30 Sep, 08 | by Steven Reid, Evidence-Based Mental Health
No, it didn’t crop up in the first presidential debate – arguably there were more pressing issues to deal with. But the National Alliance on Mental Illness, a US advocacy group, has posted the replies to a questionnaire on mental health care sent to both Barack Obama and John McCain. Unsurprisingly, health care reform features prominently in the campaign platforms of both candidates. The problems are well known: the US has the most expensive health care system in the world, but 47 million Americans remain uninsured with both life expectancy and infant mortality falling well short compared to other developed nations. Dissatisfaction with the status quo is widespread but there is little agreement about how to change it. Mental health care always struggles to get attention until, of course, cases of gross neglect such as that of Esmin Green come to light. So that NAMI were able to get detailed responses from the two presidential candidates is noteworthy, whatever you think of the responses themselves.
Unlike McCain, Obama did answer all 24 questions that were submitted. In fact he responded by “strongly supporting” every point raised by NAMI: he’s all for guaranteeing comprehensive coverage, improving access to services, increasing funding for all, and awarding all of those living with mental illness a $1 million dollar tax-free lump sum (that last part is fiction, but you get the idea). In other words, an adroit political response: overwhelmingly supportive, but promising nothing too specific.
Although John McCain responded with his own statement (his campaign doesn’t do questionnaires), his comments are certainly more revealing than those made by Obama. Firstly, a positive: he recognises the importance of co-existing psychological disorder in chronic medical illness, stating that untreated depression raises dramatically the costs of treating the physical ailments such as diabetes. Let’s integrate psychological care into general medical practice: not much to argue with there. I’m not so sure about his emphasis on “the central role of personal responsibility” which sounds like a rerun of the ‘mental illness equals lack of moral fibre’ argument. What comes across most clearly, however, is his enthusiasm for cutting costs, mentioned four times here. At least that’s consistent with his overall approach to health care reform: “Opening up the health insurance market to more vigorous nationwide competition, as we have done over the last decade in banking, would provide more choices of innovative products less burdened by the worst excesses of state-based regulation.” Oh dear.