By Thomas R. Insel and Patrick J. Kennedy
President-elect Joe Biden entered the presidential race with a pledge to help “heal the soul of America” — rent asunder by inequality, racism and a loss of hope. A booming economy had left millions behind. Homelessness, mass incarceration, deepening poverty, addiction and deaths of despair had become inescapable parts of the American landscape, driven by a profound mental health crisis.
Over decades, America’s mental health care system has been chronically underfunded and broken such that people with serious mental illness were more likely to be living on the streets, languishing in jails, or dying two decades prematurely in poverty rather than receiving compassionate treatment. And all that was before COVID-19 arrived.
Just as our anemic public healthcare system left us unprepared for the pandemic, we were even less prepared for an unprecedented mental health crisis afflicting half of all Americans. The prevalence of depression symptoms has jumped three-fold, overdose deaths have increased in 40 states, and the CDC reports that 25% of young adults struggle with suicidal ideation. Suddenly, mental health has become everyone’s problem, requiring not simply an emergency infusion of federal resources, but a commitment to resolve the crisis.
The good news is that there is a plan – a roadmap for the new administration, Congress and state governments to reinvent our broken mental health care infrastructure. The leaders of the nation’s 14 leading advocacy groups and professional organizations began meeting early in 2020 in emergency session to generate proposals to address the new wave of need. With our combined expertise working on the fault lines of substance abuse, suicide and severe mental illness, we created a unified vision statement for Transforming Mental Health and Substance Abuse Care that offers “shovel-ready” pathways for success. And, for the first time, there is agreement among all stakeholders about what must be done.
We believe that any action on stimulus relief must prioritize a significant investment in mental health. We must start by mobilizing public and private action to implement care that works. The shift to telehealth in the course of the pandemic demonstrates that our care system can make radical changes quickly. Now is the time for rapid deployment of evidence-based practices for integrated care, early intervention and prevention, and building a diverse workforce that can end this crisis.
We must also transform emergency and crisis response capabilities and fast-track emergency response systems. By marshaling resources, we can put relief within reach for millions more by bringing whole-person, virtual care outside of the clinic. Mental health crisis response typically does not require a police response followed by evaluation in a jail or an emergency room. There is a better, cheaper, more humane approach. For example, in July, the FCC adopted rules to establish a new 988 National Suicide Prevention Lifeline for Americans in crisis. Full enactment is not mandated until 2022, although some carriers have made the number available, and with it, immediate access to a continuum of crisis services. Access must be expanded and expedited.
To move from “what” to “how” and “when” we need immediate bold steps from government and the business community. Nearly 60 years ago, President Kennedy said that people with mental illness and developmental delays had become “alien to our affections,” and called upon Congress to end the neglect. More than a half century later, the chronic neglect of people with mental illness has become not simply a health crisis but a social justice crisis, contributing to the shameful inequality that sickens the soul of the nation.
If the new administration is committed to addressing the suffering in the soul of America, it must show that those who struggle are no longer “alien to our affections.” We call on the new administration to appoint leaders who understand the urgency and who will advocate for resources commensurate with the need. The lesson of the Covid pandemic is not simply about lack of preparedness. It is also about our resourcefulness as a society to mobilize public-private partnerships that could develop treatments and vaccines at an unprecedented speed and scale.
This is the moment to bring together public and private efforts to ensure that we not take another 60 years to deliver on Kennedy’s vision. By mobilizing investment in comprehensive, whole-person mental health and substance abuse care – by driving deeper systemic change over time, by pressing forward on promising clinical research into new treatments – we can inspire hope, speed healing and make possible the conditions for America’s spiritual, economic and social recovery.
Thomas R. Insel, M.D., is chair of the Steinberg Institute, co-founder of Humanest Care, and former director of the National Institute of Mental Health (2002-2015).
Former U.S. Rep. Patrick J. Kennedy (D-R.I.) is the founder of the Kennedy Forum. He lives in South Jersey.
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