Representative Beto O’Rourke (D)

We asked Beto O'Rourke to get on the record about mental health and addiction. Here’s what he had to say:

1. Suicide is the 10th leading cause of death in the US and the second leading cause of death for American youth. Every day, 20 Veterans die by suicide. What steps will you take to prevent suicide?

As a former member of the House Veterans Affairs Committee and the representative for a large military and veteran community, Beto recognizes we must treat mental health with the same diligence, seriousness, and focus as physical health, removing the physical and financial barriers to care. While in Congress, Beto authored and had signed into law measures that expanded access to mental health care for veterans.

The epidemic of veteran suicide is both unacceptable and preventable, and as President, Beto will direct his Department of Veterans Affairs (VA) to make suicide prevention a top clinical priority. To do this, the VA must collaborate with the Department of Defense, outside community groups, and Veterans Service Organizations, improving the identification and treatment of veterans at risk of suicide. Beto will direct VA health professionals to contact individuals within one week of their transition from active duty; will ensure veterans with urgent health needs receive care the same day; expand mental health services to members of the National Guard and National Reserve; and expand suicide prevention pilot programs.  Beto will also ensure benefits are reaching family members.

Beto also recognizes gun safety is an important part of preventing firearm suicides. He will ensure VA providers are talking to veterans about gun safety — focusing on safe storage options, and will provide funding for community-based public education around firearm safety and firearm suicides.

To fight opioid addiction among veterans, Beto will continue to advocate for the ability of VA doctors to prescribe alternatives such as marijuana. While in Congress, Beto fought to legalize marijuana and end its federal prohibition, An O’Rourke Administration will make it easier for doctors at the VA to get veterans the care they need, which includes allowing VA doctors to prescribe it as an alternative to opioids.


2. Every hour, eight people in America die of drug overdose, from opioids and increasingly from other drugs as well. What would your administration do to turn the tide on the addiction crisis?

Beto recognizes that on average, within the United States, the drug overdose mortality was 3.5 times higher than in peer countries. He would demand accountability for the pharmaceutical industry’s role in the crisis. The recent decision in Oklahoma demanded accountability from pharmaceutical executives, who knowingly and deliberately pushed for highly addictive opioid medications to be over-prescribed, but more needs to be done to address this crisis.

Beto would also continue his work to end the federal prohibition on marijuana so there are less addictive and non-addictive alternatives to opioids available in every state. In doing so, he would also fight to expunge the records of those who have been arrested for possessing marijuana.

Beto recognizes that we must ensure everyone, including individuals fighting addiction, have access to guaranteed, high quality, affordable health insurance — supporting the adoption of Medicare for America, which will expand access to mental health and substance abuse treatment. Beto will support the expansion of telehealth into rural communities, helping individuals facing physical barriers to mental health to access care. Beto will also extend federal resources into communities combating this crisis. Beto recognizes we must also transform pain management, allowing doctors — like those at the VA — to prescribe medications other than opioids. This includes removing bureaucratic hurdles in states that have legalized cannabis, allowing doctors to prescribe it to their patients; and creating interdisciplinary pain management teams at every VA medical center.  Beto believes that we must also expand access to drugs that help prevent overdose, including buprenorphine.


3. Rates of anxiety, depression and suicidal behavior are all rising among our teens and young adults, but the time from first symptoms (usually around age fourteen) to treatment continues to be almost a decade for many people. What would you do to make sure that more individuals get the help they need when they first need it?

Beto recognizes that there’s a suicide epidemic among our young people. Rates have reached the highest level since 2000 among 15-24 year olds, and this epidemic has particularly impacted Native youth. But suicide affects people from all walks of life – black and white, veterans and civilians, the old and the young. Beto knows that this crisis must be addressed head on. As president, Beto would encourage the adoption of universal, guaranteed, high-quality health care that includes primary health care and mental health care services through Medicare for America; he’ll expand successful suicide prevention pilot programs, and funding in to the Center for Disease Control and Prevention (CDC) to research and collect data on the epidemic of suicide in order to strengthen suicide prevention efforts, and increase resources for current suicide prevention efforts. Beto will also ensure that those who have suffered from trauma and are most vulnerable have mental health services where they are, including by expanding wraparound services in schools.


