More than 40 million U.S. adults — almost 20 percent of the adult U.S. population — will deal with mental illness this year. Yet mental health (of the citizens, not the candidates) has not been an issue in the presidential campaign. Hillary Clinton tried to change that last week, announcing a plan that offers hope for improving mental health research, diagnosis and treatment.
Central to Clinton's plan is the integration of physical and mental health care and reducing the stigma attached to mental health treatment.
Clinton would direct the Center for Medicare and Medicaid Innovation to develop new payment methods for doctors that would encourage collaborative care by health care providers treating physical and mental health problems. She would also issue recommendations to spur private health plans to pay for collaborative care.
Clinton also pointed out that though insurers have been required since 2008 to cover mental illnesses the same way they would cover physical ailments, enforcement has been spotty. Many mental health patients are forgoing treatment or struggling to pay for the care on their own.
Clinton's plan would use random audits to find violations of the 2008 law and make it easier for patients to report suspected violations. It would also require insurers to maintain up-to-date lists of mental health providers so people can more easily find an affordable therapist or doctor.
Since mental health treatment is most effective when offered early, the plan fosters early detection and intervention, including screening for pre- and postpartum depression and childhood trauma and stress. Clinton also pledged to bolster employment and housing support, both of which can help people with mental illness avoid jail and institutionalization and lead independent lives.
The plan has room for improvement. While Clinton promises to enforce existing transparency rules that require insurers to show they abide by the 2008 law, patients would be better served if she required insurers to give more detailed explanations of how they covered mental and physical health treatments.
But overall, Clinton's ideas would make an important difference in the lives of people with mental illness, as well as paving the way for improved diagnosis and treatment in the future. The biggest obstacle will be finding the money to put the plan into action.
Over time, some of Clinton's proposals might actually save money — the American Psychiatric Association estimates that integrating the mental and physical health care systems could save up to $48 billion a year. In the short term, though, her plan would have significant costs, including up to $50 million a year for suicide prevention on college campuses and $5 billion over 10 years to establish community health centers that treat the whole patient.
The hard part will be getting Congress to pay for the plan. A mental health bill made it through the House this year only after members deleted a provision to improve Medicaid coverage for inpatient mental health care that would cost $60 billion over 10 years. Still, Congress did manage to pass the mental illness coverage law in 2008. It could now draw on Clinton's ideas to build on that.