My plan to tackle the mental health crisis in America

It’s time for mental health to be taken as seriously as physical health.

Kirsten Gillibrand
Aug 20 · 11 min read

Transcending race, gender, age, religion, or life experience, mental health is a growing crisis in our country — and it has gone without sufficient attention, care or resources for too long. Antiquated stigma and systemic failures have kept millions of Americans from sharing their suffering with others, forcing them to struggle quietly.

One in five American adults is coping with a mental health condition and the mental health of our youth is in decline. This has debilitating everyday impacts for too many Americans. And with such limited access to mental health services, the untreated mental health problems of today can too often turn into the tragedies of tomorrow.

It’s all too clear that America is facing a mental health crisis, and it demands more than attention from our leaders — we need a real plan.

I’ve spoken to Americans across the country, and I’ve seen that we have to fundamentally change our mental and behavioral health system. This includes developing community-based treatments, expanding delivery systems, and ensuring true parity with insurance coverage for mental health treatment. We must strengthen our nation’s mental and behavioral health safety net by ensuring that policies address the communities most affected and hardest to reach. And we need mental and behavioral health systems that work for everyone.

If we truly believe that health care is a right and not a privilege, then access to quality mental health treatments cannot be up for debate. It’s time for mental health to be taken as seriously as physical health.

I’ve spent my career fighting these important fights and standing up for families just as I would my own. As president, I’ll deliver on this issue.

Here’s how I’ll get it done:

Reform treatments so they can work for everyone

Too many Americans struggle with inefficient and inadequate treatments or delivery systems. As president, I will fundamentally change the way we currently provide mental health treatments, and tailor different treatments to different communities. There isn’t a one-size-fits-all solution for mental health issues, so we should stop treating this issue like a monolith. My administration will invest in and account for different perspectives so that everyone has access to the treatments they need.

1 I will invest in a community-based approach to mental and behavioral health. We need a robust and aggressive expansion of our nation’s Community Health Centers, aimed at delivering high quality, cost-effective mental and behavioral health care. Certified Community Behavioral Health Clinics (CCBHCs), which provide a comprehensive range of addiction and mental health services to vulnerable individuals, should be fully funded and supported. Community Health Centers continue to provide innovative, high-value health care and they are primed to deliver it in medically underserved communities across the nation.

Community-based approaches like the peer education model are not only cost-effective, but have also been shown to be more effective at reaching populations who find the information more credible coming from someone with a familiar background and who understands their communities and the issues they face.

2 I will make sure our health care system is responsive to the historical and cultural context that communities bring with them, and confront implicit bias in the medical system. Different communities face different barriers to seeking mental and behavioral health care. I will push providers to develop and promote alternative community-based options for treatment, so that patients are met where they are and with the treatment that works best for their needs, without obstacles or stigma.

Implicit biases in health care, especially mental and behavioral health care, disadvantage already vulnerable people. Health care providers must be trained to look out for and stop the ways in which our system has historically ignored or outright harmed communities and people of color.

I will also make sure our health care system overcomes implicit bias toward individuals facing poverty, sexual minorities, children, mothers (particularly new mothers), the elderly, the overweight, and people with disabilities. Every patient deserves respect from their health care practitioners and that respect must inform a new approach to mental and behavioral health treatment and effective services beyond traditional therapy.

3 We must expand reimbursement for mental health services for non-traditional treatments such as peer-support and alternative therapies. Cultural support can provide a gateway to other support systems. That’s why I will embrace non-traditional treatment and prevention strategies such as the peer education model, which is cost-effective, and connects those seeking treatment with a peer who understands their background and brings with them significant credibility. As president, I will make sure these non-traditional treatments are given proper reimbursement rates as well, so that high costs aren’t barriers to those looking for help.

A perfect example of this within the Latino community is the use of promotoras. Promotoras are generally people from hard-to-reach populations who act as bridges between their community and the complicated world of health care. They learn about health care principles from doctors or non-profit groups, and share their knowledge with their communities. I will make a point to encourage these localized programs and provide them with the support they need to be maintained and expanded.

Personalize the way we deliver mental health care

It’s important to reform our mental health treatments, but that alone isn’t enough to tackle this crisis. As president, I will go further to specifically address the barriers that either make it too hard or outright prevent Americans from accessing the mental health care they need. Every community is different, which is why I will invest in solutions that make health care more accessible for all Americans, regardless of who they are or where they’re from.

