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Healing and Belonging in America

A Plan to Improve Mental Health Care and Combat Addiction

We are in the midst of a devastating opioid overdose and addiction epidemic that is harming communities across the country. “Understanding the Epidemic.” Center for Disease Control and Prevention. December 12, 2018. This source notes that almost 400,000 people died from an overdose involving any opioid, including prescription and illicit opioids, and does not include 2018 overdoses due to opioids. According to the CDC, in 2018, there were 47,500 overdoses due to opioids.

In the past two decades alone, almost 450,000 people have died due to opioid overdose. By the end of this year, almost nine times as many will have died as the total number of U.S. military deaths during the Vietnam War.“Vietnam War U.S. Military Fatal Casualty Statistics” National Archives. January 2018. This crisis leaves a harrowing impact far beyond rising death rates. For every person that dies from opioid overdose, countless others are living with opioid use disorder. Family members, friends, and neighbors are deeply affected. Families are being torn apart; since 2000, the number of children placed in foster care due to their parent’s opioid use has doubled to nearly 100,000.Thompson, Dennis. “Opioid Epidemic Doubled Number of U.S. Kids Sent to Foster Care.” HealthDay. July 15, 2019.

Yet for all the attention the opioid epidemic has rightly received, Pete understands that it is only one part of a much larger mental health care and substance use disorder crisis. Last year, for every five people who died from opioid overdose, three died from overdose due to other drugs, Ahmad FB, Escobedo LA, Rossen LM, Spencer MR, Warner M, Sutton P. “Provisional drug overdose death counts.” National Center for Health Statistics. 2019. such as methamphetamine or cocaine; Dembosky, April. “Meth Vs. Opioids: America Has Two Drug Epidemics, But Focuses On One.” Kaiser Health News. May 7, 2019. five died by suicide; “Suicide.” National Institute of Mental Health, National Institutes of Health. April 2019. and nine died an alcohol-related death. “Alcohol Facts and Statistics.” National Institute on Alcohol Abuse and Alcoholism. August 2018. Combined, these deaths have contributed to the longest sustained decline in American life expectancy since World War I. Bernstein, Lenny. “U.S. life expectancy declines again, a dismal trend not seen since World War I.” The Washington Post. November 29, 2018.

quotation marksYet for all the attention the opioid epidemic has rightly received, Pete understands that it is only one part of a much larger mental health care and substance use disorder crisis.

Collectively, these deaths due to drugs, alcohol, and suicide are characterized as “deaths of despair,” which are often preceded by people and communities being left behind. Case, Anne and Deaton, Angus. “Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century.” Proceedings of the National Academy of Sciences of the United States of America. December 8, 2015. It is parents being laid off from the job they’ve had for decades and a society’s inability to provide them with the opportunity to take care of their family. It is teenagers coping with childhood trauma or living in constant fear of hearing gunshots at school. Sinha, Rajita. “Chronic stress, drug use, and vulnerability to addiction.” Annals of the New York Academy of Sciences vol. 1141 (2008): 105-30. doi:10.1196/annals.1441.030 It is older people whose aging friends don’t stop by as often, if at all, and a society’s inability to take appropriate care of its elders. Hosseinbor, Mohsen et al. “Emotional and social loneliness in individuals with and without substance dependence disorder.” International journal of high risk behaviors & addiction vol. 3,3 e22688. 25 Aug. 2014, doi:10.5812/ijhrba.22688 Each of these circumstances leaves members of our community searching for ways to numb their pain, manage their anxiety, or cope with their loneliness and isolation.

This crisis of despair is often portrayed as one unique to middle-aged white America. While mental illness and addiction rates have risen significantly for this demographic, this ignores the reality that rates of mental illness and addiction among people of color, other marginalized groups, and other age groups have historically been, and continue to be, high.