4. Our nation is experiencing a shortage of mental health and addiction care providers—including both traditional mental health professionals and paraprofessionals like certified peer support specialists and recovery coaches—and other barriers to treatment, especially in rural and underserved areas. What is your position on improving access to mental health and addiction care for these communities?

Beto recognizes that our nation is facing a severe shortage of mental health professionals. Across the country, over 115 million people are living in mental health care professional shortage areas. Only four states even meet half of the necessary demand. These gaps, both in mental health professionals and addiction care providers, are not going to change without serious action. Beto will expand telehealth, allowing individuals to access high quality providers that may not be in their area, and make the investment in broadband to ensure they can connect. To increase the number of providers in communities, ensuring every individual that needs mental health care and addiction treatment has access to it, Beto would also expand the pipeline of mental health professionals, reforming loan forgiveness and incentivizing entry into the field to account for the dramatic shortage.

Another way that Beto will work to increase the number of mental health and addiction providers is by fighting the student debt crisis we have in this country. As president, Beto will ensure every American can afford to go to college by making community college and technical college free. For those in four year degree programs, he will ensure we are covering the full cost of attendance for low-income students, and ensure middle-income students have debt-free options. To address the existing $1.5 trillion in student debt, Beto will allow borrowers to refinance their private loans at government rates; cap monthly repayment for federal loans at 10% of income; forgive 10% of loan principal every year a borrower works in public service including at the VA; and wipe clean all student debt of public educators.


5. For many people, the initial point of care for their mental health condition or substance use disorder begins with the criminal justice system. What is your plan to advance crisis intervention services in the community while also providing treatment and alternatives to incarceration for those already involved in the criminal justice system?

First of all, Beto will work tirelessly to ensure mental health and substance use disorders are treated as a public health opportunity rather than a criminal justice concern. He also recognizes that for far too many, mental health care and substance abuse treatment does not begin until after one interacts with the criminal justice system. As President, Beto will work to shift the point of care by providing for pre-trial intervention for simple drug possession through community-based treatments that lead individuals toward rehabilitation. He would allow individuals to complete a program through their treatment regimen and have their charges dismissed. This not only costs substantially less than prison, but leads to significantly greater health and behavioral outcomes. Further, for those already involved in the justice system, Beto will reduce all felony drug possession convictions to misdemeanors and apply this retroactively to those who have already suffered unjustly. These actions will save thousands of lives needlessly lost to incarceration and billions of dollars that can be reinvested into rehabilitative alternatives.


6. The Mental Health Parity and Addiction Equity Act (Federal Parity Law) was enacted in 2008, yet some insurers continue to illegally deny coverage of care for mental health and addiction treatment services. How will you ensure enforcement of the Federal Parity Law?

Beto believes health care is a fundamental right, and recognizes the federal government must play its part in offering healthcare to those who need it.  Beto will make enforcement of the federal parity law a priority. He will also work with Congress to enact Medicare for America as a means to ensure every single American gets the care they need to live to their full potential – including infants, children and adults with chronic illness, individuals with disabilities, or those in need of mental health services or treatment for addiction.  Medicare for America would fully cover mental health services and eliminate out of pocket costs for those with serious mental illnesses. Beto is also fully aware of how this issue disproportionately impacts marginalized populations and those who have been historically excluded from policy discussions on health care. Beto will continue working with and actively include everyone who calls this country home, prioritizing quality, affordable, guaranteed health care for all, that meets their healthcare needs.


7. How will you fulfill the intent of the Community Mental Health Act of 1963, a law that meant to ensure that people have access to mental health and developmental disability care within their communities rather than in institutions?

While in Congress, Beto supported the Disability Integration Act as well as the EMPOWER Care Act (formerly Money Follows the Person) to enable increased availability and priority access to home- and community-based services for people with disabilities. Both pieces of legislation will help ensure the freedom from institutionalization upheld by Olmstead becomes a reality no matter where you live. As President, Beto will work with Congress to pass these measures and end the institutional bias in funding for long term services and supports. We must ensure that the civil rights of persons with disabilities to transition from nursing homes and institutions back into their homes and community where they belong.


