Will 2016 Be the Year Our Candidates Get Serious About Mental Health and Addiction?

April 07, 2016

News Type:  Director's Corner
Author:  David Satcher, MD, PhD, Patrick J. Kennedy, and Jerry Reed, PhD

Originally published February 23, 2016 on Medium.com

Presidential candidates from both political parties have told stories about friends and family members who have struggled with depression, addiction, and suicide. It is good to hear mental illness talked about as a public health concern, rather than a personal moral failing.

But candidates and elected officials must move beyond storytelling and lay out their plans for transforming America’s mental health care system.

Far too many people continue to suffer in silence or fail to receive the services they need. Over 40,000 Americans die by suicide each year, making it the 10th leading cause of death. Deaths due to drug overdoses — which reached 47,000 in 2014 — now represent the leading cause of injury-related deaths. Sixty percent of people with mental health and substance use disorders did not receive any treatment in the past year.

Science has shown us that prevention and treatment work, but knowledge of what to do is not the complete answer. We need the political will and the necessary investments to implement solutions that will make a difference in people’s lives. Now is the time to ensure all Americans have the opportunities they need for full health and recovery.

How do we accomplish this?

First, we enforce the laws designed to end discrimination in insurance coverage against mental illness. Over 15 years ago, Dr. Satcher, as the U.S. Surgeon General, issued a groundbreaking report that called for requiring insurance companies to treat brain diseases as they would any other illness.

In 2008, then-Representative Kennedy passed the Mental Health Parity and Addiction Equity Act, with bipartisan support, to end the false distinction in insurance coverage between illnesses of the brain and the body. The Affordable Care Act went further, and insurance companies are now required to cover treatment for mental health and substance abuse disorders. A top priority for the present-day candidates and policymakers must be to enforce the Parity Law.

Second, we need to foster innovations that bring behavioral health specialists together with primary care physicians. One such innovation is the Collaborative Care model, in which a primary care provider, a behavioral health clinician, and a case manager work together to support the patient. Research shows that this model of collaboration increases mental health care access, lowers medical costs, and improves patient outcomes.

Another approach is the Zero Suicide initiative. After the Henry Ford Health System in Detroit implemented Zero Suicide, the suicide rate among its patients dropped by 80 percent. And when Centerstone — a nationwide community-based behavioral health care provider in Tennessee — instituted Zero Suicide in its facilities throughout the state, suicide rates dropped 65 percent in the first two years.

These innovations demonstrate that we know what works. Our current challenge is to invest in these approaches and support their broad dissemination.

Third, we must reduce and ultimately eliminate disparities in behavioral health. While people of all races are susceptible to brain diseases, people of color often experience more severe forms of illness because of the entrenched inequality they face. Even so, African Americans and Latinos use mental health services at about one-half the rate of whites.

The challenges are complex, but we need leadership at the highest levels that will take the issue of disparities seriously. Transforming America’s mental health system must include addressing stigma, minimizing language barriers and providing culturally competent systems of care, increasing the diversity of the behavioral health workforce, and ensuring that the criminal justice system is no longer the treatment setting of last resort for mental health and substance use disorders.

Fundamentally, bringing America’s mental health system into the 21st century is about equality. Everyone who needs treatment must get it.

A good blueprint for moving forward is provided in the President’s 2017 budget which contains some promising provisions for improving the nation’s behavioral health care system. These investments, many of which enjoy bipartisan support, are a reasonable down payment on building a system that will improve care and function better.

We all have stories about the ways mental illness, addiction, and suicide have touched our lives. And we know that when our elected officials speak up about these issues — and their own struggles — we see real progress.

So far, many of the candidates have shown that they are like the rest of us. They have lost close friends, neighbors, and loved ones to mental illness, drug overdoses, and suicide. The question voters must ask them now is, “What are you going to do about it?”

David Satcher, MD, PhD, is director of the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta and former U.S. surgeon general.

Patrick J. Kennedy is founder of the Kennedy Forum and former Democratic U.S. representative from Rhode Island.

Jerry Reed, PhD, MSW, is a vice president of the nonprofit EDC and director of EDC’s Center for the Study and Prevention of Injury, Violence, and Suicide and the Suicide Prevention Resource Center.