COMMENTARY

It’s Morning in America for Mental Health Care

Jeffrey A. Lieberman, MD

Disclosures

September 29, 2016

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Hello. This is Dr Jeffrey Lieberman of Columbia University in New York City, speaking to you today for Medscape. I am going to borrow a catchphrase from President Ronald Reagan's presidential campaign, through which he sought to inspire and energize the American people. His phrase was, "It's morning in America." My adaptation is, "It's morning in America's mental health care."

I say that because on August 29, a historic event took place. Hillary Rodham Clinton's presidential campaign released a comprehensive agenda on mental health care. This is notable for several reasons. First, you do not find presidential politics and mental health care mentioned in the same sentence very often. Moreover, candidates at the presidential level do not often prioritize mental health care as a major issue to put on their agendas, much less during the campaign.

This is the first time I can remember that a presidential candidate has elevated mental health care to the level of a major priority. In addition, Secretary Clinton is someone who knows whereof she speaks. She led the effort to develop a plan for mental health as part of healthcare reform during the first Bill Clinton administration in the early 1990s. Unfortunately that did not progress very far, but it certainly indicated that she is interested in mental health and has had experience with the issues affecting healthcare service delivery.

We are not given many opportunities like this. Presidential-level initiatives affecting people with mental illness and mental health care providers are few and far between: President Kennedy in 1963 with his Community Mental Health Act; Jimmy Carter in 1978, with his Presidential Commission on Mental Health, co-led by his wife, Rosalynn Carter; and President George W. Bush, who convened a Presidential Commission on Mental Health in 2002. This commission was chaired by Mike Hogan, the accomplished mental health care administrator and former commissioner of mental health for the State of New York. The president could not have found anyone better; however, when this commission issued a report describing the nation's broken mental health care system and offering recommendations, the vast majority of them were never implemented. Thus, having a presidential candidate focus on this in a very serious way is extraordinary and presents a great opportunity.

Judge for Yourself

If you go to Mrs Clinton's website or hear it described in other news outlets, you will see that although it is not comprehensive or highly detailed, in broad brush strokes it is a sophisticated and well-conceived discussion of the need to improve mental health care in this country. If you then look at comments on the Internet, you will find most of them laudatory, but some of them are critical, saying it does not go far enough, it does not address this or that constituency, and we are not doing enough for the people with severe and persistent mental illness. I believe that is nitpicking because this is an incredible first step—to have prioritized this issue; to have allowed a considerable amount of time and effort to be spent by her health policy staff and advisors, to convene experts, solicit their opinions, and then draft the statement. This is quite encouraging because it is not simply offering platitudes, it is not trying to take the easy way out by proposing gun control or shelters for the homeless. It is a substantive discussion of significant mental illness and addiction issues, and how they may be addressed in terms of healthcare services. I believe that this is the best hope we have had in a long time.

At this point, it is a hope and a dream. A few things have to happen in order to see whether this will be translated into action. First is the election, then there is the transition, and then the question is, how is this placed and in what position in the agenda of a new administration? What kind of priority will it get? What kind of political support will be allocated to it? And where will it be on the list of priorities with many competing issues or problems? Nevertheless, I believe that this provides more reason for us to be hopeful than in a long time, hence my refrain "morning in mental health care."

When you consider the prospect that this will be a major policy initiative of a president-elect combined with the fact that mental health legislation is pending in Congress, with the passage by the House in July 2016 of the Helping Families in Mental Health Crisis Act, HR2646, and the pending bill in the Senate for mental health reform in the United States, it may be that government is finally getting with it, with respect to the enormous healthcare disparity and degree of neglect of mental illness and addiction in our society. With Congress and the administration understanding the importance of developing enlightened and actionable mental health policy, we in the field of psychiatry and mental health care, as well as the patients and family members affected by it, can feel that our time is finally coming.

I urge you to take a look at the comprehensive agenda on mental health care that Secretary Clinton's campaign has rolled out, and to keep focused on this issue through the election and thereafter.

This is Dr Jeffrey Lieberman of Columbia University, speaking today for Medscape. Thank you.

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