Your Brain On Hillary Could Be A Whole Lot Happier
By Sonya Huber
Hillary Clinton dropped a bomb at the end of August: the Comprehensive Agenda on Mental Health.
It should have been greeted with fireworks and André 3000 doing a shimmy with Tim Kaine and a hundred Lycra-clad dancers with jazz hands, but instead the detailed agenda was met with . . . crickets. Then again, we are all distracted, our collective mental health most likely in crisis over the impending election — not that we couldn’t all have already benefited from what’s in Hillary’s plan, if she can get elected and get it passed.
The fact sheet on Hillary’s website is a 36-paragraph treatise with 25 footnotes — and the plan is as comprehensive as it is impactful, to the extent that it’s rather stunning so few are talking about it at all.
It cites a study by the Child Mind Institute, which says that 17.1 million children have a mental health disorder, the majority of which go untreated, leading many into substance abuse and contact with the juvenile justice system. Hillary’s plan, then, could disrupt the school-to-prison pipeline by replacing the incarceration of low-level offenders with mental health and addiction treatment.
She also plans to convene a multi-agency discussion about suicide with the Department of Health and Human Services, the Veterans Administration, and the Department of Education. And she would help high schools learn about and implement model programs for suicide prevention, while helping schools develop information on mental health literacy for middle and high schools to be shared with parent groups and school administrators. The Department of Health and Human Services has put forward a goal of zero suicides in the country; in adopting that goal, Hillary’s plan proposes a massive study on the matter convened by the office of the Surgeon General.
Further, Clinton wants to take on the mental health of veterans, revamp addiction treatment, and focus on early intervention of mental health problems.
The plan comes at a pivotal time. According to a study from the National Center on Health Statistics, suicide is at a 30-year high in the U.S. Meanwhile, one in five people in the U.S. deals a with a mental health issue in any given year, although the impacts of these health issues, of course, affect many more — family members, friends, loved ones, even our collective future.
I know this truth intimately, as I could have used Hillary’s plan at many points throughout my life . . . when instead I was falling through the holes in our tattered mental-health safety net.
I was a white middle-class Mathlete with much more life stability than many other high school students, yet family stress and chemical imbalance gave me a helping of uncontrollable weeping and debilitating stress headaches. I went to the family doctor for the headaches and was put on some high-powered meds that were definitely, in retrospect, wrong for my condition — and that was it; that was all the treatment I received. In Hillaryland, however, I would have received “system integration,” meaning I could have easily entered the mental health system through a primary care doctor trained to screen for mental health issues and directly and easily refer patients. Deciding on one’s own to find a therapist is bewildering, but having guidance might have made all the difference for me then.
It’s something I’ll never know.
By college, one in four students has a mental health issue — and you can probably guess that I was one of them. I went to see a terribly unhelpful counselor on campus for five visits, and then was told I’d reached my limit for services and needed to find an outside therapist. Hillary’s $50-million college plan includes a focus on helping lower income students and communities of color coordinate care with these community providers, directing a multi-agency study with a particular focus on meeting the needs of specific populations such as students of color and LBGT youth.
I could have gotten an outside therapist through my parents’ insurance. Being 19, I decided instead to treat my depression with beer and punk. I graduated to panic attacks, which were misdiagnosed as seizures or a possible tumor; I was hospitalized but then let go, then taken to the Mayo Clinic, where I was told, “It’s probably all in your head.” I left school to cry, finally got a therapist because my mom made me, and eventually graduated (thank you, Zoloft).
After graduation, I moved far away to the east coast with zero life plans, which ensured that depression had a nice comfy nest in which to establish itself. I had no insurance, so I paid out of pocket for therapy, meds, and separate visits to a psychiatrist for prescriptions — a price tag that was usually about as much as my rent. I went without a car and cut down on most entertainment so I could stay alive. I got a better job with health insurance, but it lacked mental health coverage.
This major problem, the lack of “mental health parity,” has long been called out by mental health advocacy organizations like the National Alliance on Mental Illness. Hillary co-sponsored a law in 2008 that took aim at insurers who didn’t treat mental health at the same rate as other conditions. Problems with enforcement, however, persist, so the current plan adds penalties and reporting mechanisms to catch insurers who discriminate.
As a result of the difficulties I’d faced, I of course wanted to work in the mental health field, so I found an entry-level job as a teen counselor at a private nonprofit group home. I wanted to stay, but after a few years, I couldn’t handle the pressure or the low pay at the understaffed facility. I sent away for a pamphlet from a psychiatry PhD program, but I had no way to pay for school.
