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Government News
Obama Provides More Specifics Than McCain on MH Care
Psychiatric News
Volume 43 Number 20 page 1-9

The two major-party presidential candidates have begun to expand on their mental health positions in the final weeks of the 2008 campaign. According to the National Alliance on Mental Illness (NAMI), Sen. Barack Obama (D) strongly supports a range of efforts to improve mental health care, while Sen. John McCain (R) emphasizes prevention and efforts to control the cost of addiction and psychiatric illness.

NAMI asked both candidates mental health policy questions that probed their mental health and addiction care priorities and released their responses in mid-September.

Obama responded to each of NAMI's 24 questions on mental health care issues, while McCain responded with a general policy statement on mental health and addiction care.

Obama stated that he "strongly supported" all efforts to improve and promote mental health care and screening.

In response to a question about ways to make mental health and addiction care accessible and affordable, Obama responded that his national health plan will guarantee affordable, comprehensive, and portable health coverage for all Americans through partnerships among employers, private health plans, the federal government, and the states.

"In addition, my plan will include coverage of all essential medical services, including preventive, maternity, and mental health care," his statement said.

McCain cited the need to encourage personal responsibility in preventing addiction and to increase access to mental health and addiction treatment to control overall health care costs.

"Mental health is a necessary complement to physical health in all aspects of our daily lives," McCain said. "Fortunately, the path to greater quality and lower costs is to recognize this fact and where possible provide incentives to treat physical and behavioral health together."

McCain's campaign has emphasized the need to address chronic-disease management because it is the dominant component in the growth of health care spending, and many people with chronic illnesses have a mental health or addiction problem. As an example, McCain cited research showing that untreated depression "raises dramatically" the cost of treating a patient with diabetes.

"A sensible goal is to design reimbursement for taking care of the whole patient, whatever ails them, and recognize the essential role mental health treatment plays in the overall health of the patient and the reduction in physical health needs," he wrote.

Jay Khosla, McCain's health policy advisor, told attendees at a forum on health care in September in Washington, D.C., that 20 percent of the Medicare population with chronic illness was driving 80 percent of the increases in the program's costs. The mounting financial strain will require the next president to encourage the use of "integrated teams of health care professionals" to address the needs of chronic care patients.

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The Obama campaign appears to have delved much deeper than McCain's into specific areas of mental health in which action is needed. For instance, Obama's response to the mental health questionnaire stated that he supported expanded federal mandates for private insurance and parity coverage of treatment for mental illness. Also needed, he wrote, is renewing Medicare Part D guidance to ensure coverage of psychiatric medications and changing Medicaid policy to allow reimbursements for inpatient psychiatric facilities.

Obama supported additional funding for a range of research and treatment initiatives, including expanded funding for the Community Mental Health Services Block Grant, "accelerated investment" in the National Institute of Mental Health for research on mental illness, and greater funding for the Garrett Lee Smith Memorial Act and other initiatives to prevent suicide.

The Obama campaign also voiced support for several pieces of legislation focused on mental health and addiction care. Obama endorsed the Keeping Families Together Act (HR 687 and S 382), which aims to end the practice of families of seriously mentally ill children who cannot afford the care their kids need from surrendering custody to the state so the minors can receive treatment (Psychiatric News, March 2, 2007). The legislation would authorize grants to states to pay for the care of such children and allow them to remain in the custody of their parents.

"I believe that forcing parents to relinquish custody of their child in order for the child to receive critical mental health care services is bad policy at best and unconscionable at worst," Obama's questionnaire response said.

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Both candidates called for increasing housing assistance for people with psychiatric illness. McCain urged eradicating homelessness among veterans, who frequently suffer from mental illness.

Obama's response expanded more than McCain's on the needs of veterans, including a call for recruitment of more mental health professionals, improving screening, and instituting "fairness" in decisions to deny benefits for preexisting conditions that actually stemmed from their service.

The Obama campaign also urged placing more mental health professionals with troops as they train, deploy, and return from deployment. The greater interaction would help reduce "the stigma of psychological injury by enhancing training." He also urged counseling for military families who are currently ineligible for care through the Department of Veterans Affairs (VA).

Other veterans' assistance, Obama said, should include mandatory individual, face-to-face, postdeployment mental health screenings, increasing the VA budget to recruit and retain more mental health professionals; making PTSD benefits claims "fairer" and more accurate by providing better training and guidance to personnel, and expanding Vet Centers in rural areas so that veterans and their families can get the care they need closer to their homes.

Members of the National Guard also require additional mental health assistance, Obama said. He would place a mental health coordinator in each of the states' Adjutant General's office and give the states additional resources to provide better follow-up care after returning from deployment.

Obama also called for improved screening and care for traumatic brain injuries, along with increased overall funding for the VA.

"Finally, as president, I will fully fund the VA so it has all the resources it needs to serve the veterans who need it," Obama said.

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