Kamala’s Plan to Address the Mental Health Care Crisis and Provide Mental Health Care on Demand | Full Policy

Our country is in a mental health care crisis. Over 45 million adults—nearly 20% of all U.S. adults—experienced mental illness in 2017. Suicide is on the rise, increasing 30% or higher in 25 states from 1999 to 2016. As natural catastrophes and man-made traumatic events like shootings devastate our communities, post-traumatic reactions in children and adults follow.

Yet even as nearly 60% of Americans seek mental health services for themselves or loved ones, more than half of the adults with mental illness—nearly 27 million—did not receive treatment in 2017.

In 2020, mental health care justice is on the ballot.

We need to act. As president, Kamala will make sure we deliver mental health on demand—that is, she will provide services to all Americans who need it, whenever they need it, and wherever they need it.

  • She’ll cover mental health on demand via telemedicine through her Medicare for All plan, providing direct access to mental health care professionals—with no deductibles and no copays.
  • She’ll double the number of treatment beds nationwide, prioritizing states with shortages including Iowa, Nevada, South Carolina, and Michigan, so persons with mental illness can receive the high levels of care they need.
  • As we improve mental health services across the country, she’ll make sure we meet the unique needs of vulnerable populations, including our veterans and our children. For example, she’ll double DoD and VA research dollars to address and treat PTSD, military sexual trauma, and traumatic brain injury.
  • And Kamala knows that children’s earliest life experiences, from poverty to exposure to violence and other trauma, have profound effects on their brain development and long-term health and safety, and that early intervention is key to ensuring that every child has the opportunity to develop to their full potential and become resilient when traumatic events strike. That’s why she’ll fight for evidence-based screenings for childhood trauma to diagnose and treat mental illness as early as possible.
HERE’S HOW SHE’LL DO IT:

Focus federal funding on needed mental health research.

Kamala knows that medical research into new treatments for mental illness is imperative. As Dr. Kenneth Paul Rosenberg writes, “It’s all about finding good treatments: Expand and improve scientific research because the best solutions are prevention and cure.” That’s why she’ll direct federal funds to support efforts to seek better treatment for mental illness and research on mental health issues more broadly. She’ll:

  • Dedicate Substance Abuse and Mental Health Services Administration (SAMHSA) block grants to fund data collection on rates of homelessness, arrests, incarceration, violence, and repetitive hospitalization among persons with serious mental illness (SMI).
  • Direct the National Institute of Mental Health (NIMH) to focus research on adults with SMI between 18 and 64 years old, particularly on use of medication and other interventions that reduce homelessness, arrest, incarceration, and unnecessary hospitalization.
  • Direct NIMH to focus research on the causes and treatment of mental health issues for developing children while also focusing on the approaches that enhance brain health in the developing child.
  • Support efforts to reclassify schizophrenia, schizoaffective, and bipolar disorders. While these conditions are currently classified as “behavioral,” a classification that accentuates their neuroscience will improve access to treatment and research funding.

 

Expand coverage of and access to mental health services.

Kamala will appoint a Secretary of Health and Human Services who will work to dismantle artificial roadblocks to mental health benefits, such as surprise billing for out-of-network providers or higher charges for mental health services, and will commit to expanding the mental health workforce and enforcing mental health parity laws.