Overdose deaths are spiking among Black people, on whose backs the current broken system that criminalizes mental illness and addiction was built during the crack epidemic of the 1980s. James, K, Jordan, A. “The opioid crisis in black communities.” Journal of Law Med Ethics. 2018 Jun;46(2):404-421.Native Americans experience post-traumatic stress disorder twice as often as the general population. Bassett, Deborah, Buchwald, Dedra, and Manson, Spero. “Posttraumatic Stress Disorder and Symptoms among American Indians and Alaska Natives: A Review of the Literature.” Social Psychiatry and Psychiatric Epidemiology. March 1, 2015.LGBTQ youth are almost five times more likely than their straight peers to attempt suicide.Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviors Among Students in Grades 9-12. U.S. Department of Health and Human Services. 12 Aug. 2016, www.cdc.gov/mmwr/volumes/65/ss/ss6509a1.htm.
Young Americans report being lonelier than any other age group.Ducharme, Jamie. “Young Americans are the loneliest, according to new study.” TIME magazine. May 1, 2018.Among Latinx people, mental health and overall health has deteriorated significantly under the current Administration.Wan, William, Bever, Lindsey. “Trump’s presidency may be making Latinos sick.” The Washington Post. July 19, 2019. And 20 veterans and active service members die by suicide each day, the most shameful indicator of just how badly our nation has failed those who have given so much to our country. Department of Veterans Affairs, Veterans Health Administration, Office of Mental Health and Suicide Prevention. Veteran Suicide Data Report, 2005–2016. September 2018.This crisis of pain and despair is not one unique to whiteness; it is one that is distinctly American.

quotation marksThis crisis of pain and despair is not one unique to whiteness; it is one that is distinctly American.

This crisis is the result of years of neglect by our political leadership. Our health care system is so broken—and our approach to mental health and addiction care so fragmented and often punitive—that less than one in five people with a substance use disorder and two of every five people with a mental illness receive treatment.“10% of US adults have a drug use disorder at some point in their lives.” National Institutes of Health. November 18, 2015. |“Mental Health Facts in America” National Alliance on Mental Illness. The annual economic cost of the opioid epidemic is almost $80 billion a year. Florence, CS et al. “The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013.” Medical Care. October 2016. To meet this urgent national challenge, we need a new approach to providing mental health care: one truly prepared to tackle this as the crisis it is, and one that understands the key driver of change will be based in strengthening our communities.

Pete understands that as a nation, we must begin to take mental health more seriously. All of us either live with these illnesses or may in the future, or we know someone who does. And for hundreds of thousands of us, it is a matter of life and death.

Pete’s vision for the future of mental health and addiction care is rooted in embracing prevention and ensuring that every person with a mental illness or a substance use disorder has the resources and support they need to begin to heal. We will ensure that at least 75% of people who need mental health or addiction services receive the care that they need, an increase of more than 10 million in his first term, and prevent 1 million deaths of despair by 2028. In order to help those who heal remain well—and to build Americans’ resilience to these illnesses—we must ensure that everyone feels that they belong in their community and in our country.

HEAL

  • Enforce mental health and addiction treatment parity across insurance companies
  • Improve access to affordable and high-quality treatment
  • Expand the mental health and addiction workforce and their overall cultural and clinical competency
  • Universalize access to life-saving medication for opioid use disorder and increase investment in drug treatment research
  • Integrate mental health and addiction health care with physical health care systems
  • Expand take-home naloxone programs to all 50 states by 2024 and advance the implementation of harm reduction services
  • Enhance access to treatment for veterans, particularly through the VA

BELONG

  • Implement a $100 billion community innovation grant program
  • Address mental illness and addiction stigma by changing how we talk about it
  • Require all schools to teach Mental Health First Aid courses
  • Address disparities in mental health and addiction through national and community-based efforts
  • Decriminalize mental illness and addiction through diversion, treatment, and re-entry programs
  • Launch a national campaign to end social isolation and loneliness. Raise awareness about trauma and expand trauma-informed care
  • Hold drug companies that exacerbated the opioid crisis accountable and establish new systems to prevent such abuse

Heal

Tackling this crisis starts by ensuring that everyone has access to affordable and comprehensive health coverage, and that mental health and addiction care services are integrated into settings such as primary care. It means using technology to make it much easier for someone to find a therapist to talk to, in person or virtually. It means making it simpler to get a prescription for medication to treat addiction, such as buprenorphine to treat opioid use disorder, so unnecessary regulations don’t prevent physicians from prescribing life-saving medication that could help thousands of people every day. To ensure that people with a mental illness or substance use disorder can heal, we will decriminalize these conditions. When someone is undergoing a crisis or is caught using a drug, they should be treated by a health professional rather than punished in a jail cell.

quotation marksTo ensure that people with a mental illness or substance use disorder can heal, we will decriminalize these conditions.

