Which Presidential Candidates are talking about Mental Health? And What are they Saying?

Do you know someone who has been diagnosed with a psychological disorder – perhaps depression, anxiety, an eating disorder, or even Schizophrenia? If you don’t, there’s a good chance you will eventually. It could be a close friend, a family member, or maybe even yourself.

Each year, mental illness affects roughly 1 in 5 adults in the United States. That’s about 43.6 million people or about 18.1% of the U.S. population. And that’s just within the time span of a single year.

The chances of experiencing a bout of mental illness at some point in your life is a staggering 46%. Essentially the flip of a coin.

For individuals and their families, the effects of mental illness can be devastating. According to the National Alliance on Mental Illness (NAMI), those struggling with serious mental illness die, on average, 25 years earlier than those without mental illness, often because of treatable medical conditions.

But the damaging effects of mental illness reach beyond individuals. Ripples can be felt throughout communities and even throughout the entire country. All other matters aside, consider the mere financial expense of trying to combat mental illness.

Each year, the U.S. government spends about $113 billion on mental health treatment. This includes spending on things like medications, clinic visits, and hospitalizations. However, the costs don’t end there. Research suggests that, when left untreated, serious mental illness costs the U.S. at least $193.2 billion annually in additional indirect expenses. This means additional expenses incurred from things like Social Security payments, homelessness, incarcerations, and lost earnings.

All totaled then, mental illness costs the American public somewhere along the lines of a whopping $306.2 billion dollars each year! For comparison, that’s nearly three times the total amount the federal government spent on education in 2015 ($102.26 billion).

Why is mental illness such a persistent problem in 21st century American society? And why might someone who suffers from a psychological disorder not simply seek professional medical or therapeutic help? Alarmingly, recent estimates suggest that between 40-50% of people with severe psychological disorders – specifically Schizophrenia and Bipolar disorder – receive no treatment for their illness.

Answers about how best to reform our country’s mental health system are obviously complex and beyond the scope of a simple blog post. Nonetheless, research has identified a number of crucial barriers to mental health treatment, including the following:

  • Access to mental health care is worse than other types of medical services.
  • Mental health care is pricey, with 45% of the untreated citing cost as a barrier.
  • Attitudes about mental health services and the persistent stigma surrounding mental illness lead people to “try to solve the problem on their own.”
  • State cuts to mental health budgets following the 2007-2009 recession have further blocked access to quality care.

And while important progress has been made in addressing a few of these barriers in recent years, clearly a lot of work still needs to be done. For instance, the Mental Health Parity and Addiction Act of 2008 requires insurers to provide the same level of benefits for mental health treatment as for medical and surgical care. Prior to this law, insurers could effectively discriminate against people with mental illness by providing only minimal coverage for behavioral treatments and by imposing strict annual limits on therapy visits.

Assessing Where the 2016 Presidential Candidates Stand on Improving the U.S. Mental Health System

Meaningful reform of our country’s mental health system is imperative given the enormous burden mental illness creates for government as well as individuals and their families. And with the 2016 Presidential Election now officially in full swing, this is the perfect time to begin a national conversation about mental health. It’s also the perfect time to press those running for elected office to propose and stand behind concrete actions that will improve the lives of tens of millions of people.

Because although our society has made progress in addressing systemic mental health concerns, a lot of work remains to be done. For instance, although there are now laws in place to prevent insurers from discriminating against people with mental illness, these so-called parity laws are far from perfect. Mental health advocates warn that parity is not being consistently enforced, and that many insurers still find subtle ways to subvert the law.

So which candidates are talking about mental health on the campaign trail, and which are not? And who has so far offered the most detailed and comprehensive plan for eliminating barriers to mental health services?

To try to find out, I took to Google and did a combined search for each campaign’s website plus various key phrases related to mental health (e.g., “mental health,” “mental health” + “research,” etc.). This enabled me to identify the precise number of times a candidate mentions mental health on his or her official website. It also allowed me to more fully understand the context in which each candidate typically  talks about mental health (e.g., as part of improving health care more generally, as one aspect of improving veterans’ affairs, or as a means to reduce gun violence, for example).

