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Policy Matters: We Take a Closer Look at Where the Presidential Candidates Stand on Mental Health Care and Substance Abuse Treatment

Every so often, we hear politicians talk about mental health. But usually when they do, they do so to deflect from other pressing matters, such as gun violence. Yet mental health care and substance abuse recovery actually are very important issues, and voters deserve actual answers instead of defensive deflections.

We’ve unfortunately had front row seats here in Nevada to witness what goes wrong when we don’t properly address these issues, yet now we have front row seats to see what the 2020 presidential candidates are proposing to make it right.

Prelude: Remember Rawson-Neal
Photo by Andrew Davey

Just over six years ago, both Nevada and California were rocked by scandal… What would quickly become known as “Greyhound Therapy”, or simply the patient dumping scandal. The 2013 investigation initially centered on Rawson-Neal Psychiatric Hospital and its pernicious habit of giving patients bus tickets to head out of state rather than provide enough of the treatment they needed, but later that year Lake’s Crossing Psychiatric Hospital in Sparks also landed into legal hot water when the Clark County Public Defender’s office sued over inmates spending an average of 80 days in jails without the mental health treatment they needed and were legally entitled to.

For years, Nevada’s habitual underfunding of our mental health care system was one of those “dirty little secrets” that was not to be discussed in polite company. But when The Sacramento Bee launched an investigation into why James Flavy Coy Brown was sent from Rawson-Neal to somewhere with no friends, no family, and no plan for continuing treatment, that “dirty little secret” exploded into an embarrassing spectacle for then Governor Brian Sandoval (R), the Legislature, and the state’s inadequate social safety net.

Photo by Andrew Davey

After temporarily losing federal accreditation for Rawson-Neal and receiving lawsuits from San Francisco and Los Angeles over the patients who the State of Nevada dumped onto their streets, Sandoval and the (then Republican led) Legislature finally agreed to invest more in the state’s mental health care system in 2015, when they also finally agreed to raise taxes to pay for this and other long-awaited social safety net needs. And yet, just two years later and while facing a new federal lawsuit over Rawson-Neal patient dumping, Sandoval’s proposed 2017-19 budget proposed cuts to the state’s mental health care centers, though Democratic legislative leaders later succeeded in removing most of these proposed cuts from the final budget.

Despite that 2015 funding boost, Nevada remains at the bottom of national rankings on mental health care availability and our state continues to struggle with issues like lack of staff and “deplorable living conditions” at outpatient group homes. And with Governor Steve Sisolak (D) and Democratic leaders keeping another round of revenue-raising tax reform off the table in Carson City this year, mental health advocates will have to look to the campaign trail for the prospect of additional resources from Washington to fix this problem.

“Everyone should be pursued by grace. He was pursued by grace. That should apply to everyone.”
– Amy Klobuchar
Photo by Andrew Davey

Fortunately for these advocates and for patients in need, U.S. Senator Amy Klobuchar (D-Minnesota) has been paying attention. During a call with reporters last week, she described how her own father’s struggle with alcoholism has led her to mental health advocacy: “I loved my dad through all of this, even when he was messing up. This is why I now work on this issue.”

As she described how her father eventually sought help, Klobuchar noted, “He said he was pursued by grace. It changed his life.” She then added, “Everyone should be pursued by grace. He was pursued by grace. That should apply to everyone.”

Photo by Andrew Davey

Here’s where we find Klobuchar’s addiction recovery and mental health care plan. As she noted Nevada’s recent mental health care woes and our ongoing struggles with opioid abuse, she then promised to protect current laws like the Affordable Care Act (ACA, or Obamacare) that guarantee mental health parity and expand access to treatment (think Medicaid) while also expanding access via telemedicine, investment in community health providers (including more beds in more facilities, and more training for more professionals), more drug court and mental health court services to prioritize treatment over jail time, mandating doctors and pharmacists to participate in prescription drug monitoring programs, and providing recovery services like (non-deplorable) outpatient housing and job training to patients in need.

So how will Klobuchar avoid the deadlock that’s taken hold of the Nevada Legislature and pay for these programs at the federal level? As she sees it, “I believe you shouldn’t run for president unless you have a real solution for real problems, and that includes how you’ll pay for [solutions].” So Klobuchar proposes a two cent fee on each milligram of an active opioid ingredient in prescription pain pills that will raise $40 billion, as well as closing the “carried interest loophole” that currently allows money managers to pay a lower tax rate on “asset sales” that would otherwise be subjected to income tax.

