The 2020 presidential election will be one of the most consequential in recent memory. Whoever is inaugurated the following January will have to contend with a growing health care crisis, particularly where mental health and substance use disorders are concerned.

A 2017 estimate by the National Institute of Mental Health (NIMH) puts the number of Americans who live with a mental illness at nearly 47 million, of which 11 million are living with a serious mental illness such as schizophrenia or major depressive disorder. If left untreated, mental illness and substance use disorders will have a clear and devastating effect on our nation.

The statistics are alarming:

• Depression causes more lost workdays and impairment than common ailments like arthritis, asthma, back pain and diabetes, and costs the economy an estimated $210.5 billion each year.
• Since 1996, suicides have exploded to become the second leading cause of death among children aged 10-17. In 2016, total deaths from suicide reached 45,000.
• Overdose deaths, including those from opioids, eclipsed 68,000 in 2018 and show no signs of slowing down.

Enhancing access and treatment for mental illness and substance use disorders must be a central priority for the president. The next four years will be critical in addressing and improving the broken health care system in America, and there are a number of clear solutions that can begin to affect meaningful change when implemented.

Thousands of lives can be saved and improved by aggressively treating mental illness and substance use disorders. It is critical that they be treated like any other illness through the strict enforcement of federal parity law, and by holding insurance companies accountable when they try to skirt the law.

Medicaid and the Affordable Care Act (ACA) cannot continue to be undercut with repeated efforts in Congress to cap or replace them, potentially leaving millions uninsured. Instead, people who qualify for Medicaid should have their rights protected, and the ACA, which has resulted in more people in this country insured than ever before, should be built on and improved rather than scuttled.

There is a robust evidence-base that shows that our patients are best served when they are treated through innovative integrated approaches like the Collaborative Care Model, which has also been shown to significantly reduce costs for both health care systems and patients. Widespread adoption of Collaborative Care will help address many persistent systemic issues in American health care.

The impact of the critical shortage of psychiatrists and other mental health and addiction service providers in rural and urban areas could be lessened to a degree by expanding residency training positions and loan repayment. The underrepresented groups who live in areas without ready access to services could also benefit from increased access to telepsychiatry. Increased funding for health programs and research to improve early detection and intervention for mental illnesses is also crucial.

We are unfortunately in a situation where two increasingly urgent public health epidemics are plaguing the nation. The rising tide of suicides in this country must be stemmed by identifying early warning signs and providing early intervention and prevention services. The scourge of the opioid epidemic must be fought and defeated by investing in treatment, research and prevention, boosting training and safe availability of medication, and ensuring addiction records are treated like other medical records.

The 38,500 physician members of the American Psychiatric Association, as well as the American people, are counting on the executive branch and Congress to take meaningful action on improving the state of mental health care in this country. Leaving these issues unaddressed could potentially cost thousands of lives and untold millions of dollars and is simply not an option.

For more information on what we would like to see from the president in addressing mental health, visit this this link: Mental Health 2020: A Presidential Initiative for Mental Health

Saul Levin, M.D., M.P.A.
CEO and Medical Director
American Psychiatric Association