Once I gathered together a list of some reasonably specific statements and policy proposals from each candidate (and a few quotes from supporters in cases where policy specifics from the candidate were lacking), I categorized each statement or proposal according to the specific long-term goal I believe could be achieved.

Based on research examining barriers to mental health services, I evaluated each candidate’s proposals according to the following three goals:

  1. Improve accessibility and/or affordability of high quality mental health services (e.g., pledging to support more consistent enforcement of parity laws).
  2. Invest in basic and/or applied research related to mental health issues.
  3. Remove stigma associated with mental illness and avoid the unfair targeting of individuals with mental illness.

Which Candidates are talking about Mental Health?

First, Figure 1 provides a rough estimate of the frequency with which each candidate discusses mental health on his or her official website. The figure shows the total number of hits on Google from my search for each campaign’s website plus the phrase “mental health.”

Figure 1: Number of hits on Google when searching candidate’s website domain + “mental health”

Mental Health Google hits

As Figure 1 shows, mental health is discussed most frequently by the Democratic candidates, with the greatest number of mentions coming from the Clinton campaign.

The website for the Clinton campaign contains 26 separate pages mentioning “mental health.” This is followed by the website for the Sanders campaign, which contains 18 pages. Meanwhile, the website for the Trump campaign contains 8 pages, the website for the Cruz campaign contains 5 pages, and the website for the Kasich campaign contains a mere 3 pages.

Figure 2 provides a rough idea of the context in which each candidate generally talks about mental health.

Figure 2: Number of times mental health is mentioned in various contexts on each presidential candidate’s official website.

Context in which MH is mentioned
Note: Totals do not equal the number of search results shown in Figure 1 because some statements and proposals were discussed within multiple contexts.

Hillary Clinton and Bernie Sanders each discuss mental health most frequently within the context of criminal justice reform, such as in emphasizing treatment rather than incarceration for individuals struggling with mental illness.

On the Republican side, things are more variable. For Ted Cruz and John Kasich, mental health is mentioned most frequently within the context of endorsements from supporters, rather than as part of any specific policy proposal. Donald Trump is the exception, in discussing mental health most frequently within the context of Veterans’ Affairs.

Finally, Figure 3 below shows my tally of statements or proposals from each candidate addressing important mental health goals.

Note that the total number of statements or proposals from each candidate does not equal to the total number of search results shown in Figure 1 because my tally focuses only on what I deemed to be specific ideas relevant to the mental health goals listed here. As such, vague and overly general statements, such as a need to “revamp America’s mental health system,” are largely excluded from this tally.

Figure 3: Tally of the statements and/or proposals from the 2016 presidential candidates addressing mental health goals.

mental health tally

So, who has so far offered the most comprehensive plan to reform the U.S. mental health system? According to my (admittedly somewhat simple) tally, the answer is Hillary Clinton, with at least 12 specific ideas on how to improve access to mental health treatment, invest in mental health research, and remove the stigma surrounding mental illness.

Below in the notes section, I provide a more detailed breakdown of the candidates’ positions, including quotes of the specific policy proposals tallied above.

Please note, however, that I’ve made no attempt to evaluate the potential impact or economic feasibility of any of the candidates’ statements or proposals. Although my analysis reveals that Hillary Clinton has so far advanced more proposals than any other candidate, I leave it to you to decide for yourself whose plan will bring about the most change. And whose plan has the potential to save the most lives.

Feel free to leave a comment below if you have any opinions about the current state of mental health care in the United States, or if you have any thoughts about how mental health has so far featured in the 2016 Presidential Race.

Brian Kurilla is a psychological scientist with a Ph.D. in cognitive psychology. You can follow Brian on Twitter @briankurilla 

 

Notes: List of the specific statements and proposals tallied in Figure 3

What Do the Democratic Presidential Candidates Have to Say About Mental Health?

