One in four adults across the United States suffers from a mental illness — including schizophrenia, bipolar disorder, depression, post-traumatic stress disorder — according to the National Alliance on Mental lllness (NAMI). Among that group, less than 40 percent receive professional treatment, choosing instead to battle their ailment in silence, often to their detriment and that of others.
But in the months and years after a young man opened fire on students and teachers at Sandy Hook Elementary in Connecticut, President Obama has helped elevate the conversation about mental health to the national stage.
The current administration has taken several significant steps forward in this area, potentially ensuring that President Obama has found his place as the most progressive executive on mental health issues in the last 30 years. Some of the desired results, however, have not yet come to fruition.
Under the Affordable Care Act (ACA), Obama has expanded access to mental health treatment for afflicted Americans as part of an effort to destigmatize this silent killer and prevent future massacres. In February, the president signed into law the Clay Hunt Suicide Prevention for American Veterans Act — legislation that would improve veterans’ access to mental health treatment — after it passed through the House and Senate. And earlier this month, First Lady Michelle Obama announced the launch of “The Campaign to Change Direction,” her attempt to raise mental health awareness among Americans.
“With President Obama being a prolific figure in our society, this act of stepping out and advocating equal access for all is crucial,” Lanada Williams, licensed psychotherapist and CEO of Alliance Family Solutions Counseling, told ThinkProgress. “I don’t think that I’ve seen that in other administrations.”
Williams said that while conversations about the lack of access of mental health services have taken place among practitioners, Obama taking the lead on the issue has brought awareness to the stigma of mental illness to a new federal level that will shift national conversation of behavioral health; hopefully, the president’s successor can keep up the momentum.
“His actions highlight the need for more mental health research and affordability of professional mental health services. Those are two things that we need to keep at the forefront because even with the Affordable Care Act, the stigma is still there in some communities,” she said.
Under the ACA, mental illness is no longer treated as a preexisting condition, allowing people to receive coverage as they would for treatment for physical ailments. That change has allowed some young people — many whom were able to remain on their parents’ insurance plan a bit longer under the health care law — to seek treatment. According to the Substance Abuse and Mental Health Services Administration, the number of people receiving mental health and substance abuse treatment services rose by seven percentage points within a two-year period.
However, issues still remain, particularly when one takes access to treatment into account. Many states haven’t been able to keep up with the influx in demand among the mentally ill for treatment. A Mental Health America report released earlier this year designated Arizona, Mississippi, Nevada, and Washington as the lowest ranking states for access to care. In January, nearly 2,600 mental health practitioners went on a week-long strike to combat what they described as Kaiser Permanente’s refusal to hire more psychiatrists, social workers, and therapists.
Lisa Ferentz, a licensed clinical social worker, said that the low coverage also remains a hurdle for people who need mental health services. Ferentz, a practitioner with 30 years of experience, told ThinkProgress that solving this particular issue may be out of President Obama’s hands. The current insurance reimbursement system, according to Ferentz, places patients at a disadvantage.
“Many insurance plans are restrictive. There are many people who deserve mental health care resources but who don’t get it because they can’t access them,” Ferentz said. “Even if people want to see me, the level of reimbursement is so low it ultimately discourages them. This has been an issue for years. Many of us who have been frustrated with the insurance companies opt out so what’s left for patients is a small pool of professionals limited in experience.”
Farentz recounted instances when she had to lobby insurance companies to cover her clients’ additional sessions once they reached the threshold outlined in their insurance plan. She said those experiences made her realize why it’s important that insurance providers let those who suffer from mental ailments — regardless of income level — choose their therapists and duration of care without worrying about financial burden.
New York-based attorney Carolyn Reinach Wolf, the director of her firm’s mental health law practice, added that federal laws need to change so that families can have more of an input in how their loved ones with mental illnesses receive treatment. She also called on the mental health care system to be more proactive rather than reactive, stating the need for involuntary commitment of those who pose an imminent danger to themselves and others. “We have misplaced ideas about how to treat the mentally ill. I’ve seen this through my own clients,” she told ThinkProgress.
Katrina Gay, NAMI’s national spokesperson, places much of the onus on Congress, which has struggled to pass bill that would comprehensively reform the mental health care system since the Sandy Hook massacre.
Lawmakers haven’t built consensus around two pieces of legislation that tackle various aspects of mental health treatment problem: Rep. Tim Murphy’s (R-PA) Helping Families in Mental Crisis Act and Rep. Ron Barber’s (D-AZ) Strengthening Mental Health in Our Communities Act. Last year, thousands of NAMI representatives converged on Capitol Hill to lobby their representatives to pass mental healthcare reform to no avail.
“It’s great that the Obama administration has taken action, but Congress as a body has failed to pass legislation and that’s a huge part of this issue,” Gay told ThinkProgress. “Pulling one lever in the executive branch is not enough. The administration’s actions have not been replicated in other policy circles on the scale that it should have been. There has been some good attention and that’s meaningful especially when it comes to veterans and young adults. However, health care reform and increasing coverage doesn’t translate into better access.”
During his time in office, President Obama has urged Americans to “bring mental illness out of the shadows.” While he’s arguably taken some important steps in that direction, he can’t do it without other lawmakers on the state and national level.