Psychiatr News October 17, 2008
Volume 43, Number 20, page 1
© 2008 American Psychiatric Association
Obama Provides More Specifics Than McCain on MH Care
Rich Daly
Both the Obama and McCain campaigns say that mental health care is a
priority, but the proposals they describe to NAMI for dealing with this issue
differ in scope and specificity.
The two major-party presidential candidates have begun to expand on their
mental health positions in the final weeks of the 2008 campaign. According to
the National Alliance on Mental Illness (NAMI), Sen. Barack Obama (D) strongly
supports a range of efforts to improve mental health care, while Sen. John
McCain (R) emphasizes prevention and efforts to control the cost of addiction
and psychiatric illness.
NAMI asked both candidates mental health policy questions that probed their
mental health and addiction care priorities and released their responses in
mid-September.
Obama responded to each of NAMI's 24 questions on mental health care
issues, while McCain responded with a general policy statement on mental
health and addiction care.
Obama stated that he "strongly supported" all efforts to
improve and promote mental health care and screening.
In response to a question about ways to make mental health and addiction
care accessible and affordable, Obama responded that his national health plan
will guarantee affordable, comprehensive, and portable health coverage for all
Americans through partnerships among employers, private health plans, the
federal government, and the states.
"In addition, my plan will include coverage of all essential medical
services, including preventive, maternity, and mental health care," his
statement said.
McCain cited the need to encourage personal responsibility in preventing
addiction and to increase access to mental health and addiction treatment to
control overall health care costs.
"Mental health is a necessary complement to physical health in all
aspects of our daily lives," McCain said. "Fortunately, the path
to greater quality and lower costs is to recognize this fact and where
possible provide incentives to treat physical and behavioral health
together."
McCain's campaign has emphasized the need to address chronic-disease
management because it is the dominant component in the growth of health care
spending, and many people with chronic illnesses have a mental health or
addiction problem. As an example, McCain cited research showing that untreated
depression "raises dramatically" the cost of treating a patient
with diabetes.
"A sensible goal is to design reimbursement for taking care of the
whole patient, whatever ails them, and recognize the essential role mental
health treatment plays in the overall health of the patient and the reduction
in physical health needs," he wrote.
Jay Khosla, McCain's health policy advisor, told attendees at a forum
on health care in September in Washington, D.C., that 20 percent of the
Medicare population with chronic illness was driving 80 percent of the
increases in the program's costs. The mounting financial strain will
require the next president to encourage the use of "integrated teams of
health care professionals" to address the needs of chronic care
patients.
Obama Provides More Specifics
The Obama campaign appears to have delved much deeper than McCain's
into specific areas of mental health in which action is needed. For instance,
Obama's response to the mental health questionnaire stated that he
supported expanded federal mandates for private insurance and parity coverage
of treatment for mental illness. Also needed, he wrote, is renewing Medicare
Part D guidance to ensure coverage of psychiatric medications and changing
Medicaid policy to allow reimbursements for inpatient psychiatric
facilities.
Obama supported additional funding for a range of research and treatment
initiatives, including expanded funding for the Community Mental Health
Services Block Grant, "accelerated investment" in the National
Institute of Mental Health for research on mental illness, and greater funding
for the Garrett Lee Smith Memorial Act and other initiatives to prevent
suicide.
The Obama campaign also voiced support for several pieces of legislation
focused on mental health and addiction care. Obama endorsed the Keeping
Families Together Act (HR 687 and S 382), which aims to end the practice of
families of seriously mentally ill children who cannot afford the care their
kids need from surrendering custody to the state so the minors can receive
treatment (Psychiatric News, March 2, 2007). The legislation would
authorize grants to states to pay for the care of such children and allow them
to remain in the custody of their parents.
"I believe that forcing parents to relinquish custody of their child
in order for the child to receive critical mental health care services is bad
policy at best and unconscionable at worst," Obama's questionnaire
response said.
Veterans Issues Highlighted
Both candidates called for increasing housing assistance for people with
psychiatric illness. McCain urged eradicating homelessness among veterans, who
frequently suffer from mental illness.
Obama's response expanded more than McCain's on the needs of
veterans, including a call for recruitment of more mental health
professionals, improving screening, and instituting "fairness" in
decisions to deny benefits for preexisting conditions that actually stemmed
from their service.
The Obama campaign also urged placing more mental health professionals with
troops as they train, deploy, and return from deployment. The greater
interaction would help reduce "the stigma of psychological injury by
enhancing training." He also urged counseling for military families who
are currently ineligible for care through the Department of Veterans Affairs
(VA).
Other veterans' assistance, Obama said, should include mandatory
individual, face-to-face, postdeployment mental health screenings, increasing
the VA budget to recruit and retain more mental health professionals; making
PTSD benefits claims "fairer" and more accurate by providing
better training and guidance to personnel, and expanding Vet Centers in rural
areas so that veterans and their families can get the care they need closer to
their homes.
Members of the National Guard also require additional mental health
assistance, Obama said. He would place a mental health coordinator in each of
the states' Adjutant General's office and give the states additional
resources to provide better follow-up care after returning from
deployment.
Obama also called for improved screening and care for traumatic brain
injuries, along with increased overall funding for the VA.
"Finally, as president, I will fully fund the VA so it has all the
resources it needs to serve the veterans who need it," Obama said.
The responses of Obama and McCain to the NAMI questionnaire are
posted at
<www.nami.org/Template.cfm?Section=2008_Primaries_and_Elections&Template=/ContentManagement/HTMLDisplay.cfm&ContentID=55411>.
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