My situation is illustrative of the general staffing crunch in mental health fields, which is at a crisis level and has been for decades — now with fewer trained professionals than needed in the pipeline. Hillary will also address that in her plan via a multi-agency approach to recruit and retain staff, including loan forgiveness programs for people who enter mental health fields.
As I wasn’t employed in Hillary-land, I left the mental health field — but not the mental health wilderness. I got into a long-term relationship with a guy who had both addiction and serious mental health issues. This guy had also desperately needed Hillary’s intervention in his early teens, but instead he learned to self-medicate and to live at the lip of self-annihilation. Finding him meds was a constant battle. We tried community free clinics — where the wait time for each appointment was months — but he couldn’t get the kind of monitoring he needed to safely take his meds.
The best hidden surprise in Hillary’s plan includes a massive $5 billion increase for community health clinics, “including emergency psychiatric care, treatment for mental health and substance use disorders, and peer support” at subsidized rates. Visits to those clinics might have helped give my boyfriend a safety net, and me enough peace of mind to be able to gather my wits, get support, and leave him. Instead, my life felt unpredictable, receiving spotty and unreliable care for my mental and physical health due to gaps in insurance and changing networks. At one point, when no doctors I called were taking new patients, I had to resort to an outpatient psych ER to get meds, which was both expensive for me and a waste of the emergency staff’s time — when all I needed was a prescription for Zoloft.
As for my partner, by the time he decided he needed addiction treatment, we were both exhausted and desperate. We called around to try to find him help, and learned we’d either have to pay several times our income, or the wait for treatment would be months. Hillary’s plan would step in here too, committing $7.5 billion for proposals from states to combat drug and alcohol addiction. Another $2.5 billion would be contributed over 10 years to increase current federal substance abuse support — which could potentially change the landscape of suffering in this country, slowing the trickle-down wreckage caused by addiction that affects generations.
Instead, my boyfriend went through a great outpatient program that was free but over-stretched and under-staffed, without the capacity to provide much follow-up care, so he eventually slipped away from that structure. His addiction and mental health crises continued — as I continued to stand by his side.
Some kind of coordinated care is especially vital for people who have a “dual diagnosis,” i.e., both an addiction and a mental health condition. People with these dual diagnoses are likely to end up in the criminal justice system, so it’s notable that Hillary’s plan emphasizes treatment instead of incarceration, including training and incentives for police. This is crucial, as about half of male inmates have a mental health issue — and in state prisons, as one example, 73% of female inmates have some type of mental health issue; up to 65% of those people who are incarcerated have some kind of addiction.
Looking back on my own story, it’s impossible to separate my mental health challenges from the stress of finding care. I had to beg for freebies and resort to complicated and hidden applications for assistance, as if I were seeking a back-alley solution to an embarrassing problem. It’s no wonder that many people give up before finding support.
Meanwhile, Republican candidate Donald Trump’s website merely says that mental health is a “need” and that there are plans being developed in Congress; in other words, he has no plan besides stressing us all out.
Hillary’s plans for mental health and substance abuse treatment come with some hefty dollar signs — about $16.5 billion in the explicit financial commitments alone, not including the many efforts that don’t have specific price tags attached. One might wonder where all this cash is going to come from. Julie Wood from Hillary Clinton’s outreach team replied to my question on the matter in an email, writing: “Some of these efforts, including early intervention and promoting system integration, can save billions of dollars.” The plan’s fact sheet describes savings of $26-$48 billion, with $7-$10 billion of savings for Medicaid alone. The Committee for a Responsible Federal Budget, which tracks the costs of each candidate’s campaign promises, explains that Clinton’s health proposals are calculated to be offset by tax increases on those making above $200,000 a year.
The plan is chock-full of so much more: an emphasis on drug courts to keep low-level offenders out of jail and in treatment; supportive housing and job placement help for those with mental illnesses and disabilities, including $100 million in housing support and the designing of new workplace opportunities; an expansion of current federal support for brain research; a focus on pre-natal health care and screening for infant and mother mental health to address the fact that one in five new moms develops a mental health issue; and an increase state grants (called block grants) to support school programs for children with behavioral and developmental issues.
If Hillary is lucky enough to meet with a majority Democratic congress, her plan has a much better chance of passing, but a Republican congress intent on avoiding anything that would help Hillary’s approval rating might block anything that can be described as an entitlement program. Building bipartisan support for this effort, however, could finally address the emotional stress that burdens families and communities.
I really do want to imagine a different version of my own story. Instead of fighting to get care for myself and others, it would have been great to know what I was dealing with, to have names for the problems, to get meds and calming private talks with professionals, so that I could then get on with the business and the joy of growing up and living.
Lead image: flickr/Mark Nozell