According to the Washington Post, Hillary Clinton's staff said she will make mental health a focus of her campaign, but her history on the issue doesn't bode well. To understand why, look back to January 25, 1993, when President Bill Clinton created a President's Health Care Reform Task Force charged with developing a national health-care plan. While Bill is not Hillary, he appointed her to head the task force.
Hillary's task force created a Working Group on Mental Health headed by Tipper Gore, wife of Vice President Al Gore, who had a degree in psychology, suffered from depression, and had strong connections to Mental Health America. According to their website, Mental Health America is focused on the very expansive agenda of "helping all Americans achieve wellness by living mentally healthier lives."
The key issue facing the task force was whether government funds should be used to "help all Americans live mentally healthier lives," or be limited to helping those who are so severely mentally ill that they genuinely need government aid. This is still a key issue today. It is the seriously ill, not the worried-well, who are overcrowding our jails and shelters and living a hellish existence encased in psychotic delusions. The working group rounded up all the usual mental-health trade associations and naturally concluded that the national plan should cover all mental-health services for everyone. This bloated the cost and increased projected premiums for Hillary's proposed health-care plan by $275 a year per person. That stopped the idea of including expansive mental-health coverage in its tracks. Rather than exercise control and include benefits for only the most seriously ill, Hillary jettisoned virtually all mental-health coverage from the plan, thereby losing the opportunity to reduce homelessness and incarceration. Her plan never passed Congress, but even if it had, the seriously ill would still be left to fend for themselves.
This issue of whether government should try to improve the mental health of everyone or focus its limited resources on the truly needy is a leitmotif. It came up again later in the 1990s, when Congress was considering what to do about private insurers. Senator Pete Domenici (R., N.M.) led a reform group that included Senators Paul Wellstone (D., Minn.) and Ted Kennedy (D., Mass). They all clearly understood the difference between poor mental health and severe mental illness. Domenici had a daughter with schizophrenia; Wellstone, a brother with bipolar disorder; and Kennedy, a mentally ill aunt. They didn't want to repeat the mistakes Clinton made, so they commissioned a report on serious mental illness only. It found that requiring private business insurers to end discrimination against the seriously mentally ill and provide parity coverage for narrowly defined severe mental illnesses would increase costs just 10 percent. There would also be significant cost savings for government via decreasing incarceration and hospitalization. This led to the passage of Mental Health Parity Act of 1996. It was watered down but succeeded because the sponsors ignored the mental-health industry's desire to cover everything for everyone and limited the bill to the narrow public interest of helping the most seriously ill.
Democrats have had trouble understanding this. (Disclosure: I am one). They throw money at mental health but fail to understand it's not helping the seriously ill. First Lady Michelle Obama recently trumpeted Mental Health First Aid. It's a training program for the public that large mental-health groups sell. Her husband scheduled it for tens of millions in incremental funding, in spite of the fact that research does not show it helps the seriously mentally ill.
In 2009, President Obama, coincidentally while also in New Hampshire and answering a question, asserted his desire to include treatment for mental illness as part of what became the Affordable Care Act. It was déjà vu all over again. His administration proposed some of the enabling mental-health regulations. But like Hillary Clinton's task force before it, his administration ignored the elephant in the room: getting treatment to adults with serious mental illness. The new regulations define what mental-health services certain programs have to fund, but inexplicably, leave out hospitalization for the most seriously ill. Plain-vanilla mental health gets funded while serious mental illness is excluded.
If Hillary becomes president, this issue is one she will probably have to take on. Congress will soon reconsider the bipartisan Helping Families in Mental Health Crisis Act. It's championed by Representative Tim Murphy (R., Pa.) and incorporates ideas from Representative Eddie Bernice Johnson (D., Texas). Like Domenici and Wellstone before them, these two know serious mental illness. Representative Murphy is a psychologist, and Representative Johnson is a former head of psychiatric nursing at a VA hospital. The Helping Families in Mental Health Crisis Act does what Clinton, when given the chance, refused to do: focus our resources on the most seriously ill. It attempts to replace years of mission creep with a dash of mission control. The bill cuts programs that lack evidence of efficacy and uses the savings to fund programs proven to work. The bill restructures the Substance Abuse and Mental Health Services Administration (SAMHSA), which has done little for the seriously ill.
The Helping Families in Mental Health Crisis Act has tremendous support from the families of the seriously ill, police, sheriffs, and even many mental-health organizations that are tired of seeing the most seriously ill go to the end of the line for services. The only real opposition comes from groups that receive SAMHSA funds and want to maintain the status quo. If the reintroduced bill passes -- it previously had 115 co-sponsors from both parties -- and Hillary is elected, her administration might be required to develop the enabling regulations. Let's hope that she will have learned from the past, and will understand that those with serious mental illness should be given the highest priority, rather than the lowest. Anything else would be insane.
D. J. Jaffe is executive director of Mental Illness Policy Org., a nonpartisan think tank on serious mental illness, and is looking for a publisher for How the Mental Health Industry Kills the Seriously Mentally Ill: A Handbook for Change. A version of this appeared in National Review Online.
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