In the run-up to the Presidential election in America, we’re examining the candidates’ views on mental health and mental illness. Last month, we examined what little Donald Trump, the Republican candidate, had to say on mental health. He has spoken using terms for mental illness that most people have long since abandoned in order to insult others — that’s been the gist of his policy statements about mental illness.
This month, we’ll examine the proposed mental health policy agenda of the Democrat’s nominee for President, Hillary Clinton.
At the end of August, she released a detailed policy statement describing her approach to mental health. The fact that she even has a policy statement is a far cry from Donald Trump’s campaign, which has only a few sentences about mental illness on his website. And this introductory statement pretty clearly states her position: “Hillary Clinton strongly believes we have to bring mental and behavioral health care on par with physical health care—and end the shame and stigma associated with treatment.”
Her main agenda for mental health while President will be to:
- Promote early diagnosis and intervention.
- Launch a national initiative for suicide prevention.
- Integrate our nation’s mental and physical health care systems so that health care delivery focuses on the “whole person” and expand community-based treatment.
- Prioritize treatment over jail for low-level, nonviolent offenders and help train law enforcement officers in responding to conflicts involving persons with mental illness.
- Enforce mental health parity to the full extent of the law.
- Improve access to housing and job opportunities.
- Invest in brain behavioral science research.
That’s a pretty full agenda. The actual briefing document goes into much detail about each of these initiatives.
Here are some of the things I especially like about the proposals she is promoting.
- Fostering integration of behavioral healthcare into the regular healthcare system.
Long the forgotten, ugly, not-talked-about stepchild of healthcare, bringing mental health care into primary care physicians’ offices will help promote its equality with physical health issues.
- Support the creation of high-quality, comprehensive community behavioral health centers in every state.Expanding on the vision of John F. Kennedy decades ago, these centers could help fill the dangerous gap left by the closing of so many inpatient psychiatric hospitals in the past decade.
- Launch a nationwide strategy to address the shortage of mental health providers.Ask any mental health professional in practice today, and they’ll acknowledge that it’s hard to get their patients in to see a psychiatrist when needed. Ask any person on a private pay health insurance plan, and they’ll tell you that if you can find a psychiatrist’s office who even return your phone calls, the first appointment available to see them will often be months out. There is a real shortage of certain mental health professionals, and this needs to be addressed.
- Prioritize treatment over punishment for low-level, non-violent offenders with mental illnesses.We need to move from imprisoning people for aberrant behavior and get them into treatment instead. Our prisons should not be the new psychiatric hospitals of the 21st century. It appears that Clinton understands this problem and will work to help encourage more people into treatment, instead of our jails.
- Strengthen federal monitoring of health insurer compliance with network adequacy requirements.Mental health parity laws mean nothing if the health insurance provider doesn’t actually offer enough providers within their network that offer mental health services. They can do this because the pay for mental health services is so low, it’s chasing professionals out of accepting insurance. When insurance companies start reimbursing professionals at rates consistent with their services, their networks will once again expand.
- Commit to brain and behavioral science research based on open data.Open data is the future, but some scientists, universities, and publishers object to making raw research data readily available to anyone who wants it. By being a proponent of open data in the behavioral sciences, Clinton appears to be on the right side of the debate.
I have more of mixed feelings about early diagnosis and screening, realizing that all too often children are misdiagnosed by well-meaning pediatricians and parents. We should continue to promote existing programs and work harder to ensure any healthcare provider who makes such diagnoses does so with proven, solid psychiatric training and experience. One or two courses in medical school hardly qualifies most physicians to make such diagnoses.
All of these policy ideas are generally good ideas with solid backing in the research for them. However, most of them would require significant new funding. And one thing we’ve learned from past administrations is that good intentions will generally amount to little without bipartisan support and a clear, sensible funding strategy. Missing from this briefing is such a strategy, suggesting that most of these initiatives would remain nothing more than proposed good ideas.
That’s too bad. Because the mental health care system in America is clearly broken, a patchwork of care that nobody is really overseeing very effectively or reliably. Until something big is done, it’s likely to remain that way no matter who’s elected President in 2016.