1 We need a mental and behavioral health system designed for and informed by young people. The world my sons are growing up in now is so different than the one where I was raised. Young people are more connected and engaged than ever, but that comes with costs. It never once occurred to me growing up that someone with a gun might walk into my school and open fire.

We can’t ignore the ways in which our young people suffer, so as president, I will invest in a trauma-informed mental health system that embraces young people’s preference for peer-based support and support from adults from their own communities with shared experiences. And I will make sure that young adults in low-income communities have the same access to these opportunities.

I will fund and expand School-Based Health Centers (SBHCs), which are important providers of mental health services for young people. SBHCs help children and adolescents nationwide receive primary, preventive, and mental and behavioral health care and health education in a convenient, high-quality, and efficient manner.

I will also pair school-based mental health services with investment and comprehensive school climate reform. School systems can leverage opportunities in the Every Student Succeeds Act (ESSA) to hold schools accountable for school climate as a key, non-academic quality indicator. ESSA also offers funding opportunities for low-income schools and schools in need of improvement to leverage resources for support including mental health services.

By changing the way in which we deliver mental health care, we have the opportunity to change norms and beliefs about these types of services for young people who may otherwise not be suited for traditional, institutional care models.

2 I will improve mental and behavioral health care access for rural Americans and improve rural workforce programs and supports such as the National Health Service Corps (NHSC), which places primary health care providers in our nation’s most underserved rural communities.

No one should have to suffer because there just isn’t access to any treatment near them. In America’s rural communities, young people in particular face too many barriers to health care already, and it is unacceptable that so many are being discouraged from receiving treatment because of who they are or what they believe. Our LGBTQ+ youth are so often discouraged from getting treatment or forcefully isolated because of where they live.

Right now, there’s only a small amount of spending for all rural health discretionary programs, but it already plays a critical role in solidifying the fragile health care infrastructure in rural communities. As president, I will continue supporting government policies that improve rural health outcomes and strengthen care delivery.

To provide long-term solutions for the lack of health care access in rural areas, the best thing we can do is invest in future physicians, doctors, therapists, and other mental and behavioral health care providers in rural places. So, I will also support programs that further develop our national health care workforce, such as the Rural Physician Training Grant program, the Targeted Support for Graduate Medical Education program, and Area Health Education Centers, which plays a critical role in addressing the health care workforce shortage. And I’d invest in the Office for Advancement of Telehealth (OAT) to make health care more accessible for all and to give people privacy as they receive treatment.

Require insurance coverage of mental and behavioral health

If we truly believe that mental and behavioral health are just as important as physical health, then our insurance coverage and reimbursements must reflect that. As president, I will ensure true parity implementation with robust oversight and consequential enforcement. Treating mental wellbeing shouldn’t only be something available to the wealthy, but insurance companies’ failure to appropriately cover these treatments acts as a barrier to millions who can’t afford the treatments they need.

1 Create accountability measures for mental and behavioral health care providers. It shouldn’t be difficult for Americans to get coverage for the treatments they need, but that’s what has happened with our current for-profit system. A watchdog would give all Americans access to oversight measures so that insurance companies are held accountable if they fail to provide coverage or reimbursements.

A watchdog program would also educate individuals and families on their legal rights to insurance coverage for mental and behavioral health services, resolve complaints when care is denied, and identify areas where insurers may have an inadequate network of treatment programs and providers.

2 Secure financing methods for mental health service improvements through insurance. If we expand what is covered under our current health care system as a part of a broader overhaul and expansion of our mental health services, overall costs will go down as fewer emergencies arise.

As president, I’ll also invest in areas like community case management, transportation, rehabilitation-recovery services, and job training to make overall and long-standing improvements to our system and create a fully coordinated system.

I’ll also further invest in suicide prevention efforts for young people, with a renewed focus on college campuses and adults 25 and older, and LGBTQ people. LGB kids are almost five times more likely to attempt suicide than their straight peers, and bullying or abuse of LGBTQ kids is directly and dramatically correlated with self-harm. I will increase funding and access to mental health services for LGBTQ youth, and I will innovate and invest in broad suicide prevention efforts that focus on scaling in small and hard-to-reach communities.

3 Pass Medicare for All and preserve and expand successful mental health programs. One of the best ways for us to ensure that everyone has the coverage for mental and behavioral health care is to provide universal health care. I’ve supported Medicare for all since 2006 because for over a decade I’ve witnessed the worry and fear and impossible choices that come from our for-profit insurance industry. As president, I will pass Medicare for All and I will make sure that everyone has the care they need and the coverage they deserve.

