Democratic presidential nominee Hillary Clinton recently released a comprehensive agenda on mental health. The plan was well received by the nation’s leading mental health groups, including the American Psychiatric Association, the National Alliance on Mental Illness, and Mental Health America. Outside of that community, however, Clinton’s plan was barely noticed, despite the fact that unattended mental illness, trauma, and their consequences are profoundly intertwined with many issues dominating the news today.
Why such an ambitious plan on such an important subject would go largely unnoticed is fairly obvious; in an election consumed by huge political questions and outsized characters, few in the media had the time or will to pay attention to the details. But they should, because mental illness has been woefully ignored in America for decades, is costing us billions of dollars annually, and along with addiction, is at the center of a major public health crisis that is affecting us all.
The situation is especially dire for people with serious and persistent mental illnesses, who die up to 20 years earlier than other Americans. They are far more likely to land in jails, emergency rooms, or on the streets than in a respectful, well-coordinated, recovery-oriented health system.
Each week police across the country are called to handle psychiatric emergencies—crisis situations that often end with people Tasered, shot, or dead. Suicide rates are rising and fewer psychiatrists are accepting insurance payments of any kind. It’s no wonder that one expert recently concluded that “the US is now probably the worst place in the developed world to have a severe mental illness.”
Clinton’s multifaceted plan addresses many well-known problems with our current mental health system: the need for better early intervention and prevention (including suicide prevention); the need to fully integrate care for mental health and addiction disorders into regular primary care; the need to address longstanding critical shortages in behavioral health providers, including greater use of certified peer support specialists and telemental-heath; the need to expand and improve community-based treatment options; the need to train law enforcement and other first responders in safe appropriate de-escalation and crisis response skills; and the need to sustain the recovery of people with mental illness with better employment and housing supports.
Anyone working within or alongside the mental health system in this country, and certainly anyone touched by mental illness–including friends, families, neighbors, teachers, employers, coworkers, service providers, and community civic- and faith-based leaders–would no doubt have important additions to this extensive list.
While comprehensive, Clinton’s proposal risks being just another plan. It reads like a list of ingredients but with no accompanying recipe or picture of the final dish. We have seen many such plans before: the US Surgeon General’s landmark report in 1999, the President’s New Freedom Commission on Mental Health in 2003, and the Institute of Medicine’s Quality Chasm report in 2006.
We have also had dozens of public awareness campaigns, spent billions of dollars, and made huge investments in brain research, and still people with serious mental illnesses are no better off. The next plan needs to be different: at its foundation, it needs a unifying vision that can drive real improvements in the lives of real people all across the country.
In a future post, I will shine a light on some places that have made it work and ask whether these examples can point the way to solutions for one of our nation’s most vexing problems.