I’ll start with the bad news first.
And if you have read anything I have ever written, none of this should come as a surprise:
When it comes to mental health in the United States, our response system is broken, our policies are disjointed, and delivery is not commensurate to the scope of hurt people are facing.
During the pandemic, 4 in 10 adults reported symptoms of anxiety or a depressive disorder. Over 5 million American adults with mental health disorders remain uninsured. And younger adults, racial and ethnic minorities, essential workers, and unpaid adult caregivers have experienced disproportionately negative mental health outcomes. And these are just the data that we have
What this boils down to is a surge in demand for care and an inability to meet that urgent need, especially for the most vulnerable among us. This is a serious problem, and it’s not going away.
But here’s the good news. This fall, across several states, voters have the chance to start doing something about the problem. The policies and structures that shape mental health can be changed—and when we recognize that those policies and structures we’ve inherited aren’t working, it’s on us to bring about change.
To lead.
To have our voice heard.
Part of this involves the work of getting informed not just at the federal, but also at the local level. Who are your state representatives? What are they saying about mental health challenges in your state? What is their vision? If it’s not clear how our representatives are advocating for one of the most significant health challenges of this moment, we need to see how, or even if, they are helping.
I grew up in a family that cared deeply about elections. I watched my grandparents unsuccessfully and successfully run in local races. C-SPAN was a constant in their house, and talk radio was always in some room, somewhere. It was never a thought as to if we should speak out on tough topics – on issues that mattered for our communities – it was a given; expected.
Chances are there are issues you care deeply about. And since this is a place you come to read about mental health, it should come as no surprise that I believe we should better position mental health as an issue anyone running for office, at whatever level of government, should address.
Beyond determining what policies different officials would emphasize or advocate for, it’s also important, as voters, to ask ourselves how we can support a candidate in his or her vision for mental health in the community. Maybe that means showing up at a rally. Perhaps it means writing to candidates to express support for their proposed mental health initiatives. Or it could involve knocking on doors for a candidate who has a robust and positive vision for mental health in your county or state. One way or another, civic engagement is a two-way street, and we as voters need to be prepared to be vocal about the importance of mental health policy in state and local politics.
We also need to be prepared to ask hard questions. For example, where do candidates stand on the issue of Medicaid expansion? Scholars have found that Medicaid expansion is associated with substantial improvements in mental health and access to care, two of the key outcomes that I believe voters should be paying attention to. As others have further argued, closing the Medicaid coverage gap is a critical step in addressing the behavioral health (to include mental health) crisis our country is experiencing. This research raises a key question for candidates—specifically, how they would utilize the availability of federal dollars to combat mental health challenges in their states and localities. Each of us should pay close attention to candidates’ stances on this particular issue, in addition to the more general question of how more federal dollars could be pushed to local communities.
To get answers to these questions in the future, states could consider adopting a format utilized several organizations, but most known to me by Mental Health Colorado (I am on the Board), which hosts forums devoted to asking candidates about mental health legislation and then grades candidates based on their responses. By engaging in a substantive fashion with candidates, civic groups in states across the country could give voters a meaningful scorecard with which to evaluate individual candidates’ levels of commitment to mental health solutions.
At the state and local level, mental health policy is often left in the hands of governors and mayors, who act as the CEOs of states and cities, respectively. This makes gubernatorial elections, like the ones being held this fall in New Jersey and Virginia, critically important. Governors decide on budgets and policies that directly impact who gets mental health services, the amount of services made available, and the vehicles with which those services are delivered. With this kind of influence over mental health in each state, each race consequently takes on even greater significance.
To be frank, we are at a national crossroads when it comes to mental health, not least because of a pandemic that has pushed so many of us to a breaking point. What that means is that our leaders have the opportunity to bring real support—both political and financial—to this issue, or they can ignore it.
As voters head to the polls, both this fall and in future elections, I want to urge you to seriously consider the role of mental health policy in each candidate’s vision for your state. Does it align with what leading mental health professionals are suggesting? Does it take care to attend to the mental health needs of the poor and the marginalized? Does it make use of available resources to get care to everyone who requires it?
These are the questions we need to be asking candidates, and the questions to which we need real answers. It is my hope that both this fall and in the years to come, we will be more intentional about asking those questions, and that we will prioritize mental health—and the candidates who do the same—on the ballot.