Trump or Clinton? Either May Lead to Better Mental Healthcare
Photo credit: Lorie Shaull (Clinton) and Gage Skidmore (Trump)/Creative Commons
In September, the Commonwealth Fund and the Rand Corporation released a comprehensive nonpartisan analysis estimating the impact of the healthcare positions of Hillary Clinton and Donald Trump.
If Trump were to succeed in repealing the Affordable Care Act, millions would lose insurance in 2018, the analysis found, while Clinton's proposed “enhancements” to the Act would extend coverage to millions more. Clinton's plan would have zero impact on the federal deficit. Under Trump's proposals, the deficit would grow.
Largely missing from the Rand/Commonwealth calculations is a comparison of how the two candidates would tackle reforms in the area of mental health. That's because of a troubling asymmetry in data. Clinton has released a comprehensive mental health agenda, but Trump has provided almost no information — and it's a shame. Nearly one in five Americans struggle with illnesses in this category, according to the National Institute of Mental Health. It's a crisis Americans can't afford to ignore.
Up to a point, legislative reforms have improved prospects for people living with these illnesses.
The Mental Health Parity and Addiction Equity Act of 2008 forged a legal framework to guarantee people with mental health conditions the same access to care and coverage as those with physical conditions or injuries. Unfortunately, there's little federal or state enforcement for the Parity Act. Meanwhile, numerous other shortcomings in our mental health safety net cry out for action.
The short list includes:
- Shortages of psychiatrists and other mental health specialists
- Limited access to mental health support for children in schools
- Too few community-based programs complementing care in hospitals or clinics
- A criminal justice system that defaults to incarceration rather than referral and treatment
Clinton's mental health agenda tackles many of these persistent challenges. For example, it would promote early diagnosis and intervention for mental illnesses, improve criminal justice outcomes by prioritizing treatment over jail for non-violent offenders, and ease access to housing and job opportunities for people with mental illness.
While Trump hasn't unveiled a roadmap, his Second Amendment Rights platform states: “We need to expand treatment programs, because most people with mental health problems aren't violent, they just need help.” In addition, his Healthcare Reform to Make America Great Again states: “There are promising reforms being developed in Congress that should receive bi-partisan support.” It's likely he's referring to two key pieces of legislation: Helping Families in Mental Health Crisis Act (H.R. 2646) and the Mental Health Reform Act (S 1945). Both bills underscore the need for early identification and intervention to address mental health issues. And the House bill calls on government to end incarceration of low-risk offenders with mental illness within 10 years.
Neither bill is a panacea, but they go further than any other bills we have seen for years — and that's something to applaud. Despite political rifts that have blocked progress on so many other fronts, Congress has managed to lay the groundwork for clear steps forward in mental health.
Keri McDonough is senior team leader at Biosector 2.