We asked Senator Elizabeth Warren to get on the record about mental health and addiction. Here’s what she 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?
In the Senate, I’ve fought to strengthen support for mental health services for everyone, including fighting to prevent budget cuts to the Mental Health Block Grant and secured an additional $160 million for the program, urging appropriators to designate $1 billion to mental health programs through the SAMHSA and for providing suicide prevention hotline access and resources to Puerto Rico and the U.S. Virgin Islands. I introduced the Native Americans Suicide Prevention Act to bolster suicide intervention and prevention in Native American communities. I was an original co-sponsor of the Garrett Lee Smith Memorial Act reauthorization to improve access to counseling, suicide early intervention, and prevention for people at high-risk of suicide.
As president, I’ll set a goal of cutting veteran suicides in half within my first term – and pursue a suite of concrete policies to make sure we get there. My administration will invest more in researching the causes of suicide, with a specific focus on contributing factors that are specific to the military experience. Under Medicare for All, everyone – including our service members and veterans — will have consistent, accessible, high-quality mental health care. I’ll make it easier for service members and veterans to see a mental health professional, increase the number of mental health specialists at DOD and VA, streamline appointment processes, and enhance access to telehealth options for those who cannot come to a VA facility.
We should also focus on preventive care – early and often throughout a military career, including by incorporating annual mental health exams for service members in the same way they receive annual physical exams. We should clearly communicate benefits and eligibility, raising awareness about available care. And we must continue to remove the stigma around seeking help, and do more to support military families who lose someone to suicide.
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?
I introduced the CARE Act with my colleague the late Congressman Elijiah Cummings, which would invest $100 billion over 10 years to make sure those in need receive the treatment they deserve. That includes $4 billion annually for states, territories, and tribal governments; $2.7 billion for the hardest hit counties and cities, including $1.4 billion to counties and cities with the highest levels of overdoses; $1.7 billion for public health surveillance, research, and improved training for health professionals; $1.1 billion for public and nonprofit entities on the front lines, including those working with underserved populations and workers at high risk for addiction, and to support expanded and innovative service delivery of treatment, recovery, and harm reduction services, and $500 million to expand access to naloxone and provide this life-saving overdose reversal drug to first responders, public health departments, and the public.
Under my plan, resources would be used to support the whole continuum of care, from early intervention for those at risk for addiction, to harm reduction for those struggling with addiction, to long-term support services for those in recovery. Along with addiction treatment, the CARE Act would ensure access to mental health services and help provide critical wraparound services like housing support and medical transportation for those who need them.
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?
To start, we need to support our very youngest. We know that adverse childhood experiences, like poverty, homelessness, violence in the community or in the home, family separation, or a caretaker with a substance-use disorder, can affect brain development and have an impact on mental health in the teen years and beyond. My plans on gun safety, housing, immigration, and the opioid crisis confront many of the conditions that can cause childhood trauma.
The LGBTQ+ community is also at a higher risk for mental health issues. Under Medicare for All, every person will have comprehensive mental health coverage, and as president, I’ll also fight to make sure every LGBTQ+ young person is treated with dignity, fairness, and love at home and in school. I’ll fight to close the mental health provider gap in our schools and expand funding for school-based health clinics, and I will end zero-tolerance discipline practices and support programs like restorative justice that bring students in instead of pushing them out.
I also secured increased funding for the Mental Health Block Grant, which supports early intervention for children experiencing serious mental illness for the first time, since 50 percent of all chronic mental health conditions have their onset by age 14. I’ve also supported a resolution recognizing the effectiveness of integrating trauma-informed care across federal, state, and local agencies, and I co-sponsored legislation to ensure timely mental health for children entering foster care and legislation to provide critical services to homeless and runaway youth.
Additionally, I’ve supported strengthening schools to meet the mental health needs of their students. I co-sponsored the Mental Health in Schools Act, which would bolster successful youth-focused programs to strengthen community-school partnerships for improved mental health and substance abuse services.
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?
