Vice President Joe Biden (D)

We asked Joe Biden 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 society, we need to work together to eliminate the stigma felt by those who are suffering and struggling with their mental health. We must ensure that everyone has access to affordable quality health care and that​ mental health services are covered. As Vice President, I championed​ efforts to implement the ​Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (​MHPAEA​)​,​ and ​I am proud that Obamacare defined mental health treatment as an essential health benefit. ​As President, I will redouble these efforts to ensure enforcement of mental health parity laws and expand funding for mental health services.​ I will build on Obamacare to ensure universal health coverage. For rural communities, I will accelerate the deployment of telehealth for mental health and specialty care. I will also work to ensure that the VA provides the world class health care, including mental health care, that our veterans have earned and deserve and sets the example for private sector care.

When it comes to veterans suicide, you can read more about my plan for veterans at https://joebiden.com/veterans/​. It includes commitments to:

  • Publish within the first 200 days in office a comprehensive public health and cross-sector approach to addressing suicide in veterans, service members, and their families.
  • Work aggressively to facilitate immediate access to mental health services for veterans in crisis, including the elimination of wait times for veterans who reach out with suicidal ideation so that they are immediately taken into treatment.
  • Together with states, community-based organizations, and employers, implement public education and outreach initiatives to help veterans understand that care is available and effective.
  • Expand capacity at Vet Centers to ensure veterans in communities can access readjustment counseling services and resources, including financial and long-term planning.
  • Implement programs to disseminate high-quality treatments for PTSD.

 

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?

Millions of families are impacted by the opioid crisis. It’s ravaging communities coast to coast, from New Hampshire to California. The challenge of substance use disorders is not limited to opioids. ​Millions of individuals are affected by misuse of other substances such as alcohol or methamphetamine. ​I will tackle this crisis by making sure people have access to high quality health care​—​including substance use disorder treatment and mental health services. That’s what Obamacare did by ​designating substance use disorder treatment and mental health services​ as essential benefits that insurers must cover, and ​expanding Medicaid​, the nation’s largest payer​ for mental health services which also plays an increasingly growing role as payer for substance use disorder services.

Step one of my plan to tackle the opioid epidemic and substance use disorders is to defeat Trump and then protect and build on Obamacare. And, I will pursue a comprehensive, public health approach to dealing with opioid and other substance use disorders. I will build on the 21st Century Cures Act, which​ provided $1 billion​ for grants to states for substance use disorder prevention, treatment and recovery efforts.

My plan will:

  • Hold accountable big pharmaceutical companies, executives, and others responsible for their role in triggering the opioid crisis.
  • Make effective prevention, treatment, and recovery services available to all.
  • Stop overprescribing while improving access to effective and needed pain management.
  • Reform the criminal justice system so that no one is incarcerated for drug use alone.
  • Stem the flow of illicit drugs, like fentanyl and heroin, into the United States​—​especially from China and Mexico.

 

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?

As President, I’ll use the bully pulpit of the White House to eliminate the stigma around mental health. During the Obama-Biden Administration, I hosted the ​National Conference on Mental Health​ at the White House. We brought together teachers, students, mental health professionals and more to have an important conversation about mental health.

I also will build on the ​progress​ made through the 21st Century Cures Act to promote the integration of behavioral health in pediatric primary care, including increased funding for mental health telehealth programs. ​One in five​ ​children in the U.S. experience mental health problems. Yet, the current school psychologist to student ratio in this country is roughly 1,400 to 1, while ​experts​ say it should be at most 700 to 1. As President, I will make an unprecedented investment in school mental health professionals in order to double the number of psychologists, guidance counselors, nurses, social workers, and other health professionals employed in our schools, and partner with colleges to expand the pipeline of these professionals. I will ensure our schools have the resources needed to support students’ physical and emotional needs by tripling funding for Title I, fully funding the Individuals with Disabilities Act and investing in community schools, tapping community resources to support the emotional and developmental well-being of students. You can read more about my education plan at ​https://joebiden.com/education/​.

At the Biden Foundation, I launched the “​As You Are​” campaign, which worked toward lifting up the stories of LGBTQ youth and their families, friends, and peers, to encourage and promote a culture of acceptance and support. As President, I’ll build on that work and ask organizations, from faith to education and the private sector and from media to health care, to make commitments to raising awareness about youth mental health.

 

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?

There is no doubt we need a better system of care for the mental health needs of adults and children. As pointed out by the ​National Alliance on Mental Illness​, “individuals living with mental illness experience recovery through a combination of community services, medication, peer support, housing, education, employment and other supports.” We can and must ensure that these services and supports are available.

The first step is to ensure individuals have access to needed health care, which includes health insurance coverage, enforcement of mental health parity laws and expanded funding for mental health services. Y​ou can read more about my plan to accomplish these goals by protecting and building on Obamacare at ​https://joebiden.com/healthcare/​.

