Part III of a National Mental Health Rescue Plan

What a post-COVID plan for mental health should look like, with a special focus on who we need to be behind it.

I’m picking up this week with the following words from last week’s post, as they perfectly tee up the third and final part of this series on why we need a National Mental Health Rescue Plan, and what exactly that looks like:

 “If we are going to be encouraging people to take a more proactive approach to improving their mental well-being and seeking help, leaders have to make sure that the system is capable of meeting their needs and the demand.”

The first post in this series highlighted – through a discussion about the barriers that keep men in particular from talking about their mental health – why we need to find creative ways to reduce stigma and have meaningful conversations about our mental health and well-being. We need to bring care to where people are.

The second focused on the improvements we need to make to our mental health and addiction workforce, so that it is better prepared to handle any increase in people seeking help as that changed conversation gains momentum. We need to reconfigure the who does what, where, and for whom.

And while I could have this series go on forever, including other much needed reforms like delivery, payment, and training, this post will focus on the word bolded above, because without strong and dedicated leadership, any kind of plan can only go so far.

LEADERS WORTH LEARNING FROM

I’ve written previously about our national leaders who’ve led on mental health. In short, President Harry Truman, President John F. Kennedy, President Lyndon B. Johnson, President Jimmy Carter and First Lady Mrs. Rosalynn Carter, President George W. Bush, President Barack Obama and then Vice President Joe Biden.

However, while these presidential figures did dedicate a portion of their time in office to advancing mental health, there are other advocates out there who’ve advanced mental health much more aggressively. Sometimes their work is forgotten, though it is on their shoulders we stand today advocating for mental health the way that we do.

Dorothea Dix is a good example. If you read through the history books (online), Dorothea is remembered as one of the greatest mental health advocates who, after seeing how women with mental illness were treated in a prison she was teaching at, took it upon herself to ensure something changed. She saw the problem and she did something about it.

Beginning with the simple act of making sure these women weren’t cold – at that East Cambridge jail, she was told that people with mental illness didn’t need heat because they couldn't feel extreme temperatures – she would go on to do to ensure the humane treatment of individuals with mental illness, not just humane confinement. The latter seemed to be the dominant form of “treatment” at the time (and in some cases, still is today!).

In her subsequent memorial to the Massachusetts legislature, Dorothea Dix detailed the suffering she saw at other Massachusetts prisons and poorhouses and successfully moved legislators to put more funding toward an asylum now called Worcester State Hospital. As she toured the country and highlighted similarly disturbing conditions in their prisons and poorhouses, others followed suit. (There needed to be some place for people to go to receive care, and though that’s not the solution we are looking for today – recall the reasoning behind Kennedy’s Community Mental Health Centers Construction Act – it was arguably better than the status quo at that time.)

Dorothea Dix was an advocate who made sure her message was heard no matter what – even when women were not allowed in the Massachusetts Capitol. Dorothea would stand on the steps and yell to every lawmaker coming in what they needed to do for mental health. She was determined to make sure that mental health was not forgotten while lawmakers continued their debates on whatever was the topic de jour.

For us to truly begin to push for mental health reform – for things like I have outlined briefly in this National Mental Health Rescue Plan series – we need more people like Dorothea Dix. We need people who are devoted to fundamentally changing the way we think about mental health, talk about mental health, and respond to it.

Enter you. Yes, you. You may already be well-versed in this space – an outspoken advocate daily pushing for mental health reform – or you may not. You may know a bit about mental health and the dire need to improve it, but maybe you haven’t heard of the policies impacting it, nor how to help change those policies. (For that, see my previous series on why it is so hard to put better mental health policies in place.)

SO, WHERE DO WE START?

I talked last week about the role each of us have to play in bolstering our mental health and addiction workforce:

“So that mental health is not just left to clinicians to manage, all of us should read up on evidence-based interventions to help friends, family, neighbors and any others we see struggling with mental health and addiction issues. Checking out http://empower.care/ is a great place to start understanding this broader approach to mental health. ”

This is a critical first step each of us can and should take, because when demand for mental health services is as high as it is today, we need all hands on deck to ensure we can help people wherever they present with need, whether that’s at a barbershop – check out The Confess Project if you haven’t already – or as I recently shared, on the side of the road. But a very close second arises from a new report from the U.S. Government Accountability Office, which talks about the issue of mental health coverage – a barrier to care for millions of Americans despite the fact that “The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 generally requires that coverage for mental health and substance use disorder be no more restrictive than coverage for medical/surgical services.”

Specifically, the report mentions how:

● Virginia Hospital & Healthcare Association members are experiencing more delays or denials for inpatient claims for individuals with combined physical and behavioral diagnoses;

● It often takes significantly longer for one mental health provider’s members’ claims to be processed for intensive or residential mental health and addiction treatment compared to similar medical/surgical treatment; and,

● Some payments for mental health emergencies (such as attempted suicide) leading to hospital admissions have been denied and delayed for Texas Hospital Association members because of pre-approval requirements.

Our country needs to change the way that mental health is covered. In the very least, it should mirror the way in which services for physical health care are covered. We have such mental health parity policies in place, it’s just that right now, they’re not really being enforced.

Holding payers accountable by penalizing those that don’t practice mental health parity ultimately falls to state and federal leaders, but before that happens, there’s plenty of work that we the people can do to drive that change. If you experience firsthand a denial for a medically necessary mental health claim, you can fight back. (Stay tuned, because in the coming weeks Well Being Trust will be sharing a guide to make families more informed about insurance coverage, especially as it relates to mental health). And even if you don’t have a personal experience to share, you can still be an advocate by writing letters to your legislators, helping craft state- if not federal-level bills, or – channeling your inner Dorothea Dix – marching over to your state Capitol.

We know what we need to do to improve mental health in America. The last few weeks, we’ve sketched out a plan and made a few of the top priorities clear. Now, all we need to know is this: Will you be the Dorothea Dix of our generation? Will you help bring about the change we need for mental health?

For change at this scale, it’s going to take all of us to lead in some way.

Time to get to work.