Federal lawmakers will have to be strong backers of mental health care
initiatives if psychiatric conditions are to be included in any expansion of
health care access.
The departure of several of Capitol Hill's strongest mental health
advocates will be felt by APA and other likeminded advocates when the new
Congress convenes later this month. Some supporters do, however, remain among
the leadership of both the Senate and House of Representatives.
Several longstanding mental health advocates retired at the end of the
110th Congress, including Rep. Jim Ramstad (R-Minn.), and Sen. Pete Domenici
(R-N.M.), while Sen. Gordon Smith (R-Ore.) lost his bid for reelection.
“They were absolutely wonderful” supporters of mental health
issues, said Andrew Sperling, J.D., director of legislative affairs for the
National Alliance on Mental Illness (NAMI).
First elected to the House of Representatives in 1990, Ramstad was credited
with leading the push to pass the historic Paul Wellstone and Pete Domenici
Mental Health Parity and Addiction Equity Act of 2008 (Psychiatric
News, October 17, 2008; November 7, 2008). In 2007 Ramstad and Rep.
Patrick Kennedy (D-R.I.) embarked on a nationwide tour to highlight the
importance of mental health insurance parity that used a series of field
hearings to galvanize support for legislative action.
“Ramstad, in particular, was an outspoken advocate of parity coverage
for alcohol and drug addiction treatment,” said Nicholas Meyers,
director of APA's Department of Government Relations.
Domenici's accomplishments include extensive leadership on mental health
parity, as well as legislation to fund more mental health services for public
school children. Domenici, whose daughter has schizophrenia, has said that
many members of Congress with undisclosed mental illness in their families
have privately approached him with support.
The surprising defeat of Smith in his reelection race against Democrat Jeff
Merkley also reduced the ranks of strong mental health advocates. Smith is
most known for sponsoring the Garrett Lee Smith Memorial Act, to create
screening programs to identify and help youth at risk for suicide. The
legislation honored his son, Garrett, who committed suicide in 2003 at age
“I hope and pray that my Senate colleagues, while I am gone, will not
forget those who struggle with mental illness,” Smith said in a farewell
address on the Senate floor.
Commented Meyers, “Sen. Smith has been a tireless and devoted ally
for many of APA's legislative objectives over the past few years. He's most
deservedly a past winner of APA's Jacob Javits Public Service Award, and APA
was proud to be joined by AACAP in our successful nomination of Sen. Smith for
the AMA's Nathan Davis Award. We will miss him.”
Of course, several key mental health advocates remain in Congress,
including Kennedy and his father, Sen. Edward Kennedy (D-Mass.). The elder
Kennedy, diagnosed with a brain tumor in 2008, has vowed to remain on the job
and dropped his chairmanship of the powerful Judiciary Committee to focus full
time on health care reform.
The coming political battles over efforts to greatly expand health care
access have led advocates to worry that some may look for cost savings by
leaving out funding for psychiatric illness, including addiction care. These
concerns make the continued efforts of mental health leaders, such as the
Kennedys, and their past accomplishments critical in the new Congress.
“With comprehensive health care reform on the agenda, the passage of
parity puts us in a much stronger position,” Sperling said.
Continued support also is expected from much of Congress's Democratic
leadership, including Rep. Chris Van Hollen (D-Md.), chair of the Democratic
Congressional Campaign Committee; Rep. Steny Hoyer (D-Md.) the House majority
leader; and Sen. Harry Reid (D-Nev.), the Senate majority leader. Reid, who
lost his father to suicide, and the other Democratic leaders were supportive
of a mental health parity law and a law to end Medicare's discriminatory
copayments for outpatient mental health care (PL 110-275) (Psychiatric
News, August 1, 2008).
The ranks of mental health supporters also might be reinforced by newly
elected members. New to the 111th Congress is Rep. Paul Tonko (D-N.Y.), a
former New York State Assembly member who was a sponsor of New York's mental
health parity law, “Timothy's Law,” enacted in December 2006.
Another new member of Congress, Rep. Jon Adler (D-N.J.), supported several
issues of concern to APA and other mental health advocates as a state senator
including a state mental health parity bill, youth suicide prevention
programs, and postpartum depression awareness campaigns.
Some new congressional leaders, however, could add items to their agendas
that might not be popular among all mental health advocates.
The ascension of Sen. Daniel Inouye (D-Hawaii) to the head of the Senate
Appropriations Committee, which has a primary role in all government spending,
gives him broad influence over any expansions in mental health treatment. He
has used his previous position as chair of the Veterans Affairs Committee to
push for expanded mental health care for returning warriors. However, Inouye's
leading role in supporting a now-discontinued Department of Defense
psychologist prescribing program raised serious concerns among psychiatrists,
their physician colleagues, and many others concerned about patient
Also unclear is the impact of the plans of the incoming chair of the
powerful House Energy and Commerce Committee, Rep. Henry Waxman (D-Calif.), to
launch increased scrutiny of drug company marketing efforts. He voiced support
for legislation that would give the Food and Drug Administration the authority
to ban direct-to-consumer advertising in the first two years a drug is on the
market, and he has called for Congress to take action to restrict marketing to