8. Poverty is associated with very poor outcomes for people with mental health or substance use disorders, primarily due to lack of secure housing and employment opportunities. What will you do to ensure that income is not a barrier to recovery?

Poverty, often associated with intergenerational trauma, can exacerbate access to care — imposing not only physical barriers, but financial barriers. Beto understands that our system is often designed to punish those in poverty, with a criminal justice system that can destroy the possibility of those with mental health and substance abuse disorders from securing employment, a health care system that imposes prohibitive costs, and housing that is unavailable for too many. As president, Beto will guarantee universal, high-quality health care, including the full spectrum of mental health coverage, for every American through his Medicare for America proposal. Beto will also champion significant reforms in our criminal justice system to provide for pre-trial interventions for those charged with simple drug possession to keep those with substance use disorders out of the justice system. Beto will also retroactively reduce those with felony drug possession charges to misdemeanors and seal the records of those with drug possession convictions. To ensure fair housing for all, Beto will direct his Department of Housing and Urban Development to expand federal assistance for short-term, rapid re-housing and long-term, permanent supportive housing, to meet the needs of those experiencing homelessness. These steps and others will work to guarantee that one’s income or a criminal record do not present barriers to recovery.


9. People of color, immigrants, Veterans, people living in poverty, people who identify as LGBTQ+, and others have unique needs and challenges as it relates to mental health and addiction. What will you do to ensure that these and other underserved groups have access to the mental health and addiction resources and supports that they need?

Beto is committed to implementing universal, guaranteed, high-quality health care through Medicare for America, which would eliminate out of pocket costs for low-income individuals. It would also guarantee that key marginalized groups, including people of color, immigrants seeking citizenship, people living in poverty, LGBTQ+, and other groups, have access to mental health and addiction resources.

But until that is signed into law, Beto would work to stop the assault on LGBTQ+ individuals, including by reversing Trump’s efforts to block access to healthcare for LGBTQ+ people and enforce protections for LGBTQ+ individuals under the Affordable Care Act.  He’ll defend care for our Veterans, working to build a new state-of-the-art VA and guarantee the veterans have access to mental health care, addiction resources, and suicide prevent resources, helping to stop the crisis of 20 veteran suicides a day. And to ensure that we’re tackling the mental health component of the maternal mortality crisis that is three times as deadly for women of color, Beto would ensure that mental health services available to new moms.

While a member of Congress, Beto co-sponsored the Equality Act, and as president, he will sign it into law to ensure the full civil rights of LGBTQ+ Americans are protected. This will improve access to health care and ensure every individual is treated with dignity and respect.


10. Given that overdoses and suicides are decreasing US life expectancy, evidence-based treatment options are critical, but treatment options are still limited. What role do you see research playing in improving mental health and addiction treatments?

Beto believes research is critical to improving treatment for both mental health and addiction. As President, he will invest significant resources into the CDC to study treatment options to combat the opioid epidemic and mental health treatment. Beto also recognizes that suicides account for nearly two-thirds of gun deaths and that of deaths by suicide, almost half come at the hand of a firearm. To address this vital component in the fight against suicides, Beto will use his executive authority to invest $320 million annually for the CDC and NIH to study gun violence.

Beto also recognizes that we must take other, significant, steps to combat overdoses. This includes expanding access to buprenorphine and to continue to hold pharmaceutical executives accountable for knowingly and deliberately pushing for highly addictive opioid medications to be over-prescribed.


11. Is there anything else you’d like to share with the mental health and addiction community?

Beto believes that everyone deserves access to high quality, affordable health care, regardless of where they live, or what they are suffering from. As president, Beto will ensure everyone who calls this country home is treated with dignity, regardless of their background or experiences. Mental health and addiction are illnesses like any other. There is no shame in experiencing them, and there is no shame in receiving treatment. Beto will support anyone seeking care, working to ensure no barriers remain.

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