In the summer of 1972, faced with a steep fight against Richard Nixon and a limited supply of potential vice presidential picks, George McGovern narrowed in on Thomas Eagleton, a young Senator from Missouri. Democratic strategists predicted the last-minute choice, selected without any formal vetting, would bring in Catholic and labor union voters.
But when news surfaced that Eagleton had previously suffered from three bouts of depression, and had twice undergone electroshock therapy, his political viability plummeted. The public questioned whether a man who suffered from mental illness was fit to be President of the United States. Despite McGovern’s initial insistence that Eagleton was in fact fully prepared to take office, the Senator was subsequently asked to step down, after only 18 days of campaigning.
This summer’s Washington Monthly special report, “Mental Illness and Addiction Don’t Respect Party Boundaries,” reflects how far American society, and its politicians, have come, since 1972, when discussing mental illness. No longer would discovering that a politician had suffered from mental health problems be akin to discovering their extramarital affair. Introduced with a touching, personal essay by the American Enterprise Institute’s Norman Ornstein, the report delves into some of the more intimate and complex questions surrounding mental illness, while also highlighting the important work of presidential candidates Hillary Clinton and John Kasich in advocating for much-needed mental health care reform.
Perhaps most importantly, the report highlights what national politicians and the media have still failed to do: engage with mental health on its own terms. While most politicians ostensibly “support” action on mental health, at least as buzzwords, the public debate over what mental health reform is and should be remains shockingly lacking. Though mental illness affects one-in-five Americans, along with countless family members and friends, real progress on this issue is alarmingly opaque—merely something to “de-stigmatize”—but never a public policy challenge that requires true critical engagement and public discussion.
Put simply, where mental health is concerned, politics just hasn’t caught up to policy. When our presidential candidates use the words “mental health” on the campaign trail, they expect an uncritical, communal nod of approval. Mental health is presented as an issue of the education system, of the criminal justice system, of the debate over gun control. But in public campaigning, it’s never evaluated in its own right.
This is not because of an absence of relevant tension and contention among reformers. The true diversity and complexities of this issue are articulated clearly in this report, which delicately weaves through a number of discussions. For example, there’s the issue of health care access. Sally Satel’s piece focuses on the struggles faced by recovering drug addicts trying to access prescription medication, while Keith Humphrey argues that the quality of mental health care has not caught up to increasing demand. Meanwhile, Elizabeth Hewitt analyzes the unique struggles faced by rural communities, which face higher rates of drug overdoses with limited resources. And Jenny Gold impresses the need to better enforce mental health parity laws, which require that insurance companies treat mental and physical health needs equally.
The report also considers the important relationship between the criminal justice system and mental health. For example, Paul S. Applebaum discusses mental health courts, which aim to direct the mentally ill, who have also been convicted of crimes, to treatment, rather than prison. While diverting these individuals away from the criminal justice system may sound good in theory, Applebaum points out that “family members desperate to obtain treatment for a loved one may see no alternative but to have the person arrested, hoping detention will lead to diversion to [a mental health court].” Relatedly, Harold Pollack discusses the work police forces need to do to better understand those with serious mental and intellectual disabilities. These are vital questions that we, as a society, should be carefully considering.
Yet, if you’re a member of the public following the presidential election, these questions and debates simply sound like alien, wonkish mush.
And it’s not that these issues are uncontroversial, or that there’s been no recent, relevant legislation under debate—although the public could not seriously be faulted for not knowing about them. For instance, Ornstein explains, “the [recent] Murphy-Johnson bill faces opposition from both Democrats and Republicans—with many Democrats resistant to anything that impinges on the civil liberties of the mentally ill, even if they are deeply psychotic or don’t recognize their illnesses, and many Republicans resistant to spending any money through the federal government.” Some legislators think the law doesn’t go far enough in addressing the incarceration of mentally ill people. Others think the legislation too greatly limits the power of Protection and Advocacy (P&A) organizations, groups who provide legal support to underserved individuals with disabilities. Debate over out-patient assistance to the seriously mentally ill is also a current area of debate. Some legislators have even proposed an overhaul of SAMHSA (the Substance Abuse and Mental Health Services Administration⎯an agency that falls under the Department of Health and Human Services), which they believe undermines patients.
Thankfully, at the beginning of the primary season, it seemed that mental health could finally have a chance to shine in a presidential campaign, and that a real evolution in mental health discourse was on the horizon. In May 2015, Hillary Clinton made early calls to discuss the substance abuse epidemic, and spoke about the need for better funding of treatment facilities, which she promised to make central to her campaign. And Hillary is no stranger to mental health advocacy. As outlined by Greg Sargent in the Washington Monthly report, Hillary did important work with Tipper Gore to advocate for mental illness awareness and reform, helping organize the first White House Mental Health Conference in 1999, and has long been a supporter of mental health parity with regard to insurance.
And on the other side of the aisle, Ohio Governor John Kasich also advocated for increased financial support for the seriously mentally ill, primarily through expanding Medicaid in Ohio. Carly Fiorina frequently spoke about her own family’s struggle with drug abuse and mental illness. Even Ted Cruz weighed in, discussing the dangers of alcoholism.
But now, in the face of Trumpism, any opportunity for the country to pursue meaningful policy discussion on mental health reform has been all but shattered.
Trump’s rhetoric with regard to mental illness has failed to impress mental health advocates, to say the least. He’s also continued the Republican trend of making vague calls for mental health reform in the wake of a mass shooting—and then doing nothing. (These platitudes have been equally present following Orlando.) Of course, one might wonder, if Republicans really believed mental health was the primary issue behind gun violence—and the belief isn’t unfounded, more than 60% of gun deaths are suicides, according to the CDC—wouldn’t the GOP be filibustering for mental health legislation, as Democratic Senator Chris Murphy did for gun control?
Ultimately, if politicians really thought mental health was as important as their occasional stump speech references might suggest, the state of mental health care in the United States might be very different. But unlike the Trans-Pacific Trade Partnership, the Affordable Care Act, NAFTA, and laws concerning equal pay, bathrooms, net neutrality, marriage equality, abortion, and fracking, civil engagement and public debate on mental health has a long way to go. And, for people who seek the office of President, just saying the words should not be enough.