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Mental Health Reform Agenda

Governor Howard Dean

Dartmouth-Hitchcock Medical Center
Lebanon, New Hampshire
September 12, 2003

As a physician, I have a special appreciation for the devastating effect of mental illness on individuals and families. Approximately eleven million adults in this country live with a serious mental illness and three million children suffer from a severe emotional disturbance. Yet, the public mental health system in many states is in shambles and the federal government does too little to help.

Over the last forty years, medical and behavioral science has come a long way in understanding mental illness and improving the effectiveness of mental health care. Treatments for illnesses ranging from depression to anxiety and from post traumatic stress disorder to schizophrenia are better than ever, helping millions of Americans lead better lives. Successful rehabilitation and recovery has increased the recognition that mental illness is treatable, reducing the stigma associated with mental illness and leading many more people to seek treatment.

Yet public and private health care systems have been unable to keep pace with increased demand. Recent scientific and medical advances have been slow to translate into effective care, the high cost of new medications has been a barrier to more effective treatment and a disjointed and often shortsighted approach to social services has stifled the development of community mental health treatment.

As access to health insurance has declined for all but the wealthiest Americans, mental health care has been pushed to the bottom of the barrel. The result has been treatable illnesses turning into serious health crises and too many working people being driven into poverty and homelessness. We’re not doing nearly enough to address suicide, which claims nearly 30,000 Americans every year and is the 3rd leading cause of death among young people. At the same time, state and local mental health departments are squeezed by lower budgets and rising costs, yet they get too little assistance from inflexible and inefficient federal programs.

The United States spends over $70 billion per year on mental health treatment, yet the economy still loses around $63 billion each year from lost productivity caused by mental illness. Clearly, we’re not getting our money’s worth.

We can do better. Treating mental health problems early is less expensive, more effective and more humane than waiting until people with serious mental illness end up in a hospital or a jail cell. Similarly, there is no question that an integrated treatment approach works better than isolating mental health treatment from other health care and social services. Effective integrated treatment respects the rights of individuals and includes them and their families in treatment planning and takes into account the complex relationships among mental illness, unemployment, homelessness, drug addiction and involvement with the criminal justice system.

If elected President, I will seek real solutions to the mental health care crisis. My priorities will be: (1) programs that make early investments in community care and save money on less effective institutional care whenever it can be avoided; (2) programs that integrate mental health treatment with drug addiction treatment, housing assistance, job training and education for individuals who need additional services; and (3) programs that address the unique needs of children with severe emotional disturbances. My national mental health agenda will include:

  • Parity for insurance coverage of mental health care. The federal government should prohibit private insurance companies from discriminating against individuals with mental illness. It is common practice for insurance companies to charge more and cover less for mental health treatment than they do for physical illnesses. The late Senator Paul Wellstone was a champion of comprehensive legislation to fix this problem, along with New Mexico Republican Senator Pete Domenici. I would be proud to sign the Wellstone bill into law. Public insurance parity also provides fewer benefits for mental health treatment and I will seek innovative and cost effective ways to solve the problem.
  • Integrating mental health care with other social support systems. Government agencies should coordinate programs for mental and physical health care, drug treatment, housing and employment training. One of the most pressing needs is for programs that integrate mental health care and drug treatment. Integrated treatment programs for these co-occurring illnesses provide earlier, better and less expensive community care. Addressing the housing needs of people with mental illness is also crucial. When federal health, housing, employment and criminal justice agencies don’t work together, they discourage state programs that rely on federal funding from developing integrated community solutions. I will find innovative ways to coordinate these efforts, for example pooling agency funding to create integrated programs.
  • Improving access to community care to prevent people with mental illness from being imprisoned and abandoned. Despite the fact that community mental health care costs a fraction of incarceration, jails and prisons have become the largest providers of mental health care – the Los Angeles jail now treats more patients than any psychiatric hospital in the country. Over 600,000 people with serious mental illness are arrested every year, most for non-violent crimes like trespassing and disorderly conduct. Police officers, courts and prisons should focus on violent crime and dangerous felons, and divert non-violent mentally ill offenders into the mental health system. The federal government should encourage successful models of cooperation between the criminal justice system and mental health providers, such as those in Memphis and San Diego
  • Ending rules that discourage work. Two-thirds of adults with serious mental illness are unemployed and many are dependent on Medicaid, social security insurance (SSI) and disability insurance (SSDI). Despite living at or below the poverty line, too many end up even poorer if they go to work. Working in a low wage job and paying for mental health care is often far more expensive than staying unemployed and keeping federal benefits. A recent law allows states to extend Medicaid benefits to people who begin working, but it hasn’t been adequately funded. Other federal rules distort local job training programs by creating incentives to train only those who are already close to work, not people with less education and skills who need training the most. I support logical funding incentives to get more people into the work force with jobs that pay enough to purchase private mental health care
  • School-based screening and treatment for children. Children with behavioral health issues and more severe emotional disturbances require unique services. Too many children who need help are going unnoticed and failing to address their needs contributes to alarming suicide and drop out rates. Federal programs should help childcare providers, teachers and school staff recognize children who need mental health treatment and help provide services for children and support for their parents. Schools need enough resources to help all children who would benefit from counseling instead of struggling to barely address only the worst crises. Reaching at-risk children early will improve education and life outcomes for children with emotional problems, create a better learning environment for all children and save money spent later on crisis intervention.
  • Recovery programs for people with mental illness to help others. When quality care is available, many people with mental illness return to work as active members of their communities and the economy. Drug and alcohol treatment program have had great success employing recovering addicts as counselors. Mental health systems also successfully use peer educators to help others with mental illness learn about medications and coping skills and strategies. The federal government should support programs that employ people who are recovering from mental illness to provide peer support and counseling for people who need mental health care.
  • Public education to decrease stigmas and raise awareness. Despite recent gains, we still have a long way to go to end public stigma, fear and discrimination against individuals with mental illness. Public education is still needed to address cavalier and cruel attitudes toward individuals with mental illness, and to help the millions of Americans who could benefit from treatment feel comfortable seeking it.

A principal reason I am running for President is to improve access to quality health care for all Americans. Adults and children living with mental illness have been denied quality health care for too long. As President, I will work to create better, more comprehensive and more effective mental health treatment programs that will give people with mental illness hope for a better life and the chance to participate in their communities.

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