Wednesday, November 9, 2016

Impact of Trump Election on Federal Mental Health Policy

(Full disclosure: I am a left-wing Democrat.) 

Here are two snippets from Trump's policy platform on serious mental illness

From Trump Healthcare page:
"Finally, we need to reform our mental health programs and institutions in this country. Families, without the ability to get the information needed to help those who are ailing, are too often not given the tools to help their loved ones. There are promising reforms being developed in Congress that should receive bi-partisan support.

From Trump 2nd Amendment page:
"Fix our broken mental health system. All of the tragic mass murders that occurred in the past several years have something in common – there were red flags that were ignored. We can’t allow that to continue. We must expand treatment programs, and reform the laws to make it easier to take preventive action to save innocent lives. Most people with mental health problems are not violent, but just need help, and these reforms will help everyone.

My experience is that Dems are willing to throw money at improving mental health in the 18% of adults who may have some form of illness (anxiety, ADHD, mild depression, etc.) but they won't admit to the unpleasant truths that need to be recognized to help the 4% of adults with serious mental illness. Dems will not admit that not everyone recovers, that when the most seriously ill go untreated they are more violent than others, that some people do need hospitals, that involuntary treatment is better than incarceration, etc. 

If they won't admit the problems, they will not solve them. They are also unduly influenced by the mental health industry, much of which wants to continue to receive mental health funds, free of any obligation to help the seriously ill. As an example, the mental health industry is cheering the new Obama-appointed federal Mental Health Parity Task Force Report, in spite of the fact that it left out the most seriously ill. I have previously written on Hillary Clinton's failure to focus on the seriously mentally ill. And today, election day, the NY Daily News gave big play to my op-ed on the failure of NYC Mayor Bill de Blasio to focus the $850 million NYC mental health plan on the seriously ill. Again: this is from a Dem.

On the other hand, Republicans are concerned about the effect of homelessness and untreated serious mental illness on quality of life, the spiraling cost of funding pop-psychology and politically-correct pablum (MHFA, stigma etc.) and disturbed by the growing jail populations. So while they are tight-fisted and may be less willing to fund the worthy, but tangential social services that often are wrapped in a mental health narrative, I have found they are willing to fund evidence based interventions that really do prevent homelessness, arrest and incarceration of the most seriously ill. Even if one argues Republicans have (what to some are) impure motives for supporting mental illness reform (i.e., to stave off calls for gun control), that still gets them focused on improving mental illness treatment. From our perspective, that is a good thing.

So from a mental illness policy perspective, if Trump sticks to what has become Republican orthodoxy (a big 'if', i.e, focus on the most seriously ill), then perhaps things will get better. For example, he could start by "Draining the Swamp" at SAMHSA/CMHS, which is funding so much anti-psychiatry and anti-science that passes as "recovery" or "trauma" treatment these days.

One idea for Trump would be to appoint this person as SAMHSA Administrator. She was the former Medical Director of SAMHSA, and wrote this devastating critique on 
SAMHSA/CMHS when she left. Reforming SAMHSA and CMHS is more likely to happen under Republicans, than Dems (assuming again that Trump is a Republican). Of course, he has also promised to dismantle the Affordable Care Act which would hurt persons with mental illness as it hurts all others. And it is hard to pin him down on specifics. 

Effect on Mental Illness Legislation in Senate

The Senate will come back to work for just a few short weeks before the new administration takes over. They do have mental health reform on their calendar, but it is questionable as to whether there is actually enough time in the short session to get around to it, and if they do get around to it, will it be the weak bills they are currently considering or something stronger.  We should try to get the Senate to take up and pass the The Helping Families in Mental Health Crisis Act (HR2646) during this short lame duck session. It passed House in uniquely bipartisan 422-2 vote. It will start to get the federal mental health agencies to focus more on the seriously ill, help create more hospital beds, fund programs like Kendra's Law and focus on programs that have evidence of efficacy.  Mental Illness legislation should not have to wait until a new administration takes office.

Call your two U.S. Senators at (202) 224-3121 and urge him/her to bring the Helping Families in Mental Health Crisis Act (HR2646) to a vote in Senate as soon as Senate returns to work.  Mental Health reform should not be put on hold until the new administration takes over. The call takes two minutes


Thanks for all you do. Reminder. My book, Insane Consequences: How the Mental Health Industry Fails the Seriously Ill is a valuable advocacy tool that can be pre-ordered on Barnes & Noble and Amazon. Follow Mental Illness Policy Org on Facebook and Twitter.


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