While mental health advocates are pleased that a presidential candidate is discussing behavioral health reform and say that Hillary Clinton's recently released plan is a good foundation, they worry the plan lacks implementation details and a funding source, which has stalled legislation in Congress.
Clinton's plan highlights early diagnosis and prevention; integrating mental and physical healthcare and enforcing parity; access to housing and job opportunities; suicide prevention; prioritizing treatment over incarceration; and expanding brain and behavioral research.
She also promises she would host a White House conference on mental health in her first year in office.
“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 that care,” the plan states.
Clinton's opponent, Donald Trump, has said he agrees mental health needs reform but has given few details as to how he would accomplish that. A position statement on healthcare on his website states that there are “promising reforms being developed in Congress that should receive bipartisan support.”
Indeed mental health reform has been a frequent topic in Congress this session and is likely to be discussed when Congress returns next week.
The Helping Families in Mental Health Crisis Act passed the house in July with a vote of 422-2 while the Mental Health Reform Act in the Senate has passed a key committee but has not received a floor vote. Both have received bipartisan praise and support. Republicans have rejected Democrats' efforts to attach funding, however, which the Democrats say is necessary for the reform to be meaningful.
The bills' pending funding agreement calls for an increase in the number of mental health providers and an expansion of evidence-based treatment.
There have also been disagreements about whether to include language on gun control, which most advocates say doesn't belong in mental health legislation, as it continues to stigmatize all patients as being violent.
Clinton's plan does not mention gun control.
Paul Gionfriddo, president and CEO of Mental Health America, wrote in a blog post that the plan lacks details about access and what services will be covered by Medicaid. He notes that the outline avoids dividing the advocate community by not choosing one approach over another. It doesn't mention some more controversial topics such as assisted outpatient treatment and adjustments to privacy laws.
“But what it does do is more important—it recognizes that without a comprehensive set of integrated services, discussion about payment mechanisms and consumer choice don't mean much,” he said.
A major part of the plan focuses on training law enforcement officers to deal with people who have mental illnesses and creating programs like specialized courts that encourage diversion programs instead of jail time. Law enforcement encounters with the mentally ill and the use of force by police officers have been brought up during the campaign. Clinton has also tried to distance herself from some of her husband's “tough on crime” policies in the 1990s that some believe led to incarceration over treatment.
Ronald Honberg, senior policy adviser with the National Alliance on Mental Illness, said it's key that mental health reform is being discussed on the campaign trail, and that Clinton's plan includes vital issues such as evaluating children for mental health problems, improving mental health services at school and colleges, and reducing unnecessary incarceration.
He also appreciated that she calls for a balanced approach to research that includes long-term study of the brain and research on current clinical treatment options.
Her plan is “a good start,” but there's no escaping that Congress controls the purse strings, he said.
“Ultimately, Congress has the final say,” he said. “We can only be optimistic ... that the climate will be conducive to action.”