It’s the kind of proposal mental health advocates say they have waited years to see.
Last week, Democratic presidential nominee, Hillary Clinton, unveiled her comprehensive plan to reform mental healthcare in the United States.
The candidate says she wants to put mental health on the same level as physical health.
To do that, Clinton proposes an initiative on suicide prevention as well as increased funding for community health centers, housing, and jobs for people with mental illness.
The plan also calls for keeping a closer eye on insurance coverage and training for law enforcement officers.
“I believe that together we can make sure that the next generation gets quality mental healthcare — without shame, without stigma, without barriers,” Clinton says in a statement on her campaign website.
However, the plan lacks the detail included in the Clinton proposal.
And it’s those details that have sparked praise from mental health professionals.
“For a presidential campaign to talk so extensively about mental health, that is groundbreaking,” Angela Kimball, national director for advocacy and public policy for the National Alliance on Mental Illness (NAMI), told Healthline. “There is nothing in there that we dislike. We support all of it.”
Early diagnosis, insurance coverage
Kimball said there are three things in particular that stand out in Clinton’s proposal.
One is putting mental health on the same footing as physical health.
On its website, the Clinton campaign states that 40 million adults in the United States, and 17 million children, cope with mental health problems.
It states the country must “bring mental and behavioral healthcare on par with physical healthcare.”
Kimball says this overall approach is “the right track.”
She also praised the proposal’s call for early diagnosis.
The Clinton plan notes that adults with mental illness usually show signs of distress at an early age.
The plan calls for increased funding for programs through which schools and pediatricians can identify children facing behavioral problems. It also calls for colleges and universities to provide comprehensive mental health programs.
Kimball said the third item that stands out to her is the section on parity.
“This is a huge issue,” she said.
The Mental Health Parity and Addiction Equity Act of 2008, which Clinton co-sponsored as a senator, requires group health plans to provide the same level of benefits for mental health as other medical conditions.
Clinton says she will strengthen federal monitoring to make insurance companies comply with this law.
Officials at America’s Health Insurance Plans (AHIP), an association that represents the insurance industry, did not respond to Healthline’s request for an interview for this story.
Kimball said this is a straightforward issue.
“[Insurance companies] are already subject to federal parity. They’re just not complying with it,” she said. “We’re asking them to follow the law.”
As for any concern that increasing mental health coverage would add to insurance costs, Kimball said such programs actually bring down expenses in the long run.
“With mental health and addiction programs, you help rein in costs,” she said.
Suicide, centers, housing
Suicide prevention is another key component of the Clinton proposal.
The Clinton plan calls for a national initiative for suicide prevention. The campaign would be headed by the surgeon general and involve other federal agencies from Health and Human Services to Veterans Affairs to the Department of Agriculture.
One key component will be making sure schools are meeting the mental health needs of students.
“This is enormously important,” said Kimball.
The Clinton plan also calls for the creation of comprehensive community health centers in every state where behavioral care is available.
To accomplish this, the number of mental health specialists would be increased.
That might alleviate one potential hurdle.
In a column on the website of the Association of Health Care Journalists (AHCJ), Joseph Burns writes that the Clinton proposal could be hampered, at least at the beginning, by a shortage of mental health professionals.
The Clinton plan also calls for more funding to build community-based housing for people with mental illness as well as expand job opportunities for them.
Kimball said this portion is a key to reducing the number of mentally ill people who are homeless.
“If you don’t have housing, you can’t experience recovery,” she said. “When people are homeless, they don’t get the mental healthcare they need.”
This preventative angle is also at the heart of the provision that calls for more training for law enforcement officers to properly respond to people with mental health issues.
Along the same lines, the plan encourages rehabilitation over imprisonment for low-level offenders with mental health problems.
“It prioritizes treatment over punishment,” said Kimball.
Mental health reform is mentioned in three different sections of Trump’s campaign website.
The first is under his healthcare reform plans.
In the next to last paragraph, the proposal reads:
“Finally, we need to reform our mental health programs and institutions in this country. Families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones. There are promising reforms being developed in Congress that should receive bi-partisan support.”
In the Trump campaign’s gun rights platform, it states the mental healthcare system is broken and needs to be fixed. It states “red flags were ignored” in many of the mass murders in this country.
“We need to expand treatment programs because most people with mental health problems aren’t violent, they just need help. But for those who are violent, a danger to themselves or others, we need to get them off the street before they can terrorize our communities,” the campaign platform states.
It tells gun owners that this program is important because they have been “blamed by anti-gun politicians, gun control groups and the media for the acts of deranged madmen.”
Finally, in the campaign’s veterans’ section, it states the “whole veteran” needs to be treated, including their “invisible wounds.”
It proposes to increase funding for programs to counter post-traumatic stress disorder (PTSD), traumatic brain injury, and suicide. It also proposes extra funding for job training and education.
Officials at the Trump campaign did not respond to Healthline’s request for an interview for this story.
Kimball said she is glad the Republican nominee’s plans mention mental health reform. She said her nonprofit, nonpartisan group would welcome more specifics to stack their proposal up against the Clinton plan.
“We’d be delighted to see that comparison,” she said.
Kimball said, however, she is bothered by some of the terminology in the Trump proposal. The phrases “deranged madmen” and “terrorize our communities” aren’t the best choice of words.
“The terminology used on the websites does give me concern,” she said.
Action in the near future
It does appear that Congress may be ready to take some action in mental health reform.
The Helping Families in Mental Health Crisis Act of 2016, a bill sponsored by Republican Congressman Tim Murphy of Pennsylvania, was approved by the House this summer. It awaits Senate action.
Kimball said there seems to be a shift toward more open discussion of mental health as well as more acceptance of treatments and diagnoses.
She said the mental health problems of veterans, as well as the fact mental illness strikes so many families, have spurred much of the change.
The country has come a long way since Democratic presidential nominee George McGovern had to jettison his vice presidential running mate, Thomas Eagleton, in 1972 after it was revealed Eagleton had been hospitalized three times for depression and had undergone electroshock therapy.
“I think there has been an evolution in political candidates,” said Kimball. “It’s easier for politicians now to discuss the issue.”