There are two problems with Hillary Clinton’s mental health plan: What’s in it and what’s not. The plan mainly continues the practice of moving mental health funds away from helping the most seriously mentally ill, and instead allocates the funds to helping people without serious mental illness and programs that lack any independent evidence they work.
We need an all-hands-on-deck approach aimed at helping reduce homelessness, arrest, incarceration, suicide and violence among the seriously mentally ill. While there are bills in Congress that do that, this plan doesn’t. It focuses on where serious mental illness isn’t, rather than where it is.
What’s in the Hillary Clinton mental health plan.
- The plan for early diagnosis and intervention, focuses spending on kids younger than eighteen in spite of the fact that serious mental illnesses like schizophrenia and bipolar disorder begin in late teens and early twenties, not grade school. While some serious mental illness strikes early, most of the illness that affects kids, like ADHD, is mild and transient.
- The plan diverts resources to fund programs that are proven not to work including Positive Parenting and Mental Health First Aid.
- The national initiative for suicide prevention, will focus on spending dollars on high-school and college students the two groups least likely to commit suicide. In 2014, there were 43,000 completed suicides of which 5,500 involved people under the age of twenty-four. Congressional mandates already target $54 million in suicide prevention funds to that age group and only $2 million to address the 37,500 completed suicides by people over twenty-four. The plan proposes to make the disparity worse.
- The plan focuses on requiring private insurers to provide parity coverage for mental illness, but is silent on the federal government’s own discrimination within Medicaid (IMD Exclusion) that prevents the most seriously ill from getting treatment.
- The plan does nothing to increase hospital beds and instead trains police on how to handle those who will become their responsibility as a result of the lack of beds.
- The initiative funds peer support, in spite of the fact there is no independent evidence it works and plenty that it doesn’t.
- It provides additional funding to the Protection and Advocacy Program. These are federally funded lawyers who go to court to oppose parents who want to help seriously ill children get care, oppose states that want to provide hospital care, and oppose localities that want to fund Assisted Outpatient Treatment as an alternative to incarceration or involuntary commitment.
What’s not in the plan
- There is no attempt to get SAMHSA to focus on the seriously mentally ill rather than improving mental wellness.
- There is no support for additional hospital beds for the seriously ill.
- There is no support for Assisted Outpatient Treatment which is shown to reduce homelessness, arrest, incarceration, violence and hospitalization of the seriously ill over 70% each.
- There are no provisions that would release parents of the seriously mentally ill from the “HIPAA Handcuffs” that prevent them from getting information about mentally ill loved ones that would enable them to help.
- The research initiative does not include research on how to reduce homelessness, arrest, and incarceration of the seriously ill.
Like the plan she developed when helping her husband create a national mental health plan, the new plan throws the seriously mentally ill under a bus.
It is the most seriously ill adults— those with untreated schizophrenia and bipolar disorder who are most likely to become homeless, psychotic, arrested, incarcerated, and suicidal. Her plan continues the practice of shunning them.
Where do we go from here?
Congress should not wait for the election. There are plans in hand that could help now. The Senate should combine the non-gun control provisions of Senator Cornyn’s Mental Health and Safe Communities Act (S. 2002) with Senator Alexander’s Mental Health Reform Act (S. 2680) and pass it. That bill could then be reconciled in conference committee with Representative Tim Murphy’s Helping Families in Mental Health Crisis Act (H. R. 3717) which already passed the House, virtually unanimously.
Congress is already too far along in the mental health reform process to wait for either Hillary or Trump to ruin it. They should act now. Anything else is insane.
DJ Jaffe is Executive Director of Mental Illness Policy Org., and the author of Insane Consequences: How the Mental Health Industry Fails the Mentally Ill (Prometheus Books, April 2017, 340pp.)