Mental healthcare and the 2016 election

Approximately 1 in 5 adults and adolescents experience a diagnosable mental illness in a given year. From my perspective as a medical sociologist conducting national research with working Americans and local research with women who cycle through prisons, psychiatric hospitals, substance abuse programs and homeless shelters, I’ve taken a look at what the four candidates for President have said (and not said) about mental health and mental healthcare in their platforms and speeches.

Comparing the candidates’ platforms is a bit like comparing apples and oranges in that Clinton’s is the only one presenting a detailed plan for addressing mental illness. With that caveat in mind, in three of the four party platforms there are elements likely to have positive impacts on the populations I study.

{mosads}The Democratic Party’s plan calls for expanding access to treatment to underserved populations, including people for whom adequate treatment would reduce chances of incarceration and people who, with the help of treatment, would be better able to hold down jobs. This clearly would help Americans living on the edge of poverty, unemployment and homelessness.

Paradoxically, however, while many Americans struggle to access care, many other Americans are over-medicated or forced into treatment through civil commitment (despite no proof that coerced treatment is effective.)  Both the Libertarian Party and the Green Party address these issues, albeit in somewhat different ways.

The Libertarian Party, in the spirit of radical individualism, calls for less reliance on government supported healthcare as well as for an end to institutionalization and coerced treatment of people living with mental illness. The Green Party focuses on the very real issue of why so many millions of American children and adults suffer from poor mental health. That party calls for facilitating health through collectively improving the conditions of neighborhoods, schools and workplaces, and ensuring all Americans access to healthy environments.

Hillary Clinton’s platform retains the Affordable Care Act, which has substantially expanded mental health coverage for Americans by prohibiting insurance companies from denying coverage on the basis of pre-existing conditions. The ACA also requires that all plans offered through the Health Insurance Marketplace cover mental health and substance use disorder services, as well as rehabilitative services that support people with behavioral health challenges.

ACA funding for expansion of Medicaid eligibility (in the states that chose to accept the expansion) has proven to be a great boon for Americans struggling with mental illness.

Clinton calls for continuing to improve the ACA. At this time, the ACA does not fully mandate that insurance companies cover mental health care in parity with physical health care. Clinton, advocating better integration of physical and mental health services, advocates increasing and enforcing mental healthcare parity to the full extent of the law.

Clinton’s platform also calls for enhancing community-based treatment, training law enforcement officers in crisis intervention, expanding early detection programs, launching a national initiative for suicide prevention, and investing in brain and behavioral research.

The Democratic Party platform is more robust regarding treatment than prevention. For example, the platform calls for expanding housing and job opportunities for mentally ill individuals, but does not address the fact that inequality, poverty and violence are proven to cause depression, PTSD and substance abuse. Moreover, the platform fails to question our broad American tendency to medicate behaviors and feelings that, in other cultures, may be considered part of a range of reasonable responses to life’s challenges.

Donald Trump has not offered a specific mental health policy plan. His brief proposals for health insurance reform include repealing the ACA, allowing sale of health insurance policies across state lines, removing barriers to importing drugs from outside the United States, and giving block-grant funds for Medicaid to the states.

This agenda has negative implications for mental health treatment. Repeal of the ACA would likely allow insurance companies to resume discriminating against people with pre-existing conditions. Shifting authority over Medicaid to the states (via block grants) is particularly worrisome for residents of those states, such as Mississippi, that have a history of human rights abuses towards people labeled mentally ill.

Finally, Trump has declared on more than one occasion that mentally ill people are particularly responsible for gun violence. However, according to government statistics, only 3 to 5 percent of violent acts can be attributed to an individual with a serious mental illness. In fact, studies show that people with mental health issues are more likely to be victims of a violent crime than perpetrators.

With the exception of calling for price transparency from all healthcare providers, Trump’s platform fails to include any elements likely to have a positive impact for Americans struggling with mental health, and does not address mental illness prevention at all.

Gary Johnson has not laid out a plan regarding mental health policy. As Governor of New Mexico, Johnson vetoed a bill for a pilot program providing state employees with mental illness coverage parity with physical illness.

The Libertarian Party calls for radically reducing or eliminating, the ACA and all federal government involvement in providing health care, including mental health care. Not only would this shut down the research pipelines that develop treatments and identify best practices, it would reduce access to mental health care across the board.

Given that disabilities, including mental health disabilities, impact people’s abilities to earn a living, this effectively would eliminate mental health care for all but those few Americans with families or friends who are able to support them indefinitely.

The Libertarian agenda seeks to privatize health care. For example, the party calls for shutting down the Veterans Administration (VA), and instead putting money into individual health savings accounts for veterans. Given the exceptional medical expertise of the VA, as well as the unpredictability of one’s medical needs over a lifetime, this plan would most certainly put veterans at risk. The Libertarian agenda also calls for privatizing all medical research, a move that all but ensures that only potentially lucrative treatments will receive support.

As in other contexts, the Libertarian commitment to individual rights and responsibilities is a two-edged sword. While it would reduce access to mental health treatment for most Americans, it also calls for legalizing marijuana, encouraging harm reduction policies for illicit drug users (e.g. prescriptions to purchase needles), and prohibiting involuntary institutionalization and the threat of coercive treatment for individuals with mental illness.

Jill Stein’s platform is the only one of the four that focuses on enhancing health rather than solely on treating illness. In  2012 Stein, a physician, declared, “We can get healthy and save an enormous amount of money, as well, by preventing [about] 75% of our expenditures under what’s really a sick care system, not a healthcare system.”

The Green Party calls for investing in essential community health infrastructure such as local, fresh, organic food systems, pollution-free renewable energy, phasing out toxic chemicals, and active transportation such as bike paths and safe sidewalks that dovetail with public transit.

Stein also advocates measures to reduce cultures of violence in the schools and communities through restorative justice and expanding access to mental health services, and periodic training for law enforcement officers on de-escalating mental health crises, restorative justice and conflict resolution, mental health self-checks and privilege and bias self-checks.

Stein’s party calls for moving beyond the ACA and adopting a “Medicare for All” single-payer public health program. This system would not allow restrictions based on pre-existing illness, employment, immigration status, age, or any other category. It would include holistic, universal access to all health care services, including mental health, dental, vision and contraception.

And it would ensure easy access to health care in communities of color, including community health centers.

While Stein’s platform may be criticized for lacking fiscal rigor, it actually is the only platform that aims to reduce the need for mental health treatment (and thus mental health spending) by addressing the actual causes of mental illness.

In fact, abundant rigorous research shows that sub-standard living conditions, absence of access to green spaces, inappropriate nutrition, failing social networks and on-going proximity to violence are correlated with poor mental health.

Susan Sered is a professor in the Department of Sociology and senior researcher at Center for Women’s Health and Human Rights at Suffolk University.

The views expressed by contributors are their own and not the views of The Hill.