Watching last night’s debate on CNN between eleven of the top Republican candidates for President I was majorly disappointed in both the moderators and the candidates when it came to talking about mental health- from access and affordability of care to the role that mental health plays in discussions of gun violence and gun control. Someone on that stage will have a decent shot at being the next President and it’s an issue that’s of critical importance to almost all Americans and plays a role in everything from the social safety net, to economics and productivity and the role of government in our lives. And yet with the candidates who spoke on the subject it felt like a race to the bottom of ignorance, willful disregard and outright hostility to the challenges facing the mental health community.
Here’s my brief recap and what I would have liked to see…
Mental Health Care and Access
As one might expect, discussion of health care policy was pretty limited to talking points about repealing the Affordable Care Act “on day one!” Besides being impossible for the executive to repeal in a single day, Obamacare, for all of it’s problems, has increased the number of insured Americans and has expanded coverage for millions of people. This New York Times story has a good round-up of Census Bureau data that shows how the number of uninsured Americans have fallen. This is critical for creating an environment where people can seek treatment and medication for mental health concerns. The Affordable Care Act also requires insurers to expand coverage for mental health and substance abuse treatment. One of the key pieces of this is that the law expanded the Mental Health Parity and Addiction Equity Act to cover preventative services, including mental health screenings. Being able to identify and address a mental health issues before it reaches a crisis stage is one of the surest ways we can improve mental health care in this country. And the GOP candidates were asked next to nothing about the Affordable Care Act or their own health care plans, and when they volunteered a position on their own it was almost exclusively to decry the law without offering any kind of real solution.
Gun Violence and Mental Health
OK, this is where I wanted to throw something at the TV. I’ve written about the problems with guns and mental health here before, so when Hugh Hewitt asked:
“Last week, you said the next step in gun issues is to make sure they’re not in the hands of mentally ill. In this state, there’s a controversial law that allows guns to be taken away from people without a hearing. Where does it go — and the problem of violence is endemic, but where does it go from what you said last week, how far into people’s lives to take guns away from them?”
I was concerned by the way he asked the question, but thought, OK, at least they’ll talk about it. But then both Jeb Bush and Marco Rubio (and Hewitt himself) took the conversation in a direction that didn’t actually address the main reason we should be concerned about the mentally ill and access to guns int the first place.
As you can see from the chart on the right using data from 2013, significantly more people in the US who die from the use of a firearm commit suicide than are murdered. Jeb Bush claimed that 99.999% of gun-owners are law-abiding citizens, and accepting that at face value, it fails to account for the fact that 1 in 5 people suffer from a mental health issue. People who kill themselves are very often law abiding citizens without a criminal record but comprise two-thirds of gun deaths. Marco Rubio said that we shouldn’t concern ourselves with what people use to commit violence, but why they commit violence in the first place. I’ll assume that he would include a suicide by gunshot to violent and take him at his word that he wants to consider the reasons why someone would want to commit that kind of self-directed violence. Maybe it has to do with the fact that mental illness carries tremendous social stigma, maybe it’s because treatment is difficult to access or the affordability of treatment. So when he talks about the institutions that need to be strengthened to address these issues he has some solutions to offer other than the repeal of Obamacare.
If the media and politicians cannot understand or address that fact then any discussion of gun control and the mental illness useless unless we address the real problem of suicide we will continue to see thousands of preventable gun deaths in this country every year.
Mental Health and Productivity
Almost all of the candidates at one point or another talked about economic productivity and the need to either stimulate it (through tax cuts) or getting out of it’s way (through deregulation). What they missed is the fact that according to the National Alliance of Mental Illness (NAMI) the indirect costs of mental illness of US productivity is nearly eighty BILLION dollars and that more workdays are lost the mental illness than diabetes, asthma, arthritis, back pain, hypertension and heart disease. Proper mental health care and treatment could help stop that economic hemorrhaging, but again, the candidates without exception seem opposed to supporting or investing in that.
Mental Health and Veterans
The subject of veterans and health care access wasn’t even addressed.
My key takeaway from the debate is that mental health got short shrift in the debate and even when it was addressed it was burdened by the ignorance of the moderators and candidates. I’ll continue to watch for what the candidates do and say on this issue, and that goes for the Democrats as well when they debate. Mental health is too important to gloss over and ignore.