Candidates Reveal Positions on Mental Health

Proposals for mental health care by the candidates for the U.S. presidency are as divergent as the candidates themselves.

Democrat Hillary Clinton’s campaign devotes a detailed, 10-page document to the subject, while Republican nominee Donald Trump embeds his mental health plans within two broader areas: health care reform and ways to reform the Department of Veterans Affairs.

Trump’s core proposal rests on longstanding Republican opposition to the Affordable Care Act (ACA).

“On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare,” says the candidate’s website.

With that out of the way, he favors “free market” approaches to health care, like selling health insurance across state lines, allowing a tax deduction for health insurance premium payments, making Medicaid a block grant program, and promoting the use of health savings accounts.

Trump’s position on mental health states in full:

“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 bipartisan support.”

The latter presumably refers to HR 2646, the Helping Families in Mental Health Crisis Act, advanced by Rep. Tim Murphy (R-Pa.) and Eddie Bernice Johnson (D-Texas), and S 2680, the Mental Health Reform Act of 2016, led by Sens. Bill Cassidy (R-La.) and Chris Murphy (D-Conn.). The House passed HR 2646 nearly unanimously in July. APA supports both reform bills.

For veterans, Trump proposes to increase funding to expand and improve care for posttraumatic stress disorder, traumatic brain injury, and suicide prevention services.

“More funding will also support research on best practices and state of the art treatments to keep our veterans alive, healthy, and whole.”

He also suggested placing satellite clinics, staffed by VA health personnel, within rural hospitals or other health care sites, to ease access to care in underserved areas.

Trump would also permit veterans to get care not only at VA clinics and hospitals but also at any doctor’s office or medical facility that accepts Medicare. However, proposals to turn veterans’ health care into a health insurance system have been met in the past with skepticism, if not outright opposition, by veterans’ service organizations.

For her part, Clinton points to her record on health care as senator from New York, which included co-sponsorship of legislation backing mental health support for college students and veterans, along with mental health parity laws.

“The next generation must grow up knowing that mental health is a key component of overall health, and there is no shame, stigma, or barriers to seeking out care,” said Clinton’s statement. “Hillary will convene a White House Conference on Mental Health within her first year in office—to highlight the issue, promote successful interventions, and identify barriers and solutions.”

(The Clinton campaign generally refers to the candidate by her first name.)

Clinton’s list of proposals has several major themes, including integration of mental and physical care systems, promoting early diagnosis and intervention, and enforcing mental health parity. Many of these themes align with APA’s core priorities.

Clinton would expand reimbursement procedures for collaborative care under Medicare and Medicaid and do away with the prohibition against payment for primary care and mental health care services on the same day. Early diagnosis and care would range from action to address maternal depression and trauma and stress in the lives of young children, as well as college mental health services. Programs to identify problems among school children—like APA’s Typical or Troubled program—are included.

Clinton notes that provisions of the ACA and the Mental Health Parity and Addiction Equity Act of 2008 “are too often ignored or not enforced.” She would crack down on parity violations by randomly auditing insurers, improving transparency of nonquantitative treatment limitations, and strengthening compliance with network adequacy requirements. She also would increase federal support for suicide prevention and research, and expansion of police officers’ training for crisis intervention with people with mental illness.

Additionally, a Clinton administration would encourage independent living for people with mental illness and other disabilities by expanding community-based supported housing and employment. ■

Hillary Clinton’s “Comprehensive Agenda on Mental Health” can be accessed here. Donald Trump’s “Healthcare Reform to Make America Great Again” is available here.