We must support today’s health care workforce and build a pipeline for the future workforce. More than 75 million Americans live in health professional shortage areas, and with an aging population we need more physician’s assistants, mental and behavioral health specialists, and addiction care providers. To start, I’ll increase the Congressionally-imposed cap on medical residencies by 15,000 over five years and target residency placements in medically-underserved areas. I will also expand the National Health Service Corps’ and the Indian Health Services’ loan repayment programs to cover full loan repayment for 5 years of service in medically underserved areas.
Engaging the mental health service workforce to promote resiliency, recovery, and positive life outcomes for individuals experiencing mental health problems helps protect our most vulnerable from the negative consequences of neglect and underservice — psychiatric crises, functional disability, school failure, unemployment, homelessness, and incarceration. To build the future workforce, I’ll dramatically scale up apprenticeship programs that partner with unions, high schools, community colleges, tribal colleges, and a wide array of healthcare professionals. And my plan to fight the opioid crisis includes $500 million to train and provide technical assistance to health professionals treating substance abuse.
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?
I start with a basic principle: health care is a human right that no person should be denied. Under Medicare for All, we’ll provide continuous access to critical mental health care services, decreasing the likelihood that the police will be called as a matter of last resort. We also have to change how police work is done. Police officers have become America’s de facto first mental health providers. People with mental illnesses aren’t incarcerated at higher rates because they are prone to violence. To the contrary, most are arrested for non-violent offenses, many because they lack access to necessary services. Instead of shuttling people into a system not built to meet their needs, we should invest in preventing people from reaching those crisis points in the first place. I’ll invest in “co-responder” initiatives connecting law enforcement with mental health care providers and pilot evidence-based crisis response efforts to provide needed services to individuals struggling with mental illness.
We also need to make sure that people who are incarcerated are treated with basic dignity and respect –includingthosewithmentalillness. Thatmeanstakingacomprehensiveapproachtoincarcerated people who face mental health and addiction challenges, including requiring an adequate number of counselors and addiction specialists, individualized treatment, and increased access to medication-assisted treatment. I co-sponsored the Comprehensive Justice and Mental Health Act, which sought to facilitate collaborative mental health supports for people who have come into contact with the criminal justice system. And I’ve called to eliminate solitary confinement, which provides little carcerative benefit and has been demonstrated to harm prisoners’ mental and physical health. I’ll direct the Bureau of Prisons to establish a set of standards and reforms to protect the most vulnerable in our prison system without confining a person for more than 20 hours a day.
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?
Health care is a human right – and that means mental health just as much as physical health. That’s part of why I support Medicare for All, which would provide comprehensive coverage, including for mental health care and substance use treatment, to all Americans. Despite the widespread current need for mental health services, in 2018 less than half of people with mental illness received treatment and less than a fifth of people who needed substance use treatment actually received it.
We must guarantee health coverage, and we also should fight to ensure that no person faces illegal discrimination when seeking behavioral health care as we transition to Medicare for All. Congress banned discrimination like this in 2008, when it passed the Mental Health Parity and Addiction Equity Act to require insurance companies to adhere to the same standards of coverage for behavioral health as for other health conditions. Yet it persists, due to weak oversight and little real recourse for patients. As president, I will launch a full-scale effort to enforce these requirements – with coordinated actions by the IRS, Centers for Medicare and Medicaid Services, and Department of Labor to make sure health plans actually provide mental health treatment in the same way they provide other treatment.
In the transition to Medicare for All, I’ll work to expand Medicaid in states that have yet to do so and in U.S. territories to expand access to critical mental health services. And I will work to enact my Behavioral Health Coverage Transparency Act, which would strengthen enforcement of existing mental health parity laws by increasing mandatory federal audits of health plans, require insurance companies to disclose how they make decisions on behavioral health care coverage, and establishing a Consumer Parity Portal to help patients navigate the system.
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?
