Senator Bernie Sanders (D-VT)

1. Suicide is the 10^th 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?

We are experiencing a crisis in mental health treatment in this country. Bernie’s Medicare for All plan would address this crisis by providing comprehensive coverage for mental health and substance abuse treatment services as well as prescription drugs. Mental healthcare, under Medicare for All, will be free at the time of service, with no co-payments that can be a barrier to treatment.

Bernie’s Medicare for All plan requires an evaluation of health disparities, including racial and geographic disparities, and a plan for addressing the disparities found in the evaluation. A central part of the plan requires increasing access to mental health care, including how to train the workforce we need to address these disparities.

He will dramatically expand access to community health centers which provide primary medical, dental, and mental health care, as well as low-cost prescription drugs, to more than 28 million Americans.

And he will significantly expand the National Health Service Corps and Teaching Health Centers to recruit and train mental health providers to deliver culturally competent care in underserved communities.

We must also address the two-thirds of gun deaths in this country caused by suicide by passing life-saving gun reform supported by vast majorities of the American people.

As a nation, we have a moral obligation to provide the best quality care to those who have put their lives on the line to defend us. Bernie will:

• Fully fund and expand the VA so that every veteran gets the care that they have earned and deserve.
• Get veterans compensated faster by improving how compensation claims are processed.
• Expand the VA’s Caregivers Program.
• Expand mental health services for veterans.

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? 

The opioid epidemic is killing thousands of Americans every year. No one is unaffected. This epidemic, caused by the greed of pharmaceutical companies, is ravaging communities across America.

We know that pharmaceutical companies lied about the addictive impacts of opioids, and knew how dangerous these products were, but refused to tell doctors and patients. Yet, while some of these companies made billions each year in profits, not one of them has been held fully accountable for their role in this epidemic.

Bernie will address this crisis with the urgency it requires and hold these pharmaceutical companies responsible for the destruction they caused and continue to exacerbate.

To accomplish that, Bernie believes we must focus on treatment and prevention. We cannot continue to treat the people struggling with the disease of addiction as criminals. We’ll use effective therapeutic, not punitive, solutions to address drug addiction.

Bernie will:

• Provide people struggling with addiction with the health care they need by guaranteeing health care — including inpatient and outpatient substance abuse and mental health services with no copayments or deductibles through Medicare-for-All.
• Decriminalize possession of buprenorphine, and ensure that first responders carry naloxone to prevent overdoses.
• Legalize safe injection sites and needle exchanges around the country, and support pilot programs for supervised injection sites, which have shown to substantially reduce drug overdose deaths.
• Invest at least $100 billion in funding for treatment, recovery, prevention, and research.
• Ensure that Americans with chronic pain have access to pain management and treatment, including, where appropriate, access to pain medication.
• Pass Bernie’s Opioid Crisis Accountability Act to hold CEOs of drug companies criminally liable for illegal advertising, marketing, or distribution of opioids; prohibit the harmful direct-consumer marketing for opioids; and prevent illegal distribution of opioids and large unreasonable number of opioids from flooding rural communities and states.

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?

Cost, availability of services, and stigma all act as barriers to care for too many young people. Despite the progress we’ve made, many young people avoid seeking the treatment they need because of the stigma associated with mental health issues.

Health care is not a commodity. It is a human right. The goal of a health care system should be to keep people well, not to make stockholders rich. That is why we need Medicare for All, which will provide comprehensive health coverage to all with no premiums, deductibles, copayments, or surprise bills.

Medicare for All will provide comprehensive coverage for mental health treatment services. For too many families with teens and young adults, cost is a barrier to getting the mental health care they need. Mental health care will be free at the time of service, with no co-payments.

In addition, he’ll transform our public schools into more than just places where children learn – they will be community centers that build the health and well-being of students. He will transform our education system into a high-quality public good that connects education, health, and social-services to young people. A strong investment in sustainable community school programs can help us achieve that. President Trump has proposed eliminating funding for community school programs.

Instead of cuts, Bernie will:

• Provide $50 billion over the next decade for sustainable community schools to provide a holistic, full-service approach to learning and the wellbeing of our young people.
• Our schools are a public good. By transforming them into community schools, we can provide health and support services including dental care, mental health care, and substance abuse prevention. Through this investment, we will provide trauma-informed care and services in schools, especially those schools which have been impacted by the War on Drugs, immigration raids, and shootings.

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?

34 million Americans are uninsured, even more are underinsured as the price of healthcare continues to soar.