Enforce mental health and addiction parity so that treatment for mental illness and addiction is as accessible as treatment for other chronic conditions, such as diabetes.

  • Enforce parity for mental health and addiction treatment coverage across all payers by penalizing insurance companies that do not comply with parity. 
  • Establish mental health parity in Medicare and Medicaid. 

Improve access to affordable and high-quality mental health and addiction treatment.

  • Require plans to provide a free annual mental health check-up to anyone who wants one.
  • Increase reimbursement rates for mental health and addiction care, including care delivered through telehealth. 
  • Increase access to treatment for people with serious mental illness and addiction by repealing the Medicaid rule that prohibits large psychiatric facilities from receiving reimbursement. 
  • Invest in and promote early interventions for serious mental illness.

Dramatically expand the mental health and addiction workforce to make culturally and clinically competent mental health and addiction services available to everyone.

  • Create training and education programs to prepare front line clinicians, such as primary care clinicians, to better address and manage mental health and addiction. 
  • Expand loan repayment programs to encourage mental health and addiction professionals to choose to work in rural or underserved areas. 
  • Invest in the community workforce, including peer support specialists. 
  • Encourage medical schools to require medical students to complete free coursework on how to treat substance use disorders. 
  • Increase the number of residency programs and fellowships for mental health and addiction clinicians.
  • Expand community members’ basic knowledge and training to address mental health and addiction.
  • Create a three-digit suicide hotline.

The National Shortage of Mental Health & Addiction Professionals

Source: “Mental Health Care Health Professional Shortage Areas (HPSAs).” Kaiser Family Foundation.
115 million Americans, in over 5,100 communities, live in areas with a shortage of mental health and addiction professionals. Only four states and territories meet more than 40% of the demand.

Universalize access to life-saving medication to treat opioid use disorder and increase investment in pharmaceutical research to treat other substance use disorders.

  • Deregulate buprenorphine to make it easier for more Americans to get access to addiction care.
  • Increase the number of clinicians able to prescribe medication-assisted treatment (MAT). 
  • Standardize addiction treatment by defining the elements of care provided throughout the continuum of care using national guidelines.
  • Require all insurers to cover all three types of MAT to treat opioid addiction. 
  • End policies that require patients to wait days or weeks to receive access to MAT by getting rid of prior authorization.
  • Incentivize states to increase Medicaid reimbursement rates that clinicians receive for providing MAT. 
  • For patients in hard-to-reach rural or medically underserved areas, increase mobile clinics and access to longer-lasting forms of MAT. 
  • Prioritize research to develop medication to treat other types of drug dependence disorders.

Promote whole-person care by integrating the mental health and addiction health care system with the physical health care system.

  • Incentivize the integration, co-location, and deployment of mental health and addiction clinicians in primary care settings.
  • Pursue innovative payment models that reinforce a more integrated approach to mental health and addiction. 
  • Encourage states to end Medicaid carve-outs.

Expand take-home naloxone programs to all 50 states by 2024 and advance the implementation of harm reduction services to reduce overdose deaths and the spread of infectious diseases related to needle sharing.

  • Make naloxone, a drug that can be administered by any individual, broadly available in order to reverse overdoses.
  • Remove legislative and regulatory restrictions on the use of federal funds for syringe service programs.

Increase veteran engagement with the Department of Veterans Affairs (VA) and enhance access to mental health and addiction treatment for veterans.

  • Increase investments in suicide prevention for veterans. 
  • Expand the number of mental health and addiction clinicians treating veterans.
  • Increase access to telehealth, including teletherapy and telepsychiatry, for veterans through the Connected Care pilot program.

Veteran Suicide

20 veterans and active service members die by suicide in the United States each day, and we know that 14 of those veterans were not receiving care from the VA.