Institutionalization of those experiencing mental illness and with developmental disabilities is not the answer. I firmly believe in the right of those with mental illnesses and developmental disabilities to live and participate in their communities. I will fight to end the bias towards institutional care and guarantee seniors and those with disabilities the right to home and community-based services. A Warren administration will enact and build on the D isability Integration Act and fully enforce the Olmstead d ecision t o achieve its promise of community-based treatment and services under Medicare for All. I’ve also supported expanding access to Community Mental Health Centers and Community Behavioral Health Clinics. To improve access to community-based services broadly, I’m committed to expanding funding for Community Health Centers by 15% per year over the next five years and increasing mental and behavioral health providers in medically underserved communities by expanding the National Health Service Corps and Indian Health Service Corps to cover full loan repayment program for five years of service.
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?
Worrying about making rent, finding a job, paying for life-saving medication, or feeding your kids are huge stressors that can cause or exacerbate anxiety, depression, and a whole host of other mental illnesses. None of these issues can be treated in a silo. That’s why I’ve proposed comprehensive, intersecting, and overlapping plans to ensure that communities all over this country can thrive. My Housing Plan for America invests $500 billion over the next decade to create more than 3 million new low- and moderate-income housing units, bringing rents down by 10% and ensuring that people can afford to live in the communities they call home. My plan for universal child care provides access to high-quality affordable child care, so that parents can pursue economic opportunities while knowing their children are safe. My plan to invest in rural America invests in expanded health access and creates and defends jobs in communities with few resources. And I support Medicare for All so that ability to pay is never a barrier to care and support.
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?
I’m committed to ensuring everyone — no matter where they live, where they’re from, how much money they make, the color of their skin , their gender identity, or their sexual orientation — has high-quality mental health care. That’s why I support Medicare for All, which will ensure that every person in this country can get high quality mental health and substance use treatment. I’ve fought for better access to behavioral and mental health programs for Native American communities and am committed to expanding tele-mental health services and resource for staffing, infusing tribal communities with new resources to combat substance use disorder, empowering tribes to resolve the suicide crisis, and addressing childhood trauma. I co-sponsored the Protecting Sensitive Locations Act to end the practice of arbitrary immigration enforcement in places like hospitals, so that immigrants aren’t afraid to access needed health services, fought against solitary confinement of immigrants with mental illnesses in ICE facilities, and am opposed to the Trump administration’s new Public Charge rule that forces immigrant families choose between staying together and getting access to critical services. I am also a co-sponsor of the Equality Act, and I believe Congress must pass this bill to explicitly ban discrimination against LGBTQ+ individuals in health care. And I’m committed to fully investing in a 21st Century VA Health Care system worthy of the veterans it serves and ensuring that veterans are prioritized in our response to the opioid crisis. The opioid crisis has severely impacted communities of color, exacerbated by existing health disparities. My comprehensive plan with the late Congressman Elijah Cummings to end the opioid epidemic works to strengthen our addiction treatment infrastructure — demanding states use Medicaid to its fullest to tackle the crisis, expanding access to medication-assisted treatment, and ensuring treatment programs and recovery residences meet high standards.
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?
It starts by investing more in the National Institutes of Health to conduct research in the treatment of mental health disorders. With the Medical Innovation Act, I called on Congress to penalize rule-breaking pharmaceutical companies by reinvesting a portion of their profits into the NIH. I’ve also fought against the sequester of funds for medical research and against President Trump’s proposed cuts to the NIH budget. I introduced the National Biomedical Research Act, a bill that would establish a reliable funding stream for the NIH by establishing a $5 billion Biomedical Innovation Fund at the NIH. And I co-sponsored the Mental Health Reform Act, which would create a new Mental Health Policy Laboratory at HHS that supports innovation grants that identify new and effective models for mental health treatment.
11. Is there anything else you’d like to share with the mental health and addiction community?
We all know someone who has dealt with a mental health condition or a substance use disorder — a friend, a family member, a partner, a co-worker, a neighbor. Nearly one in five adults live with mental illness, and more than 11 million Americans experience a serious mental illness that substantially impacts their major life activities. Mental health issues are too often swept under the rug, whether its people dealing with schizophrenia, substance use, or other mental illnesses. It’s time to make sure everyone has access to high-quality, affordable mental health care – and I’m in this fight all the way.