Presidential debate moderators should ask about mental health policy

As the mom of three young adults, I am worried about their economic future — their ability to get jobs and afford homes.

But I am equally concerned about their mental health and well-being. A 2022 national survey found that approximately half of young people ages 18-25 have a mental illness, substance use

disorder, or both. Suicide and overdose rates remain persistently high: As Nicholas Kristof has written, “every three or four days we lose as many Americans to drugs, alcohol and suicide as

died in the Sept. 11 attacks,” affecting nearly all families in America. And yet, except for addressing the supply of fentanyl, neither presidential candidate has prioritized this country’s

mental health crisis in their speeches, nor have interviewers questioned them on the topic. 

The upcoming presidential debate is the perfect opportunity for both candidates to inform voters how they will address the most pressing public health issue of our time.

There is no denying that we are in a mental health crisis. The Centers for Disease Control and Prevention recently released data showing that 53% of high school girls report being

persistently sad or hopeless. It’s no wonder that parents of children under 18 now rank mental health as their top concern.

While the youth mental health crisis is concerning, adults are also suffering. Researchers determined that roughly one in four maternal deaths are caused by suicide and overdoses, making

mental health the leading cause of maternal mortality.  Men are also affected by these conditions. They are four times more likely to die by suicide and more likely to use lethal means, such

as firearms.  As in other areas of health care, there are stark disparities based on race, ethnicity, gender identity, sexual orientation, disability, and income.

I’m not naive — I know that behavioral health policy is less polarizing than other issues and media may not get the memorable quips or soundbites from these questions. But given the outsized

impact on our future prosperity and the loss of hundreds of thousands of lives every year, voters should have the opportunity to evaluate the quality and comprehensiveness of their

response.

Here are three areas that moderators David Muir and Linsey Davis should be sure to address.

1) How will you improve access to critically needed mental health and addiction services? 

It is extremely difficult to find a mental health provider that takes your insurance.  A recent study found that “in the largest US cities, only 17.8% of clinicians listed as in-network for

Medicaid were reachable, accepted Medicaid, and could provide a new patient appointment.”  In 2023, Senate Finance Committee staff conducted a secret shopper study of Medicare Advantage (MA)

plans’ provider directories, which yielded similar results. In the MA program, insurance plans can earn extra quality payments, but the size and accuracy of the networks are not factored

into the $13 billion bonus program. How will the candidates align incentives to ensure better access to providers in the Medicaid and Medicare programs?

Private plans are not any better. In summer 2023, the Biden administration proposed stronger parity rules to hold private health insurance plans more accountable for access to care. Do the

candidates support strong parity rules and pledge to enforce them?

Provider rates continue to be inadequate. For example, Medicaid rates for peer support specialists, who help engage and support people with mental health and substance use conditions, vary

tremendously and inexplicably — from $5.98 per 15 minutes in South Carolina to $26.23 in Missouri, two states with roughly comparable cost of living. How will the candidates address

workforce shortages and the underlying causes of the shortages, including below-market rates?

Telehealth has been a bright spot in this grim landscape, but progress is by no means ensured. State licensing laws and in-person requirements threaten progress. There is a current battle

between the federal health care and drug enforcement agencies around prescribing addiction and mental health medications through telehealth. Who will you put in charge, and what will you do

to expand access to telehealth?

Schools and medical settings are important opportunities for serving people in local communities and reducing disparities. Providing mental health care in schools has been shown to reduce

absenteeism.  Given that one in eight children in America is served by community health centers, making an investment in early childhood programs and integrated behavioral healthcare across

these centers would be impactful. Research indicates the majority of people who died by suicide received health services in the previous year, providing an opportunity for better outcomes.

How will the candidates integrate behavioral healthcare into schools and primary care to reach people where they are? 

We will never have enough resources to treat our way out of this crisis, so we need a prevention strategy that addresses social drivers of much of our poor mental health. For example,

reducing adverse childhood experiences, providing housing, and increasing economic stability through tax credits or grants have been shown to decrease risk and improve mental health

outcomes. What ideas do the candidates have for getting upstream and preventing mental health and substance use conditions? 

No preventive strategy would be complete without a focus on social media. A recent survey indicates that young people are spending an average of roughly five hours per day on social media

platforms. Yet no federal agency is charged with keeping users safe. 

When you go to the grocery store, you can look at the box and find information in the same format. The same should be true for social media and knowing where to go to control our feeds and

enhance our privacy. 

And we need to invest in research so social media can be more effective in promoting well-being, instead of harming it. So, to the candidates: Do you agree that we need to better regulate

social media companies and understand the benefits and harms of these platforms? What agency will you put in charge and what would you have them do?

And finally, I hope that moderators will ask the most important questions:

3) Do the candidates recognize the scope and danger of the current mental health crisis?

If so, how will they mobilize a national response that is equal to the challenges that we face led by people who have experienced these issues?

Voters deserve to know the answers to these questions, and moderators need to ask.

Mary Giliberti is the chief public policy officer at Mental Health America, a national advocacy organization with 143 local and state affiliates. She is the author of the Designed to Fail 

blog series and numerous mental health advocacy publications.

If you or someone you know may be considering suicide, contact the 988 Suicide & Crisis Lifeline: call or text 988 or chat 988lifeline.org. For TTY users: Use your preferred relay service or

dial 711 then 988.

The smartest thinkers in life sciences on what's happening — and what's to come