I’ll also start to immediately incorporate a wellness framework into what is considered a “medical necessity” and “health care,” with ample opportunities for state and federal reimbursement. And I’ll preserve and expand existing Medicaid programs, like the Community Mental Health Services Demonstration Program, that improve mental health coverage for low-income adults.

Tackle the linked mental health crisis and opioid epidemic

The opioid epidemic is a defining crisis in our country right now as millions of families are ripped apart and hundreds of thousands of communities lay destroyed. As I’ve traveled the country, my heart has broken as I’ve heard story after story of people whose lives have been forever altered because of this crisis. In places like New Hampshire, Substance Use Disorder is so devastatingly common, it’s often impossible to find anyone who hasn’t been personally affected.

The opioid epidemic has a real and inextricable link to our nation’s mental health crisis, which my mental health platform takes on directly.

1 Integrate substance abuse treatments with our mental and behavioral health treatments. When those struggling with Substance Use Disorder enter into recovery, their mental wellbeing is a crucial part of the recovery process.

As president, I will fully fund and implement the SUPPORT for Patients and Communities Act to directly address this problem. This legislation would allow us to take advantage of provisions that support trauma-informed care, funding for peer support, and prevention opportunities. It would improve access to medication-assisted treatment. It would incorporate counselors and behavioral health professionals, services which can generate impact beyond substance abuse treatment. This “whole-patient” approach is crucial because it not only helps those suffering from Substance Use Disorder begin recovery, but it helps them remain in recovery in the years ahead.

2 Invest in family support services for those struggling with Substance Use Disorder. By authorizing a grant program for nonprofits and health care providers to administer family support services, we can help treatment outcomes. When people in recovery reenter the workforce and their daily lives, it’s vital they have support from those around them and can lean on those they’re closest to. Family support services provide that security and have been proven to help with prevention, treatment, and recovery.

But too often, these services are not covered by insurance. As president I will change that. The support of family can play a crucial role in maintaining the mental health of those suffering from Substance Use Disorder. These services are health care by any real definition, and deserve to be treated as such.

3 Formalize pain and addiction in medicine. We need to take steps to systematize pain treatment so that doctors and practitioners can more safely help their patients with the treatments they require. With this comes additional training, both in pain and addiction.

As president, I plan to comprehensively address the syndemic of mental health, chronic pain, and addiction. I will incentivize specialized training to prepare more health care providers with the diagnosis and treatment of chronic pain, and to incorporate alternative pain management treatments that stymie the risks of opioid addiction.

We need nationally accredited addiction medicine programs in the education pipeline, Continued Medical Education (CME) regarding chronic pain and addiction for frontline providers like emergency physicians and primary care providers, and more scientific research into the nexus between pain, addiction, and mental health. It’s important that our providers get better training around diagnosing chronic pain and identifying, treating, and managing Substance Use Disorder in order to improve mental health outcomes across the board.

I’d also fund more research around chronic pain and addiction to learn more about how things like brain chemistry and social environments can contribute to addiction. This preparation will better our health care workforce, but it will also go a long way towards reducing stigma around addiction and further operationalize it as a medical field of study.


On the campaign trail, I hear a lot about mental wellbeing. I hear it from the grandparents in New Hampshire who have taken their grandchild in now that their daughter passed away from Substance Use Disorder. I hear it from kids scared to go to school in case there’s a mass shooting. I hear it from health care providers in Iowa who don’t have access to the resources they need.

There is not one family in this country that isn’t concerned about mental health to some extent. But for all of these conversations I’ve had, they’re almost always whispered. People are too afraid of the stigma to voice them loudly. As president, I will break down those barriers.

I will make sure everyone across the country knows and sees that mental health care is real health care. I will increase access to care, fight stigma and change the way people perceive mental health care, and then provide resources for communities to invest in solutions that are already working.

Together, we can spark a fundamental shift in our country that will make us all more understanding, compassionate, and healthy in every sense of the word. That’s a world that I want to live in, and as president, I’ll get it done.

Kirsten Gillibrand

Written by

Mom to Theo, Henry and dog Maple. Wife to Jonathan. U.S. Senator from NY and candidate for president. Text BRAVE to 60980 to get updates from Gillibrand 2020!

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