for the construction of the kind of mental health delivery system we should expect in the future, and for that we have Rep. Tim Murphy, Sen. Chris Murphy, Rep. Eddie Bernice Johnson, and Sen. Bill Cassidy – and many of their colleagues and many of our colleagues in the advocacy movement – to thank. So, yes, in these uncertain and frequently distressing times, I think we still have reason to be optimistic.

You can read Paul Gionfriddo’s biography here. 


About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.