The simple act of asking a question at a town hall meeting is a great way to make candidates go "on the record" with important mental health and addiction issues. Here are some mental health facts and suggested candidate questions. Check your local paper for scheduled candidate forums and town hall meetings. The August Congressional recess will likely start August 3rd and go through Labor Day Weekend and the entire month of October is dedicated to preparing for the election. Look for events during those times as Congressional members will be in their districts and states campaigning.
Affordable Care Act
FACTS - Individuals with mental health conditions are twice as likely to be uninsured than the general population. The Affordable Care Act of 2010 mandates coverage for mental health and substance use conditions and prevents insurers from denying coverage for "pre-existing conditions," including substance abuse and mental illness. The Supreme Court's decision to uphold the Affordable Care Act will give more than 30 million Americans access to health insurance by 2014*—up to one third of these individuals will have some mental health or substance abuse condition.
What is your stance on the Affordable Care Act, and if you support it, how do you plan to promote the implementation of the law or if you do not support it, how do plan to change the health care system so it protects those with mental health and substance use conditions?
*For state candidates: What is your stance on the Affordable Care Act, and do you support accepting federal funding for the expansion of Medicaid and state action to develop insurance exchanges?
FACTS - Twenty percent of people age 55 or older experience some type of mental health condition each year. The presence of conditions such as depression or anxiety among older Americans often adversely affects their overall health and complicates the treatment of other chronic diseases. Older adults with mental health conditions are likely to visit the doctor and emergency room more often, use more medication, incur higher outpatient charges, and stay longer in the hospital.
With the total number of older Americans increasing annually, how will you ensure their access to and affordability of effective mental health resources?
FACTS - Less than half of youth with common mental health conditions receive professional care. The total economic cost of mental, emotional, and behavioral conditions among youth in the United States is estimated to be $247 billion. More than 50 percent of adolescents who fail to complete high school have a diagnosable psychiatric disorder.
There is a strong connection between mental health prevention and early intervention programs and student success in school. What are your plans to support the whole wellness of children and adolescents?
If half of those with a mental health condition will experience it by age 14, what steps will you take to ensure implementation of prevention and early intervention initiatives in school and health settings?
Eliminating Barriers to Access
FACTS - Mental health conditions are readily diagnosable and effectively treatable. Yet more than 60 percent of the 46 million adults with some type of mental health condition in America did not receive any treatment in 2011. Nearly 50 percent of those individuals reported inability to afford services as their largest barrier to accessible care. Unemployed adults and families whose incomes fall below the poverty line are more likely to have mental illnesses in the past year than persons who are employed and families not in poverty, a fact that becomes more troublesome as rates of chronic unemployment continue to rise.
With budgets tightening and services being cut, what are your plans to improve access to mental health care?
FACTS – The federal investment for the Substance Abuse and Mental Health Administration (SAMHSA), the lead federal agency charged with addressing behavioral health issues, has been cut two consecutive years and is in major jeopardy of debilitating cuts for Fiscal Year 2013, starting in October. The House has advanced a bill that would cut funding for SAMHSA by 10 percent and there is a chance of a budget sequester that would cripple the agency's funding even further.
Given that federal public health funding has been cut three straight years, what is your position on the current approach of deficit reduction that relies solely on cuts to discretionary funding, largely to funding of supports, services, and research for individuals with mental health and substance use conditions?
FACTS - Individuals with mental health conditions die an average of 25 years earlier than other Americans due to preventable diseases such as diabetes, heart disease and cancer. Physicians often lack the knowledge or time to adequately diagnose and treat mental health conditions, and mental health providers suffer the same problems when dealing with general health conditions. Yet 54 percent of individuals with a mental health condition are served in primary care settings.
How will you implement policies to overcome the clinical, financing, policy, and organizational barriers to fully integrated mental and general health care?
FACTS - Mental illnesses make up four of the 10 leading causes of disability in the United States. By 2020, major depressive illness will likely be the leading cause of disability in women and children. Over 20 percent of our nation experiences a mental health condition each year. More than 34,000 lives are lost each year to suicide; nearly twice the number of homicides and more than the number of traffic accident fatalities.
What will be your plan to address the leading cause of disability in the nation? What policies or actions will you take to ensure that mental illness and suicide prevention efforts are readily and easily available for vulnerable individuals and their families?
FACTS - Providing unequal coverage for behavioral health and primary medical care limits consumer access to mental health and substance use treatment and subjects millions of Americans to the risk of major financial losses from out-of-pocket costs. Parity laws passed in 1996, 2008, and 2010, call for equal coverage of mental health and substance abuse care to that of medical/surgical care, yet the final rules have not been issued by the federal government nor fully implemented.
How do you propose making sure insurance plans comply with parity laws, and state insurance commissioners are enforcing the laws?
FACTS - President Bush's Commission on Mental Health highlighted the active role of consumers of mental health services in their path to recovery. Consumer-oriented services allow behavioral health consumers to see that recovery is real and possible, and allows for a personal directive role in their recovery.
How will you ensure consumers are both knowledgeable and in charge of their own treatment and care?
FACTS - States have cut mental health budgets by over $4 billion over the last 3 years —the largest reduction to mental health spending since the de-institutionalization of state hospitals in the 1970s. Nearly 60 percent of all mental health spending is from public funding sources. Medicaid alone accounts for 44 percent of mental health funding managed by state mental health authorities. Individuals receiving treatment through state funded resources are increasingly vulnerable as states cut other important community supports such as education, criminal justice, and housing.
With cuts in state budgets, how do you plan to maintain adequate and equitable access to mental health services for economically vulnerable populations?
FACTS - According to the Department of Defense, more than 40 percent of returning National Guard and Reservists are in need mental health care. In 2010, Army suicides reached an all-time high, and the number of National Guard service member suicides increased by 55 percent—more than half of them had never been deployed. More than half a million Iraq and Afghanistan war vets have not sought care from the Department of Veterans Affairs (VA), even though 20 percent of vets have PTSD or depression, and another 20 percent report traumatic brain injury (TBI) during deployment. Cumulative deployments also have contributed to more mental health diagnoses among U.S. Army spouses and higher rates of emotional difficulties for children of service members.
What are your plans to make sure we fulfill our duty to our military service members, families, and Iraq and Afghanistan veterans?