When Bernie is in the White House, he will guarantee health care as a human right to every person in America, rebuild America’s health care infrastructure, and bring more providers to our underserved and rural communities.

As part of this effort, Bernie will increase the number of health care facilities and providers to provide mental care in underserved communities.

Increase federal funding and expanding community health centers, which currently serves over 28 million people in underserved communities. In 2017, community health centers served one in five people living in rural areas and almost one million agricultural workers.

Significantly expand the National Health Service Corps and Teaching Health Centers to recruit and train mental health providers to deliver culturally competent care in underserved communities.

Cancel all student debt to free up providers to work in communities that need care the most. Second, Bernie’s plan sets up regional offices to help administer Medicare for All, and one of their responsibilities is to recommend changes in provider payment rates to help meet the needs of the area.

Medicare for All removes the bureaucratic nightmare from providers’ daily practice. No more spending a significant part of your day filling out forms and arguing with insurance companies. No more having to navigate getting reimbursed by many different insurance companies. This is especially important for mental health providers, the vast majority of whom are self-employed. Under Medicare for All, the doctor-patient relationship, not insurance company profits, comes first.

By eliminating the predatory, wasteful, and restrictive private insurance system, and replacing it with a universal, comprehensive, Medicare for All program, Bernie will empower every American to seek the care they need, regardless of their income.

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?

According to the DOJ, one in five inmates have a serious mental illness. Instead of incarceration, we should be providing people with disabilities with the services and supports they need to stay in the community, including mental health care. In addition to passing Medicare for All, we will also train, recruit, and increase the number of mental health providers to provide culturally competent care in underserved communities.

Recognizing the humanitarian crisis in our country created by the incarceration of people with mental illness, we will use the Supreme Court’s Olmstead decision to challenge states that have failed to adequately support the voluntary, community-based mental health services that can divert people with mental illness from ending up in the criminal justice system. We’ll invest in diversion programs as alternatives to the court and prison system for people with disabilities and ensure those people have community-based supports and services.

The disastrous War on Drugs has not reduced drug use and violent crime. We must use effective therapeutic, not punitive, solutions to address drug addiction. We must provide people struggling with addiction with the health care they need by guaranteeing health care — including inpatient and outpatient substance abuse and mental health services with no copayments or deductibles — to all people as a right, not a privilege, through a Medicare-for-all. We’ll decriminalize possession of buprenorphine, which helps to treat opioid addiction, and ensure that first responders carry naloxone to prevent overdoses.

We’ll guarantee incarcerated individuals access to free medical care in prisons and jails, including professional and evidence-based substance abuse and trauma-informed mental health treatment. And we’ll remove the profit motive from our re-entry system and diversion, community supervision, or treatment programs, and ensure people leaving incarceration or participating in diversion, community supervision, or treatment programs can do so free of charge.

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?

Bernie strongly supported the Mental Health Parity and Addiction Equity Act and through negotiations, successfully fought for protections in the bill for Vermont’s already robust parity laws. As President, Bernie would expand those parity regulations nationally through federal regulation.

He will also pass Medicare for All to guarantee every person in this country mental health treatment. Mental health care, under Medicare for All, will be free at the point of service, without copayments or deductibles, which can be a barrier to treatment. It will also cover medical devices and assistive technologies and cap what Americans pay for prescription drugs at no more than $200 per year. Furthermore, Medicare for All provides people struggling with addiction with the health care they need by guaranteeing health care — including inpatient and outpatient substance abuse and mental health services with no copayments or deductibles — to all people as a right, not a privilege.

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?

Bernie will pass Medicare for All and the Disability Integration Act to end the institutional bias in our system and provide community-based mental health care and home-and community-based services to everyone who needs it regardless of income. We will no longer force people to “spend down” their savings and impoverish themselves in order to qualify for assistance and well eliminate the long backlog and waiting lists for services. Mental health care, under Medicare for All, will be free at the point of service, without copayments or deductibles, which can be a barrier to treatment. It will also cover medical devices and assistive technologies and cap what Americans pay for prescription drugs at no more than $200 per year.

He’ll defend the rights of people with disabilities to make their own choices about treatment. He will oppose proposals to expand involuntary commitment laws or weaken HIPAA and FERPA privacy protections, recognizing that mental health services work best when they are voluntary, evidence-based and available without cost or waiting.

