Tonight, Democratic presidential candidates will debate the issues one last time before we enter the 2020 election year. The debate will take place in Los Angeles – a city experiencing an unprecedented surge in homelessness, with over 17,000 people chronically homeless, of which an estimated 67% are living with a mental illness and/or a substance abuse disorder.
Unlike election years past, every candidate on stage has put forth some form of mental health and addiction policy. The shared responses across all plans are commendable – spotlighting substance use programs, the need for parity in reimbursement, improving access to mental health care, and training more providers. The existence of these plans is a remarkable first, and clearly places mental health as a pivotal issue of our time. However, it has not yet been addressed in any televised debate, where these plans can be dissected, and further thinking drawn out. It’s time to change that.
Mental illness directly impacts the lives of millions of Americans and their families. Nearly one in five (18.9%) U.S. adults experience mental illness and only 43% of them have received treatment. People with serious mental illness experience an increased risk for chronic diseases like cancer, and rates are twice as high for cardiometabolic diseases like heart disease and diabetes. The World Health Organization estimates that people living with serious mental illness die up to 25 years earlier than the general public, due to unaddressed mental, physical, and social needs.
Mental illness is also a driver in the widely debated public policy challenges facing the country such as the opioid epidemic, criminal justice reform, spiraling healthcare costs, and homelessness, among others: At a minimum, 25% of people experiencing homelessness in the U.S. have a serious mental illness; the estimated loss of productivity due to serious mental illness is approximately $257 billion; 70.4% of youth in the juvenile justice system have a diagnosed mental illness; and adults with serious mental illness have extraordinarily high rates, 50% or more, of co-occurring substance use disorders.
The candidates each bring their own policy proposals to address these larger issues, such as improving access to and reducing costs associated with healthcare, combating addiction and mass incarceration, and addressing homelessness. While these are broadly right, there is a critical component missing from all these plans - a focus on the lasting solutions needed to help a person move from mental health crisis to durable recovery.
As we divest from prisons, try to build more affordable housing, reduce our use of involuntary treatment, and reimagine crisis response, candidates have the opportunity to propose corresponding investment in the solutions that will give us better results in the mid- to long-term. It’s not enough to talk about what they want to dismantle; our candidates need to talk about what they will build in its place.
We should have a serious conversation about the social infrastructure needed to help people recover from mental illness and social isolation. Community-based, social therapeutic solutions that are necessary for sustainable recovery from debilitating mental illness currently exist. Clubhouse psychosocial rehabilitation programs, which Fountain House has pioneered, are a prime example. By focusing on resilience, relationships, and skill development, they fundamentally redirect trajectories from incarceration, homelessness, and multiple hospitalizations toward better health outcomes, stronger community connections, and a more productive workforce. We need to center our solutions to our mental health crisis in communities, and not in institutionalized settings.
As the debate approaches, it is critical that our candidates consider the role of community-based solutions to address the mental health crisis in our country. The moderators must ensure that the right questions are asked to fuel a deeper discussion. And most importantly, we, as a society, must ensure that we’re holding our elected representatives accountable to their plans on one of the most pressing social and health issues of our era.
Ashwin Vasan, MD, PhD
President and CEO, Fountain House