Hillary’s New Comprehensive Agenda on Mental Health
What could go right and what could go wrong?
Posted Aug 30, 2016
On Monday, August 29, 2016, Hillary Clinton released a comprehensive agenda to deal with expanding mental health problems in the United States, including a call to convene a White House conference on the issue during her first year in office should she be elected president.
What can go right?
This is a welcome step for the millions of Americans coping with mental illness with little support apart from a dose of a psychiatric drug, with minimal or no emotional or moral support from their doctors or community. There are two points that are especially laudable about Clinton’s agenda with regard to children, an especially vulnerable population with respect to mental health.
First, the recognition that children develop mental health conditions not because they are born with defective brains, but because many children are growing up in environments that cause them to experience trauma or other forms of toxic stress. The public recognition that trauma and extreme stress are causal factors in children developing emotional and behavioral issues is a giant step in the right direction.
Training pediatricians, teachers, and school counselors to identify children the real causes of childhood problems: namely, abuse or other forms of toxic stress at home is a critical step to improving childhood mental health and the unnecessary drugging of children with psychiatric drugs that merely cover their symptoms (and may be shown do them harm when and if long term studies are done on drugs and the child’s developing brain).
Leveling the field
A second promising point in Clinton's agenda, especially with regard to children, is to “Expand reimbursement systems for collaborative care models in Medicare and Medicaid. Collaborative care is a model of integrated care that treats mental health and substance use conditions in primary care settings. A team of health care professionals work together to coordinate the patient’s services, including a primary care doctor, a care manager, and a behavioral health specialist.”
At present, children on Medicaid who are experiencing emotional and behavioral difficulties are given short shrift. Medicaid pays for a twenty minute appointment with a child psychiatrist. Children walk out of the session with a prescription for a psychiatric drug that Band aids their symptoms, instead of a comprehensive evaluation of the real causes of the child’s distress.
More affluent children, whose parents have private insurance, are able to afford in- depth family therapy, behavioral therapy or other talk therapies which can include therapist communication with the child’s teacher or school counselor to open every avenue of support to help the child. At present, poor kids take more psychiatric drugs than more affluent children in our society. Clinton’s program provides at least a suggestion that less affluent children on Medicaid will finally be able to have the advantages of extensive talk therapies and parental training to help them overcome their challenges.
What could go wrong?
Finally, we get to the question of what could go wrong with Clinton's sweeping and hopeful agenda. The answer is simple. If the "experts" who carry the most weight in shaping the new agenda are the proponents of the view that most if not all mental health problems of children are manifestations of brain defects and as such are best treated with psychiatric medications.
Today, more than eight million children in the United States are taking psychiatric drugs for so called “medical illnesses” like attention deficit hyperactivity disorder (ADHD) and other behaviors that have been presented by academic psychiatry as akin to physical illnesses. Instead, panels of experts should include social workers, family therapists, teachers, and school counselors and other non-academics who work in the front lines with children and who are all too familiar the real causes of their problems in the child's social world.
Clinton’s proposal is especially laudable in that she insists on equal reimbursement and parity for emotional and psychological problems. But there must also be the recognition that emotional and psychological problems, even severe ones, are not the same as physical illnesses in that drug treatment for symptoms is the first solution the doctor thinks of with medical illnesses. Her agenda mentions treating the “whole person.” In the case of children, as well as adolescents and young people, the concept of the whole person must be extended to the whole social environment: family, school, peers and culture.
Copyright © Marilyn Wedge, Ph.D.
Marilyn Wedge is the author of the recent book: A Disease called Childhood: Why ADHD became an American Epidemic
She is the author of the popular Psychology Today article "Why French Kids don't have ADHD" which has more than 16 million views.