In a Sanders’ administration, the Olmstead decision will be vigorously enforced through the DOJ Civil Rights Division including to challenge states that have failed to adequately support the voluntary, community-based mental health services that can divert people with mental illness from ending up in the criminal justice system;  we will reverse the Trump Administration’s disgraceful rollback of disability rights enforcement to end the institutional bias that forces people with disabilities out of their communities. Bernie will also issue an executive order instructing HHS to incorporate people with disabilities into their definitions of Medically Underserved Populations.

Every person with a disability has a right to live in their community and receive the services and support they need to pursue the American dream. We’ll guarantee that right through Medicare for All.

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?

Bernie believes we must recognize that in the 21st century, in the wealthiest country in the history of the world, economic rights are human rights.

We must guarantee everyone in our country basic economic rights – the right to quality health care, the right to as much education as one needs to succeed in our society, the right to a good job that pays a living wage, the right to affordable housing, the right to a secure retirement, and the right to live in a clean environment.

To guarantee housing a human right, he will ensure that every person has affordable, accessible housing. He will build the 7.4 million affordable units to fully close the affordable housing gap. He will fully fund Section 8 rental assistance and guarantee vouchers to everyone eligible for the program without waitlists. He will end homelessness in America by building permanent supportive housing and connecting homeless people to available services.

He will raise the minimum wage to a living wage of $15 an hour and enact a federal jobs guarantee to ensure everyone is guaranteed a job that pays a living wage.

Bernie’s Medicare for All program will guarantee comprehensive health care, which includes substance abuse and mental health services, as a human right to all people, regardless of income.

When he is President, Bernie will increase educational opportunities for all including an expansion in career and technical education opportunities to prepare students for good-paying community employment. He will cancel all student debt and guarantee tuition and debt free public colleges, universities, trade schools and apprenticeship programs and end equity gaps in higher education attainment by ensuring all our students get the help they need so they are ready for college and receive the support they need when they are in college.

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?

Bernie’s Medicare for All program will guarantee comprehensive health care, which includes substance abuse and mental health services, as a human right to all people, regardless of income, race, sexual orientation, gender identity, or immigration status.

He understands that one policy alone will not solve this crisis. Both his plans and his record show that he will address this issue with the urgency it deserves.

Specifically, his plan requires the Department of Health to conduct an evaluation of health disparities, including racial and geographic disparities, and to submit a plan to Congress for addressing the disparities found in the evaluation. It also creates an Office of Primary Health to increase access to care including mental health care. It also includes training the workforce we need to address these disparities. His Medicare for All plan includes explicit language that bans providers from discriminating against patients, including discrimination based on race, color, gender, and pregnancy, and allows courts to award damages to patients if this is violated.

He will dramatically expand access to community health centers which provide primary medical, dental, and mental health care, as well as low-cost prescription drugs, to more than 28 million Americans.

And he will significantly expand the National Health Service Corps and Teaching Health Centers to recruit and train mental health providers to deliver culturally competent care in underserved communities.

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?

Bernie believes we need to make significant investments in health research, including robust mental health and addiction research funding. Bernie strongly supports additional funding for the NIH. He also believes that a comprehensive health research agenda should include not just the necessary financial support for disease-specific research, but must also consider our long-term investments in science education and how we can broadly support the next generation of scientists tackling some of the greatest medical challenges of our time.

Medicare for All removes the bureaucratic nightmare from providers’ daily practice and lets providers do what they were trained to do: provide care. For providers: that means no more spending a significant part of your day filling out forms and arguing with insurance companies. No more having to navigate getting reimbursed by many different insurance companies. This is especially important for mental health providers, the vast majority of whom are self-employed. By eliminating the predatory, wasteful, and restrictive private insurance system, and replacing it with a universal, comprehensive, Medicare for All program, Bernie will empower every American to seek the care they need, regardless of their income.

The amount of medical research and quality improvement that could be done with data from a national, public single payer system will be transformative. With a renewed focus on research and quality improvement, the US can finally focus on improving population health, and stop lagging behind other countries on health outcomes.

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

Bernie is running for President so that, when we are in the White House, the movement we build together can achieve economic, racial, social and environmental justice for all. He believes that in the richest country in the history of the world, everyone should be afforded the right to health care, an education, a good job, affordable housing, a clean environment, and a secure retirement. The time is long overdue for the United States to join every other major country on Earth and guarantee health care to all people as a right, not a privilege, through a Medicare for All program. Health care is not a commodity. It is a human right. Bernie’s Medicare for All program would provide comprehensive health coverage to all with no premiums, deductibles, copayments, or surprise bills. And he will address the disparities in our healthcare system. He will rebuild America’s health care infrastructure and bring more providers to our underserved communities.