“The Republicans were willing to say, ‘Roll it all back. Throw it out the window. It is more important to protect billionaires than to protect our own people.’”
– Elizabeth Warren, speaking about the Affordable Care Act in June 2018
Photo by Andrew Davey

When it comes to health care, national pundits have generally focused on whether or not Democratic candidates support “Medicare for All” single-payer health care. While Senator Elizabeth Warren (D-Massachusetts) is on record in support of “Medicare for All”, she often explains her stance on health care by explaining the importance of Medicaid and using that program to illustrate the need to care for our fellow Americans in need.

Last week, Elizabeth Warren released her opioid action plan and traveled to West Virginia and Ohio to talk with voters about the new and improved CARE Act she’s introduced with Rep. Elijah Cummings (D-Maryland). If it becomes law, the CARE Act will provide states and local communities with $100 billion over the next ten years, including over $8 billion that goes directly to Native American tribal communities. Here in Nevada, the CARE Act provides approximately $41.4 million in guaranteed annual grants to state and municipal authorities. In addition state and municipal authorities will have access to a $500 million reserve in discounted naloxone for immediate overdose reversal treatment, clinics and nonprofit organizations can apply for $1.1 billion in annual grants, and municipal governments can apply for up to $1 billion in annual competitive grants.

Photo by Andrew Davey

While Warren has yet to provide more specifics on the larger issues of substance abuse and mental health care, she has been saying plenty about the even larger issue of our overall health care system. While speaking at a Nevada State Democratic Party event in Henderson last June, Warren provided examples of people who would be harmed by the 2017 Obamacare repeal legislation that would have resulted in severe cuts to Medicaid: “They were willing to roll back the Medicaid expansion that helps babies born seven weeks early who incur millions of dollars in medical bills, that helps your neighbor who uses a wheelchair has a home health aide, so he can live in his own home.” Warren continued, “The Republicans were willing to say, ‘Roll it all back. Throw it out the window. It is more important to protect billionaires than to protect our own people.’”

To pay for her “Medicare for All” single-payer plan, her opioid action plan, and other economic justice programs she’s proposed, Warren offers a “wealth tax” on 2% of assets worth at least $50 million and 3% on assets worth at least $1 billion.

So where exactly does everyone else stand?
Photo by Andrew Davey

Thus far, Klobuchar and Warren are the two candidates who are offering some specific policies on mental health care and substance abuse on the campaign trail. Yet when it comes to their respective governing records, Montana Governor Steve Bullock (D) and Washington Governor Jay Inslee (D) have already provided some key clues on where they stand. In Montana, Bullock signed into law bills that establish mobile crisis units in rural communities, allow Native American tribal communities to license community health workers in their health centers, cover peer support under Medicaid, and reauthorize ACA Medicaid expansion for another six years. And in Washington State, Inslee included in his budget request $155 million to expand mental health services in the state’s public schools, though he’s also run into some trouble over the federal government decertifying Western State Hospital due to health and safety violations.

Two other candidates have also made news on the issue, but not for flattering reasons. After former Vice President Joe Biden visited Southern Nevada last week, he made a fundraising swing through Southern California and experienced a protest outside one of his Los Angeles fundraising events due to the host sitting on the board of Kaiser Permanente, a California health care provider that’s facing scrutiny for long wait times and continuing inequities in mental health care access. Also last week, NBC News reported that South Bend, Indiana, Mayor Pete Buttigieg has yet to directly provide health insurance for his campaign workers, instead offering them $400 monthly stipends to buy individual health insurance through the ACA exchanges (though his campaign is promising to offer a group plan once it crosses the 50 employee threshold).

If you missed last week’s debut “Policy Matters” story, you can find our deep dive into where the candidates stand on gun violence here. And stay tuned in the coming days and weeks, as we’ll be going even deeper and exploring where the candidates stand on immigrant civil rights, climate change, workers’ rights, and much more.

(Editor’s Note: I’m actually about to take my own “mental health self-care” break for the next few days, but I’ll be back in full force next week. See you again soon!)

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