Hillary Clinton

  1. Goal #1: Improve accessibility and/or affordability of high quality mental health services (6 statements and/or proposals identified)
    1. Proposes “a wide-ranging autism initiative—including screening, diagnosis, treatment, services, safety and legal protections for individuals on the autism spectrum across the lifespan, steps to ensure they are treated with dignity, partnerships to help them secure employment, support for families and caregivers, and a commitment to increase research funding to deepen our understanding of autism.”
    2. Proposes a “$10 billion Initiative to Combat America’s Deadly Epidemic of Drug and Alcohol Addiction.”
    3. Proposes to “Fundamentally reform veterans’ health care to ensure access to timely and high quality care and block efforts to privatize the VA. “
    4. Proposes to “Increase funding (to the Veterans Health Administration) for mental health providers and training to ensure timely and ongoing identification and triage of mental health issues, and ongoing access to quality mental health care and substance abuse treatment, particularly for alcohol and opiate abuse, including private-sector care when necessary.”
    5. Proposes to “Prioritize treatment and rehabilitation—rather than incarceration—for low-level, nonviolent drug offenders.”
    6. Proposes to “Ensure that federal law on insurance parity is being implemented and enforced by directing federal agencies to more aggressively inspect and, where appropriate, bring enforcement actions against non-complying insurer policies; promulgate federal guidance to states and consumers on parity enforcement and how to file complaints, both in Medicaid and private insurance; and direct the Departments of Labor and Health and Human Services to make its parity enforcement actions more transparent.”
  2. Goal #2: Invest in basic and/or applied Research related to mental health issues (3 statements and/or proposals identified).
    1. Proposes “$2 billion annual commitment for preventing, effectively treating, and making a cure possible for Alzheimer’s disease by 2025.”
    2. Proposes to “Significantly increase funding so that the government can invest more in autism research.”
    3. Proposes to “Dedicate research funding and provide mechanisms for collaborative efforts to facilitate the development and expansion of evidence-based diagnostic tools and treatments for veteran-centric conditions, including mental health issues and other invisible, latent, and toxic wounds of war, and direct the VA, HHS, and DoD to collaborate and integrate portfolios when it makes sense to do so.”
  3. Goal #3: Remove stigma associated with mental illness and avoid unfairly targeting individuals with mental illness (3 statements and/or proposals identified).
    1. Proposes to “Ensure continued focus on mental health for military members and families by enhancing DoD programs to help remove the stigma of mental health issues and by developing a comprehensive whole-of-life approach with the DoD Suicide Prevention Office that includes education, training, counseling resources, and family outreach.”
    2. Proposes to “Enact the Keeping All Students Safe Act, which bans the use of mechanical and chemical restraints, and physical restraints that restrict breathing; restricts the use of restraint and seclusion to situations in which there is a risk of imminent physical injury to a student or others; requires reporting to parents if these are used on their children; prevents these practices from being written into IEPs as planned interventions; and requires districts to have a sufficient number of staff trained in crisis intervention and behavioral management techniques.”
    3. Proposes to “Protect children with autism from bullying in their classrooms” by ensuring “that the U.S. Department of Education enforces the strong guidance that has been issued to states and school districts that students with disabilities, including autism, must be protected from bullying and allowed to remain in their classrooms.”

