It’s About Mental Health, America

Paul Gionfriddo
President and CEO, Mental Health America

I became President and CEO of Mental Health America on May 1, honored by the opportunity to work with so many wonderful advocates on behalf of people with concern for mental health. At Mental Health America, our goal is:

  • prevention for all
  • early identification and intervention for those at risk
  • integrated health and behavioral health services for those who need them, and
  • recovery as a goal

Changing the treatment paradigm
For too long, policymakers and some advocates have been mired in what I call Stage 4 thinking. They have accepted the largely false premise that mental health concerns and violence are intertwined. They have accepted “imminent danger to self or others” as a standard for diagnosis and treatment of mental illnesses.

But as I have said repeatedly, mental illnesses are the only chronic conditions that we treat this way. They are the only chronic conditions where, as a matter of public policy, we wait until Stage 4 to treat, and then often only through incarceration.

Some people try to claim that this is “for their own good”—that they might otherwise refuse to accept needed care. But imagine the outcry if we treated people with cancers this way. First, we waited until Stage 4, telling them that they could probably get better if only they’d try. Second, when they progressed to Stage 4 and refused chemotherapy, we hauled them off to jail. Does anyone really think that we would put up with this?

At Mental Health America, we’re trying to change the way people think about both mental health and mental illnesses. We want people to understand that serious mental illnesses exist on a continuum. The ten years that typically pass from the emergence of symptoms to proper diagnosis and treatment give us ten years of opportunities to intervene and change the trajectories of people’s lives. We don’t have to wait until Stage 4. In fact, it is tragic when we do.

We want people to understand that mental health is a part of overall health. A body can’t be healthy without a healthy brain, and a brain can’t be healthy without a healthy body. Former U.S. Surgeon General Dr. David Satcher has made this point eloquently in a video message he prepared for our 2014 annual conference. His thoughts have been echoed by both behavioral health and public health advocates for years. As we often say—there is no health without mental health.

Putting our efforts where our advocacy is 
This past April, MHA launched a new online mental health screening site, with depression, anxiety, bipolar, and PTSD screens. Within four months, more than 100,000 screenings were completed. Young women were the most prominent screeners, and they frequently tested positive and/or in the moderate-to-severe range for one or more of these conditions. We plan to expand this program in the future, and will offer a new set of follow-up activities and programs for the coming year.

In addition, we will be publishing a new report this fall, documenting the mental health status of our nation’s people in all fifty states. This report will be available to the public, and we think that it will demonstrate just how far our policy initiatives still have to go.

It will also provide a reference point for evaluating the effectiveness of both the Affordable Care Act and behavioral health parity legislation. We’ll offer the first sneak preview of the data at our annual meeting on September 11th.

Finally, we’re in the process of launching our new umbrella campaign, called “Before Stage 4” (#B4Stage4), to help move everyone’s attention upstream. We think that everyone—no matter where they stand on heated issues—will rally around this concept, and we’ll be looking for endorsers and partners for activities throughout the coming year.


  • How do you think early screening and intervention can be used to treat mental health conditions before they get to stage 4?
  • What will you or your organization do to support upstream programs in your community?

Facebook Comments


What exactly is Stage 4? And all the other stages?


Thank you. So many bridges must be the general public, to the medical community, to our legislators, and to the media. Unfortunately for most, the best way to become educated is when mental health issues affect someone you love. The good news is that even that unexpected time provides can provide the opportunity to break the silence and end the stigma. And with at least one in four people affected, this provides a great start. There is no shame. There is no blame. There is recovery, stability, and so much hope.


I tried many times to get help for my 15 year old son. He was suddenly out of control and I knew something was desperately wrong. He was not hospitalized because he was not a danger to himself or others. He was sentenced to an 11 year stint in prison at age 16 after committing a robbery so that " the police would shoot him". This is a very serious problem and I'm glad to see attention being brought to this issue.


I am pleased to see the mental health communities efforts towards early diagnosis and treatment. My daughter was diagnosed with bipolar disorder with psychotic features at 16 years of age this past February.. She was hospitalized two times for a suicide attempt and then depression. The bipolar diagnosis was missed both times. It was not until a severe psychotic episode caused a third hospitalization where she finally received a comprehensive evaluation and was diagnosed properly. If she had not become psychotic I have no idea how long she would have suffered or if she would even be alive today. The depression and mania was intense and it's shameful that she was hospitalized twice yet the bipolar was missed. It was The Cleveland Clinic Children's Psychiatric Hospital that got it right. While the psychotic episode may not be stage four it was not stage one. She was very ill and disabled by the time the psychosis happened. Access to quality mental health care, available beds and resources are difficult even in metropolitan areas. And outpatient care can be difficult too. I had to wait 6 weeks to get an appointment with an outpatient psychiatrist. Thankfully I was able to use the clinic's pdocs in the interim for issues and med changes. I've explained to many people that if she had cancer I'd be getting help from the doctors and casseroles and cards from friends and family. Instead there is a lot of silence. It's my mission now to educated people and remove the stigma and fear. And I refuse to accept anything but full recovery for her. Better is not well.

Leslie Smith
Leslie Smith

My twin sister has chronic bipolar disorder and has been acting very ill for the last few months. I let her primary care DR know but I cannot get any help for her. She talks and laughs wildly all day and all night and chain smokes. She says Jesus is going to marry her. She is withdrawing from reality and I don't know how to get her help since she won't cooperate

Kurt Wilkens
Kurt Wilkens

How do you think early screening and intervention can be used to treat mental health conditions before they get to stage 4?  For me, I need to understand the evolution of a person getting to stage 4.  For me stage 4 is a culmination, basically a description, a diagnosis if you will.  However for me that description "mental illness" is a description of allostatic overload. See Bruce McEwen, neuroscientist, allostasis, allostatic load, and allostatic overload.  For me the stresses and strains of a person's life, the facts of those, beginning at conception are informative for early screening and intervention.  "The different timing of exposures to environmental risk factors, such as toxins, or infectious disease during pregnancy, or early trauma."  From Time, 100 New Health Discoveries, Same Genes, Multiple Disorders, Page 20.  The truth, the facts of these environmental risk factors to me can provide a way out.  Kurt E. Wilkens