To increase the number of mental health professionals and paraprofessionals, ​I will increase funding for the ​National Health Service Corps​, and develop high school-community college-health center partnerships to inspire youth to pursue jobs in health care. As Vice President, I championed passage of the ​21st Century Cures Act​, which included resources designed to increase the number of mental health and substance use disorder professionals and paraprofessionals. I will build on that progress by working to pass ​legislation like the ​Opioid Workforce Act​ of 2019​, which will support training for primary care providers, as well as other members of the health care team, to build an integrated system of care.

Telehealth can be a vital resource for rural communities with limited access to providers. The Obama-Biden Administration successfully used the ​USDA Community Facility Direct Loan & Grant Program​ to build rural hospitals and mental health clinics across rural America with the best technology. As President, I will expand this grant funding, with a focus on accelerating the deployment of telehealth for mental health and specialty care.

 

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?

To build safe and healthy communities, we need to rethink who we’re sending to jail, how we treat those in jail, and how we help them after they serve their time. As President, I will strengthen America’s commitment to justice while reforming the criminal justice system. There are too many incarcerated people with mental health or substance use disorders. That must change.

The 21st Century Cures Act, which President Obama and I championed, ​included funding​ for diversion and re-entry programs for people with mental and substance use disorders. But we need to do more. ​Too often, those in need of mental health care or rehabilitation for a substance use disorder do not get the necessary care. Instead, they end up having interactions with law enforcement that lead to incarceration. The Biden Administration will partner mental health and substance use disorder experts, social workers, and disability advocates with police departments. These service providers will train police officers to better de-escalate interactions with people in severe emotional distress. And, these service providers will respond to calls with police officers so individuals who should not be in the criminal justice system are diverted to mental health or substance use disorder treatment.

I will also expand access to mental health and substance use disorder treatment, as well as educational opportunities and job training for individuals during and after incarceration. My administration will expand the use of drug courts and other diversion programs. When individuals are incarcerated and experiencing a mental health condition or a substance use disorder, they should have access to treatment. ​You can read more about my criminal justice plan at ​www.joebiden.com/justice​.

 

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?

I am proud that the Affordable Care Act (ACA) provided individuals with pre-existing conditions, including mental health conditions, access to health insurance. The ACA also ​requires ​insurance companies to cover mental and behavioral health treatment as an essential benefit, and cover that care at parity with physical health benefits. The ACA gave​ 60 million Americans​ access to mental health and substance use disorder benefits. The 21st Century Cures Act, which President Obama and I championed,​ built on these provisions​, requiring insurers to disclose their methodology for managing care and enhancing enforcement efforts​.

But our parity laws are under-enforced. As President, I will prioritize enforcing our mental health parity laws. ​States vary​ in how they define essential mental health benefits. My administration will set clear standards raising the bar for mental health coverage, including rehabilitative services and other forms of behavioral health care.

I will build on the Affordable Care Act so all low-income individuals with mental health disabilities have access to insurance. ​My plan will offer premium-free access to a new public option for those who would be eligible for Medicaid but for their state’s inaction, and make sure their public option covers the full scope of Medicaid benefits. States that already expanded Medicaid will have the choice of moving the expansion population to the premium-free public option as long as the states continue to pay their current share of the cost of covering those individuals. Additionally, I will ensure people making below 138% of the federal poverty level get covered by automatically enrolling them when they interact with certain institutions (such as public schools) or other programs for low-income populations (such as SNAP). My Department of Health and Human Services will stop states from privatizing Medicaid while cutting services for those who need them the most.

 

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?

I will support efforts to expand the successful Certified Community Behavioral Health Clinics (“​CCBHC​”) ​Demonstration program in order to expand access to high quality evidence-based behavioral health services to the community level. ​I also will ensure adherence to the Supreme Court’s ​Olmstead ​decision​, which ​requires government programs​ to provide people with disabilities the ability to “live, work, and receive services” in the most integrated setting appropriate to their needs. I will work with Congress to expand access to long-term services and supports, reauthorize and invest in the Money Follows the Person program, which helps states expand the number of people with disabilities who have the choice to live in their home or in their communities. ​The ACA strengthened the ​Money Follows the Person (MFP) program by increasing funding for it and increasing the number of states participating in it. The Trump Administration ​proposed​ discontinuing the program.

We will also enforce the ​Home and Community Based Services Rule​ and reverse delays in enforcement ​by the Trump Administration​. We must strengthen the ability of states to provide HCBS and ensure that direct support workers earn a living wage. My administration will not only protect Medicaid, I will support efforts to build strong, stable service delivery entities with disability voices influencing the services provided.