Belong

Belonging begins by changing the way we think and talk about mental health and addiction. We must drive home the fact that these illnesses are not moral failings, and that asking for help is a sign not of weakness, but of strength and empowerment. It means training every student across the country to identify and know how to respond to signs of mental illness or addiction. It means equipping communities with resources so they can use their own ingenuity and unique experiences to help their neighbors recover and become resilient to stressors. It means helping people become part of something greater by strengthening communal bonds through, for example, national service. And it means creating livable communities that foster well-being, with decent wages, good jobs, affordable housing, and a safe and healthy place to live and raise a family.

Empower communities to leverage their own innovation to improve mental health and prevent addiction through a 10-year, $100 billion grant program.

  • Through $10 billion annual Healing and Belonging grants, we will encourage communities most affected by this epidemic to leverage their ingenuity and on-the-ground expertise to help improve health and well-being. 
  • Launch Pete’s National Service Plan to strengthen communities throughout the country. 
  • Invest in social determinants of health for people with chronic physical and mental conditions.

Address stigma surrounding mental illness and addiction by changing how we talk about it.

  • Assess and address structural stigma within existing policy at the federal level. 
  • Use the Presidential platform to change the narrative around mental health and addiction. 
  • Launch a grant program that provides local organizations with resources and training to the end the stigma around mental illness and addiction. 

Promote student mental health, which has deteriorated at alarming rates, by requiring every school across the country to teach Mental Health First Aid courses, among other initiatives.

  • Require every school across the country to teach Mental Health First Aid courses. 
  • Train teachers and school staff to know how to help students when needed.
  • Expand the mental health workforce into schools. 

Address disparities in mental health and addiction through both national and community-based efforts.

  • Launch a National Health Equity Strategy
  • Train the mental health and addiction workforce to combat bias when treating patients. 
  • Strengthen enforcement to address health inequity. 

Decriminalize mental illness and addiction through diversion, treatment, and re-entry programs, decreasing the number of people incarcerated due to mental illness or substance use by 75% in the first term.

  • On the federal level, eliminate incarceration for drug possession, reduce sentences for other drug offenses and apply these reductions retroactively, and expunge past convictions. 
  • Invest in the expansion of diversionary programs that funnel people with mental health or substance use histories out of the criminal system prior to a conviction. 
  • Invest in expanding the evidence-based national curricula training programs for drug courts, mental health courts, and other alternatives to incarceration for justice-involved persons. 
  • Train first responders to identify and deal with mental health crises. 
  • Eliminate Medicaid’s inmate exception.

Combat the culture of loneliness and social isolation, which can damage mental and physical health, by helping people form fulfilling connections to others and their community.

  • Launch a national campaign to end social isolation and loneliness. 
  • Help strengthen social and communal bonds between older and younger Americans through Pete’s National Service Plan
  • Help older adults who choose to age at home continue to live fulfilling lives through the CAPABLE program.

Raise awareness of the pervasiveness of trauma and how fundamentally it affects health, and expand trauma-informed care.

  • Direct the U.S. Surgeon General to study trauma and its effects and ensure that federal programs across agencies work to build resilience and address trauma and its impact. 
  • Ensure that Medicare beneficiaries receive trauma-informed care and incentivize state Medicaid programs to pay for trauma-informed care and services. 
  • Expand funding for local efforts to train clinicians to provide trauma-informed care. 
  • Increase access to mental health resources for caregivers. 

Hold the drug manufacturers, distributors, and pharmacies that exacerbated the opioid crisis for profit accountable, and ensure there are systems in place to prevent a repeat of this experience.

  • Work with state Attorneys General to support state-level lawsuits. 
  • Revamp the Department of Justice’s Drug Enforcement Administration’s (DEA’s) role in monitoring prescription of controlled pharmaceuticals. 

Mental health is a matter of life and death for hundreds of thousands of Americans. If you believe we must begin to take mental health more seriously as a nation, text HEALTH to 25859.

By submitting your cell phone number you are agreeing to receive periodic text messages from Pete for America. Message and data rates may apply. Text HELP for more information. Text STOP to stop receiving messages.

Footnotes

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