Bernie Sanders

  • Goal #1: Improve accessibility and/or affordability of high quality mental health services (7 statements and/or proposals identified).
    1. Proposes to “invest in drug courts and medical and mental health interventions for people with substance abuse problems, so that they do not end up in prison, they end up in treatment.”
    2. Proposes to “build on a program he has championed in Vermont, where the National Guard operates an innovative outreach program to provide pre-deployment and post-deployment support to family members and service members. This effort has been hugely successful in terms of making sure that veterans know about and receive the health care, mental health counseling, family assistance, transition assistance and other benefits they need to make sure they can live a healthy and productive life.”
    3. Proposes to “build on the implementation of President Obama’s National HIV/AIDS Strategy by significantly expanding access to mental health and substance use disorder services by protecting and expanding community health centers, which provide key behavioral health and substance abuse services to more than 1.3 million patients.”
    4. Proposes to “fight to expand the National Health Service Corps, which provides scholarships and loan repayments for health care providers, including mental health providers, in underserved communities. And he will work to ensure these critical health care professionals are appropriately compensated for their important work.”
    5. Proposes to “create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments.”
    6. Proposes to “work to fully fund the IHS, strengthen regional management and recruitment of committed IHS health care personnel, direct his administration to audit IHS operations, and ensure that Native Americans have adequate, safe, and affordable access to primary care providers, including oral health and mental health practitioners and substance abuse treatment options.”
    7. Statement from a press release describing National Union of Healthcare Workers’ Endorsement of Bernie Sanders for President: “the Sanders’ message of reversing economic inequalities; his support for a single-payer health care system, Medicare for All; and his stance of holding HMOs like Kaiser Permanente accountable for failing to comply with mental health parity laws, that resonated with NUHW members.”
  • Goal #2: Invest in basic and/or applied Research related to mental health issues (1 statement and/or proposal identified).
    1. Proposes creation of “The Prize Fund,” which “would reward medical researchers and developers of medicines based primarily upon the added therapeutic value a new treatment offers and the number of people it benefits.”
  • Goal #3: Remove stigma associated with mental illness and avoid unfairly targeting individuals with mental illness (0 statements and/or proposals identified).

What Do the Republican Presidential Candidates Have to Say About Mental Health?

Ted Cruz

  • Goal #1: Improve accessibility and/or affordability of high quality mental health services (1 statement identified).
    1. Statement from Cathy Costello, widow of former Oklahoma Labor Commissioner Mark Costello: “Ted is the only candidate who has dedicated himself to addressing mental health. He authored legislation expanding mental health courts and crisis intervention, and he has a personal interest and understanding of the tragedy of mental illness.”
  • Goal #2: Invest in basic and/or applied Research related to mental health issues (0 statements and/or proposals identified).
  • Goal #3: Remove stigma associated with mental illness and avoid unfairly targeting individuals with mental illness (0 statements and/or proposals identified).

John Kasich

  • Goal #1: Improve accessibility and/or affordability of high quality mental health services (1 statement and/or proposal identified).
    1. Statement about record as Ohio governor, noting the following: “Ohio is helping individuals with mental illness by increasing the availability of health care, expanding housing options and investing in services that save lives. In addition, Ohio has invested in early childhood mental health and crisis services for families, with the goal of helping families get the services they need before a crisis happens.  Ohio is also strengthening efforts to combat drug abuse by cracking down on prescription drug abuse and illegal pill mills, improving efforts to help those with addiction overcome it and reclaim their lives, preventing problems before they start byeducating young people on the dangers of drug abuse, and helping inmates overcome addiction while they are in prison to reduce recidivism and prison costs.”
  • Goal #2: Invest in basic and/or applied Research related to mental health issues (0 statements and/or proposals identified).
  • Goal #3: Remove stigma associated with mental illness and avoid unfairly targeting individuals with mental illness (0 statements and/or proposals identified).

Donald Trump

  • Goal #1: Improve accessibility and/or affordability of high quality mental health services (2 statements and/or proposals identified).
    1. Proposes to “Increase funding for post-traumatic stress disorder (PTSD), traumatic brain injury and suicide prevention services to address our veterans’ invisible wounds.”
    2. Proposes “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.”
  • Goal #2: Invest in basic and/or applied Research related to mental health issues (1 statement and/or proposal identified).
    1. Proposes “More funding will also support research on best practices and state of the art treatments to keep our veterans alive, healthy and whole.”
  • Goal #3: Remove stigma associated with mental illness and avoid unfairly targeting individuals with mental illness (1 statement and/or proposal identified).
    1. Statement from campaign stating the “Trump plan will help the veteran community put the unnecessary stigma surrounding mental health behind them and instead encourage acceptance and treatment in our greater society.”

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