Integrating mental health and addiction treatment into primary care must be a priority and we must expand community-based programs incorporating the full spectrum of services, including supported employment and housing, necessary for successful treatment. We also must tackle the stigma and discrimination against people with mental illness that prevent millions from seeking and receiving effective treatment. We can and must do better.

 

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?

Income should never be a barrier to getting good, quality health care and treatment. ​I will expand coverage to low-income Americans by offering premium-free access to the public option. ​My health care plan will also give ​families the ability to afford more generous coverage, with lower deductibles and out-of-pocket costs. ​For more information on my healthcare plan, visit www.joebiden.com/healthcare.

M​ore and more evidence​ is making clear that a “​housing first​” approach – “guided by the belief that people need basic necessities like food and a place to live before attending to anything less critical, such as getting a job, budgeting properly, or attending to substance use issues” – is an effective strategy for reducing homelessness. While my administration will pursue a comprehensive strategy addressing homelessness’ underlying causes – from making sure everyone has access to quality mental health and addiction support, to increasing the minimum wage and expanding workforce training, to changing the culture so more LGBTQ teenagers are accepted in their homes – in my first 100 days, I will direct my HUD Secretary to conduct a review of federal housing policies so they are guided by a housing first approach. The Secretary will identify all ways in which homelessness assistance grants can further support rapid re-housing and long-term supportive housing. ​For more information on my housing plan, visit www.joebiden.com/housing.

I will ensure that workers with disabilities have ​access to supported employment and customized employment services​. My Rehabilitation Services Administration will enforce the integrated employment provisions of the ​Workforce Innovation and Opportunity Act​. I will also restore the Justice ​Department’s ​guidance on the application of the Supreme Court’s ​Olmstead decision to employment services. I support a $15 federal minimum wage and ​eliminating​ the sub-minimum wage, calling for passage of the ​Transformation to Competitive Employment Act.

 

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?

Everyone who needs mental health treatment and support should have access to it. My health care plan will increase the value of tax credits, lowering premiums, extending coverage to more people, while also ​lowering deductibles and out-of-pocket costs. I will also expand coverage to low-income Americans by offering premium-free access to a new public option. ​Studies​ ​tell us that communities of color face higher rates of mental health stigma and often less access to treatment. As Vice President, I helped ​implement the federal mental health parity law​, ​improve access to mental health care​, and ​eliminate the stigma around mental health​. As President, I will redouble efforts to ensure access to mental health services for all.

I believe that we must care for our troops and their families. As described above, I have laid out a comprehensive plan for improving veterans’ health care, including access to mental health treatment. ​The Obama-Biden Administration increased the overall funding request for the VA by more than ​85 percent​ during its years in office, including a ​76 percent increase​ in funding devoted to the critical issue of veterans’ mental health. ​As President, I will build on these accomplishments and ​ensure that every veteran that reaches out is immediately connected to support and services, end the suicide crisis and improve the accessibilty and quality of care for our veterans.

Obamacare prohibits insurance companies from increasing premiums merely due to someone’s gender, sexual orientation, gender identity or HIV status. I will defend the rights of all people to have access to quality, affordable health care free from discrimination. I will build on my work through the Biden Foundation to promote a culture of acceptance and support for LGBTQ youth, including mental health support. You can read more about our work at https://archive.bidenfoundation.org/pillars/equality/​.

 

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?

Research plays a critical role in helping us find new treatments. I will expand funding for research with respect to mental health and substance use disorder treatment. President Trump’s most recent budget proposal ​makes​ significant cuts to health and science agencies, including the National Institutes of Health. As I ​said​ in 2017, when the Trump Administration first proposed NIH cuts: “This is not the time to undercut progress…This is the time to double down.” I will expand the work of the ​National Mental Health and Substance Use Policy Laboratory​, created by the 21st Century Cures Act, which identifies and promotes the scaling of evidence-based practices and services. I also will build on the provisions of the ​21st Century Cures Act​ designed to tackle suicide, including ​grants to states for prevention.

In this age of medical breakthroughs, I will remain committed to advancing the ​Precision Medicine Initiative​ started by the Obama-Biden Administration and the ​BRAIN (Brain Research through Advancing Innovative Neurotechnologies) Initiative​.

 

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

Mental health is health, period. It should be treated that way by our insurers and our culture.

We need to eliminate the stigma around mental health. ​I remember guys like Donald Trump from when I was a kid. They made fun of me for having a stutter. I’ve been standing up to bullies my whole life and as the Democratic presidential nominee, I’ll stand up to Donald Trump for the millions of people with disabilities. I’ll be a president who understands that everyone deserves to be treated with dignity and respect.

I am proud of the work we did during the Obama-Biden Administration to raise awareness and expand access to services and care. My administration will build on that progress and make sure people have access to the treatment they need.

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