Originally published on November 2, 2020 by Bryan Specht

Laura Mayer manages calls for the National Suicide Prevention Lifeline through PRS CrisisLink in Oakton, Virginia. Mayer, who was featured in an NPR story earlier this year, said that, under normal circumstances, she handles serious crisis calls with a 911 referral or a recommendation to go to the hospital. That script has changed in the midst of a pandemic with major concerns for hospital capacity. Instead, Mayer is spending more time providing therapy herself over the phone, well beyond the best practices most professionals recommend. Even more concerning is that the volume, nature and urgency of the calls has become far more dire this year.

“The type of call and the seriousness of the call is very different this year than it was in previous years,” Mayer told NPR recently. “There are environmental issues, internal issues, family issues. It’s never one thing.”

It is practically a cliché to say these days, but tomorrow’s election is the most important U.S. election in decades. One very important issue on the ballot is mental health, which has received reasonable bipartisan support in recent years but has never received the full national attention, investment or action it deserves. The truth is that mental health issues are touching the lives of more Americans in more ways this year than maybe ever before. The COVID-19 pandemic, resulting economic headwinds, and nationwide racial unrest have contributed to a spike in anxiety and depression. Once the data is finalized, we will likely see an acceleration of the increase in suicide rates that has occurred in recent years. Early indicators signal that U.S. 2020 addiction data will also likely show a dangerous increasing trend in drug use and related deaths.

At the center of this year’s campaign season has been the future of the Affordable Care Act (ACA), raising questions about the future of health coverage for almost 30 million Americans, and whether there is a still yet-to-be defined alternative. Also, within the ACA are important mental health parity requirements, which could be at risk, depending on the outcome of the presidential and congressional elections. Let’s take a look at this and other key mental health considerations in tomorrow’s elections.

Mental Health Parity

One of the most important mental health issues is parity in insurance coverage for mental health services. The Mental Health Parity and Addiction Equity Act (MHPAEA) was passed 12 years ago, requiring insurers to treat mental health and addiction services in ways reasonably equal to physical services such as medical treatment and surgery. Ten years ago, the Affordable Care Act expanded the original mental health parity law, but President Trump has repeatedly expressed a desire to see the ACA repealed.

The Trump administration has supported legal challenges to the ACA, and most Supreme Court experts believe the current composition of the court, with the recent confirmation of Trump’s nominee Amy Coney Barrett, favors the repeal of certain elements of the ACA. With no reasonable mental health supportive replacement measure on the table, the repeal of the ACA would be a very negative step for mental health and for access to mental health services for those in need. Without a clear alternative that includes similar mental health parity measures, this is an area of concern for mental health advocates. Vice President Biden helped craft and pass the ACA, was the original author and sponsor of the Violence Against Women Act (VAWA), and has a long history of advocating for mental health parity. With no proposed alternative from President Trump, mental health parity seems to be an area of clear contrast between the presidential candidates. However, the individual positions among congressional candidates vary greatly, so check the positions taken by your state and local candidates on the ACA and related issues.

Suicide Prevention

One important mental health issue in which the presidential candidates are a bit less divided is suicide prevention, though there are also some very key differences. Suicide prevention is growing in importance given that rates have steadily increased every year since the turn of the century. Both candidates put heavy emphasis on the alarming rates of suicide among America’s veterans.

President Trump’s 2021 budget includes more than 25% more funding for preventing suicide among veterans, and he has proposed an increase in funding for state-focused grants for suicide prevention.

Former Vice President Biden has similarly proposed significant increases in spending for prevention of suicide among veterans, but he would also establish programming outside of the Veteran’s Administration. Beyond veterans, Biden advocates prevention programming for various other populations, especially teens and LGBTQ people across the United States. This is a very important distinction between the presidential candidates, though like mental health parity there is wide variation on the positions held by congressional candidates across the country.

If you or someone you know is in crisis, help is available.

  • Call the National Suicide Prevention Lifeline at 1-800-273-8255.
  • Text the Crisis Text Line: Text HOME to 741741 to connect with a crisis counselor 24/7 in the U.S. and Canada.
  • Call the Substance Abuse and Mental Health Services Administration’s National Helpline at 1-800-662-4357.
  • Call the National Alliance on Mental Illness’ HelpLine at 1-800-950-6264.

Addiction Treatment

Self-medicating with drugs and alcohol has become a coping tactic for many Americans during the pandemic – data indicating increased risks of addiction are staggering. From the beginning of March to the end of the month, calls to the Substance Abuse and Mental Health Services Administration’s National Helpline increased 500%.

President Trump and former Vice President Biden have both strongly advocated for addressing addiction, particularly in the context of the opioid crisis. President Trump has been outspoken during his term that opioid addiction is a national public health emergency. He has advanced key addiction policies over the last four years, but he has also reduced funding for the Substance Abuse and Mental Health Services Administration (SAMHSA) and Medicaid – the U.S.’s largest payer for mental health services and a main contributor to substance use disorder services. However, his 2021 budget includes increases in state grants for addiction treatment.

Former Vice President Biden has committed to appointing an Opioid Czar to lead the government’s increased response to the crisis. The proposed increase would include new funding of $125 billion over a decade, focused on treatments, investments in underserved communities, new requirements for prescribers, and the development of less addictive alternatives.

A Culture of Mental Well-Being

There are also issues on the ballot that are bigger than individual policy measures. The president is not only the nation’s ultimate policy and security leader, they also set the cultural tone for the discourse between their supporters, detractors and those with no particular political loyalty. Our nation’s elected executive leader has enormous influence on the tone of our public dialogue and how we “treat each other” across society. One area that has to be discussed is the influence candidates will have on promoting a culture of mental health and well-being. While political correctness and “cancel culture” have become controversial, there should be no question of the need for civility, empathy and a sense of community that transcends political disagreement.

Whatever your politics, the United States has become increasingly divided at a time of crisis when unity and empathy are needed more than ever. A president who errs on the side of compassion and caring can have a meaningful impact on reducing feelings of isolation and alienation, resulting in corresponding mental health benefits for our citizens. While President Trump has supported certain mental health policies, former Vice President Biden has largely campaigned on creating a culture of empathy and understanding that can help lead to one that supports mental health and well-being.

The Hidden Issue, Hanging in the Balance

In our drama-filled, politically charged 24-hour news cycle, mental health has simply not drawn the attention it deserves during this crisis and throughout this election season. Indeed, it has not drawn the attention it deserves throughout history. But make no mistake, it is on the ballot both in the presidential election and in Senate and House races culminating across the country.

COVID-19 has compromised our physical health, but we also need to advance meaningful strategies and measures to improve the mental health of people across the country. This means reducing isolation for those who are alone, improving access to services by ensuring mental health parity in health coverage, providing much-needed resources for suicide and addiction prevention, ensuring equitable mental health coverage that is inclusive for vulnerable populations, and, perhaps most important, advancing an unwavering commitment to a culture of mental well-being.

Whatever your views on these issues or preferences between the candidates, the most important thing is that you vote. And whatever the outcome of the various elections tomorrow, the work isn’t over at the ballot box. Let’s make sure mental health is a priority in 2021 and well beyond.