  • Medicare for All coverage of mental health. Medicare plans today do not cover mental health and addiction services equally. Kamala’s Medicare for All plan will:
    • Provide mental health on demand, covering mental health care services provided through phone or video.
    • Require parity for mental health (and require private Medicare plans to do the same).
    • Cover all medically necessary services, including mental health and substance use disorder treatment—with no deductibles and no copays.
    • Provide for home- and community-based comprehensive long-term services and support, so that people will be able to access mental health and developmental disability care in their communities.
    • Close the gap in reimbursement rates between psychiatric providers and other medical professionals.
  • Improved conditions for the mental health workforce. A shortage of mental health professionals harms American families and communities. It means that people in rural areas are 5 times more likely to have an undiagnosed mental illness or suffer from a severe mental illness that goes untreated. And nearly half of American adults have had to or know someone who has had to travel more than one hour for mental health care appointments. Kamala knows that increasing the number of providers and their efficacy, and lowering their caseloads, will minimize provider stress and turnover. That’s why she’ll:
    • Invest in telemedicine to provide direct access to mental health care professionals so all Americans can get mental health care whenever and wherever they need it (Mental Health Telemedicine Expansion Act).
    • Authorize an educational loan forgiveness program for mental health professionals that agree to practice in areas with a shortage of mental health professionals (Mental Health Professionals Workforce Shortage Loan Repayment Act).
    • Fund programs for more nurse practitioners and physician assistants to certify as psychiatric specialists.
  • Community-based rehabilitation. It can be difficult for Americans to access needed mental health care in their communities. Kamala will continue and expand the Certified Community Behavioral Health Clinic (CCBHC) Medicaid program to ensure access to coordinated mental health and medication-assisted treatment services for both mental illnesses and co-occurring opioid use disorders. Kamala will also instruct the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Mental Health Services (CMHS) to support expansion of Clubhouse psychosocial rehabilitation communities (non-clinical, therapeutic, community-based working groups to support the recovery and wellbeing of adults with a history of mental illness).
  • Focus on veterans. Over 50% of returning veterans who have PTSD do not receive mental health care due to lack of access or other barriers. Seventeen veterans die by suicide each day. Even more distressing, our female veterans are 9 times more likely to experience PTSD if they have had a military sexual trauma (MST) at any point during active duty. As president, Kamala will prioritize the needs of America’s veterans, just as they’ve prioritized the needs of our nation. She’ll:
    • Focus the Departments of Defense and Veterans Affairs (VA) on treating the invisible wounds of service: PTSD, MST, and traumatic brain injury. She’ll give these agencies the resources they need by doubling their research dollars to identify and treat our veterans.
    • According to the National Academy of Medicine, VA medical centers struggle with staffing, physical infrastructure, and providing timely mental health care. Veterans can face difficulties scheduling appointments. And VA mental health providers themselves often experience high levels of stress, burnout, and turnover. Kamala’s investments in mental health on demand will streamline appointment systems and address access issues.
    • She’ll accelerate and increase funding to community-based resources that expand awareness of post-deployment mental health care access. No one should suffer in silence or shame.
    • Women veterans are the fastest-growing segment of the veterans population. Kamala will direct the VA to streamline its Women Veterans Health Care Program to provide comprehensive mental health care services throughout and immediately upon return from duty.
  • Expand coverage for other vulnerable populations, including Native Americans. Kamala knows that as we improve access to mental health care, we have to address the unique mental health disparities historically marginalized and vulnerable populations face. For example, Native American young adults between 18 and 24 years old die by suicide at higher rates than any other ethnic or racial group. Kamala recognizes that income level, racial segregation, food insecurity, access to safe drinking water and clean air, and other social determinants directly impact health. And she understands that we can narrow these unconscionable disparities among vulnerable populations by providing flexible options to see qualified mental health professionals. Kamala will create a $100 million Tribal Emergency Fund for SAMHSA to administer, so tribal communities can address these substance abuse and mental health crises in culturally competent ways.

Increase access to hospitals, housing, and other care facilities.

Persons with mental illness need adequate access to treatment. Many need adequate access to hospitals and housing to prevent homelessness and criminalization. Providers need adequate facilities to provide and sustain the high levels of care their patients need. Kamala will work to increase beds, facilities, and other services to improve patient outcomes and minimize provider stress and burnout.

  • Repeal the Institutions of Mental Disease (IMD) exclusion. The IMD exclusion precludes Medicaid funding for adults receiving care in psychiatric facilities with more than 16 beds, and has also exacerbated a severe shortage of acute psychiatric care beds nationwide. Repealing the IMD exclusion will reduce the number of Medicaid patients who end up in already strained general hospital emergency rooms when they need acute psychiatric care.
  • Kamala will double the number of treatment beds nationwide, prioritizing states with shortages including Iowa, Nevada, South Carolina, and Michigan, so persons with mental illness can receive the high levels of care they need.
  • Provide a range of housing options for patients who need sustained support to remain as healthy as possible. For example, Kamala will invest in building psychiatric assisted living campuses on mental health institutes to provide services at multiple levels of care, from secure and acute facilities to supported independent living.

End the mental illness to jail pipeline.

Our profoundly under-resourced mental health care system means the criminal justice system continues to be the frontline response for people whose primary need is mental health care. A national survey of sheriffs’ offices and police departments found that in 2017, law enforcement spent 20% of staff time and 10% of their budgets responding to and transporting persons with mental illness.

