By Kate Woodsome / The Washington Post
The last law President John F. Kennedy signed intended to empower people with mental illness and intellectual disabilities, like his sister Rosemary, to receive care outside of asylums. They would, Kennedy envisioned, “need no longer be alien to our affections or beyond the help of our communities.” That was in October 1963.
In the decades since the Community Mental Health Act was enacted, Kennedy’s vision has been distorted beyond recognition. Institutions were emptied with no plan for patients and little money for community care. Mental health coverage wasn’t prioritized in the 1965 creation of Medicaid and Medicare. Prescriptions for psychosis offered some patients some relief, but without compassionate rehabilitation, broken minds proved tough to mend.
Today, too many people needing treatment die prematurely and languish in cells, on streets and in hospital hallways. Half a million with severe mental illness are incarcerated or homeless; the height of the asylum population before Kennedy’s assassination. Suicide is a leading cause of death. Poor mental health costs the economy $47.6 billion in lost productivity every year. The pandemic traumatized our kids.
A crisis this big requires a response to match.
Enter Kennedy’s nephew, Patrick J. Kennedy. The former congressman turned advocate is marshaling a movement to make mental health care accessible to all.
“It is a scandal that this rich nation has so many of its fellow citizens dying like dogs on the streets. It should be an indictment of all of us and our political system,” he said in Boston last week at the launch of the public-private movement called the Alignment for Progress. “This is not the purview of the mental health community any longer. This is the purview of all of us.”
Mental illness and addiction specialists packed the John F. Kennedy Presidential Library for the event, feeling a rare sense of optimism as they swapped ideas with venture capitalists, philanthropists and leaders of the Biden administration.
Lending clout were White House domestic policy director Neera Tanden, Labor Department assistant secretary Lisa Gomez and the directors of the Centers for Disease Control and Prevention and the National Institute of Mental Health. “We’re trying to get the word out that people have rights and insurers have obligations to them,” Gomez told me.
The cause is personal for Kennedy, who is proudly 12 years sober. During the 2008 economic collapse, he made sure Congress’s bailout package included legislation to prohibit insurers from making behavioral care harder to access than physical care.
The cause had been personal for President Kennedy, too. His father authorized a lobotomy that left Rosemary institutionalized, unable to walk or talk.
And the cause is personal for most Americans. One in 2 of us will experience a mental disorder in our lifetimes, such as anxiety, depression or schizophrenia. Many are and will be stigmatized and criminalized for their conditions.
That’s why the Alignment for Progress is challenging public and private-sector leaders to be ambitious. By 2033, it wants 90 percent of Americans to be screened for mental illness and substance use disorder; 90 percent of those screened to receive evidence-based services; and 90 percent of those to have manageable symptoms. Currently, 60 percent of adults needing treatment receive any.
This 90-90-90 strategy is modeled on the fight against HIV. When the United Nations set similar goals in 2014, it galvanized global investment, research and action that turned the tide on the AIDS epidemic in many places.
Are such gains possible for mental illness in America?
They’re a stretch unless the U.S. treats this crisis as it did covid-19. The pandemic increased compassion and transformed health care within months. The CEOs of leading mental health organizations spoke weekly to align their federal relief requests. The government approved unprecedented spending on prevention and care. Insurers reimbursed teletherapy. Investors poured billions into health technology. Philanthropists backed efforts to stop the de facto criminalization of mental illness and addiction.
To focus this momentum, The Kennedy Forum advocacy group has created a guide of 200-plus policy recommendations. Expanding the child tax credit, for instance, would reduce the stress of poverty for kids. Mandating that every insurer cover the care of a first episode of psychosis can prevent it from becoming a chronic illness.
Corporate allies are helping by analyzing data. The McKinsey Health Institute has developed a map of the systems that can get us healthy or keep us sick, from housing to justice. KPMG, the audit, tax and advisory firm, has built a database of insurance claims, health infrastructure and census information. It reveals treatment gaps and the effect of policies and investments, by ZIP code.
A still more powerful tool is unity, so groups don’t have to compete for finite resources. To start, more than 70 have committed to the Alignment’s aims. Harsh Trivedi, president of the nation’s largest private, nonprofit provider of mental health services, Sheppard Pratt, explains: “Advocacy has been ineffective because we haven’t had an overarching goal like cancer or AIDS or heart disease have had.”
Ensuring everyone’s right to mental health requires a different kind of investment. President Kennedy saw that 60 years ago. With his nephew pulling us in the same direction, now is the time to see it through.
Kate Woodsome covers mental health and the need for collective care for The Washington Post.
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