According to the National Alliance of Mental Health, 25% of people arrested and in the criminal justice system have serious mental illnesses (SMIs)—mental, behavioral, or emotional disorders, such as schizophrenia or severe bipolar disorder, that substantially interfere with major life activities. And more than 2 million people with SMIs are arrested annually. That’s why Kamala will invest in programs that divert persons with mental illness from the criminal justice system and fight to prevent re-incarceration and robust training for law enforcement, mental health providers, and other first responders to those in crisis. Specifically, she’ll:

  • Increase federal, state, and local grants that support Crisis Intervention Team (CIT) training, which integrates specialized police, mental health professionals, EMS, 911 systems, and hospital emergency rooms in response to mental health crisis calls. The community-based CIT approach has effectively reduced re-offending, improved mental health outcomes, and increased diversion to psychiatric services rather than jails.
    • She’ll also increase federal funding for hiring mental health professionals to accompany police officers in responding to calls for individuals in mental crises.
  • End solitary confinement, ensuring alternative therapeutic and rehabilitative mechanisms are available to protect the safety of individuals in prisons and of prison staff and working to prevent the violence associated with correctional segregation.
  • Provide returning citizens with comprehensive health services—including mental health and addiction treatment both in and out of custody—to ensure successful reintegration into society.
  • Expand funding for Assisted Outpatient Treatment (AOT) programs, which prescribe by court order home- and community-based treatment for persons with a serious mental illness (SMI). These individuals sometimes fail to comply or cannot comply with treatment and become homeless, are arrested, or otherwise deteriorate without treatment. Multiple studies have shown that AOT effectively improves treatment outcomes, lowers risk of arrest, violent behavior, and other criminal justice encounters, and reduces homelessness, all at lower costs and with fewer restrictions than inpatient treatment. Kamala will:
    • Continue and expand the funding streams for AOT included in the 21st Century Cures Act.
    • Instruct the Center for Medicare and Medicaid Services (CMS) to authorize Medicare and Medicaid reimbursement for AOT court costs.
    • Educate the judiciary on AOT.

Treat mental illness early

Nearly 7.7 million children and teens in the countryabout one in sevenhave at least one treatable mental health disorder, including depression, anxiety, and attention deficit/hyperactivity disorder (ADHD). Half of these cases of mental illness begin by age 14. Half of these young people did not receive needed treatment in 2016.

Early diagnosis and treatment of mental illness is key. While most serious mental illnesses do not begin until a person’s late teens or early twenties, early intervention can prevent severe and disabling effects of serious emotional disturbances in children. A tier model that targets both treatment and prevention will help ensure that every child has the opportunity to develop to their full potential and become resilient when traumatic events strike.

  • Kamala’s Medicare for All plan covers all Medicaid benefits to children. Under her plan, cost won’t bar young people from accessing treatment and mental health services as soon as they need it.
  • Kamala will ensure all children have access to a nurse and social worker at school, increasing the workforce capacity for the large number of youth requiring mental health care.
  • She will invest in evidence-based mental health practices for every child in the country, including broad screening for childhood trauma combined with systemic programs that target those at risk, as well as treatment to mitigate potential health impacts.

Amend HIPAA to ensure family members can adequately support persons with mental illness.

The Health Insurance Portability and Accountability Act (HIPAA) and accompanying regulations aim to both protect the privacy of individuals’ identifiable health information and also establish when to make health information available for treatment or other necessary purposes. However, HIPAA can pose a barrier for family and friends to support and help care for loved ones with mental illnesses. That’s why Kamala will work with Congress to:

  • Codify that HIPAA permits health providers to receive information from family members.
  • Protect health providers who disclose protected health information if they make such a disclosures out of a good faith belief that it was necessary to enhance the health, safety, or welfare of the person involved or the general public. Family and friends supporting persons with mental illness often bring home their loved ones with no knowledge of the diagnosis, treatment plan, medication, signs of deterioration, or even suicidal or homicidal ideations. Nondisclosure can therefore put persons with mental illness and the family and friends who support them at risk and hamper recovery support.
  • Permit disclosure of “financial” and “treatment and care” health information to family members that provide housing, case management, and transportation support to loved ones with mental illnesses.

Integrate behavioral health information (medical history, lab results, medication lists, and treatment plans) with physical health information in a person’s health records to better coordinate patient care and improve outcomes.