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woman recently walked into my Massachusetts office to talk about her daughter, who had been diagnosed with serious mental illness in 2007, when she was just 4 years old.

A decade later, the stories this mother shared with me are heartbreaking. The countless hospital visits. The fights with insurers and doctors and courts. The time her daughter was kept for 21 straight days in the emergency room as her family desperately searched up and down the East Coast for a single available treatment bed. The ache of watching the person you love most in the world struggle against a merciless disease.

This mother ended our conversation by looking me in the eye and saying, without a hint of bitterness or anger, “But we’ve been lucky. Compared to other people I know, we’ve been lucky.”

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If this is luck in the American mental health system, all of us should be ashamed. With 1 in 5 of our neighbors suffering from mental illness, the time for tinkering around the margins of our broken system is over. American families and communities need deep and dramatic reform.

Instead, congressional Republicans are moving forward with efforts to make it harder and more costly for the average American to access mental health care. These efforts began last month, with a hastily drafted bill to repeal the Affordable Care Act. Although it thankfully failed to get the support it needed to secure a vote in Congress, its message to the mental health community was clear: be warned. The legislation, championed by President Trump and Speaker Paul Ryan, was the single largest attack on mental health care in recent history.

By removing guaranteed behavioral health coverage for those covered under Medicaid expansion, millions of people would have lost access to treatment for substance use disorders — in the midst of an opioid epidemic. By capping Medicaid spending for states, Trumpcare would have imperiled the largest insurer of mental health services in our country. The bill did nothing to address abysmal reimbursement rates for mental health providers. Nothing to infuse investment into the full continuum of care. And nothing to force insurance companies to stop skirting parity laws that require they treat mental illness as they do physical health.

Enough Americans spoke out against that dangerous bill that we were able to stop it in its tracks. But almost immediately, Republicans were back behind closed doors trying to revive it. Their second bill could soon see a vote on the House floor.

Unbelievably, it’s an even starker blow to those suffering from mental illness than its predecessor. The latest version of Trumpcare doesn’t just threaten access to behavioral health coverage for those on Medicaid, it threatens access to behavioral health coverage for everyone. Under the guise of flexibility, this bill would allow states and insurance companies to opt out of covering mental health care — not to mention other designated essential health benefits like maternity and emergency care. Premiums and deductibles would soar as a result. Any semblance of mental health parity would be extinguished. And current protections for those with preexisting conditions — which is particularly important when it comes to mental illness — would cease to exist.

This is not the debate Congress should be having during a mental health care crisis. We should be considering steps to vastly expand the transformative mental health reforms made by the ACA, not shrink them. It’s time to go even further.

We need deep investments across the entire continuum of care to connect patients with treatment before they reach crisis points. We need broader support for community health centers, which provide essential entry points for lower and middle-income Americans who struggle to find in-roads to our mental health system. We need increased Medicaid reimbursement rates to encourage a new generation of workers to pursue careers in the mental health field, dramatically increasing access in every community that needs it. And we need relentless enforcement of mental health parity to make insurers live up to the laws of this country, which already demand basic equity in the coverage and treatment of mental illness.

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All too often, mental illness is relegated to the sidelines of our health care debates. It’s somehow still deemed less critical, less acute, less wholly devastating than physical disease. One in five Americans and the families who love them would tell you otherwise. From the depths of opioid addiction to the searing pain of eating disorders and the long, often lonely, road through anxiety and depression, we have abandoned too many people in a system that cannot meet their basic needs.

The 40 million Americans suffering from mental illness deserve better than the paltry “luck” of that young mother in my office. They deserve better than a health care bill that degrades them. They deserve a country that is there for them, without question or condition, in their time of deepest need.

Joe Kennedy III has served as the US representative for Massachusetts’s 4th Congressional District since 2013.

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  • I have to ask because it sticks with me – what 4 year old child would be diagnosed with a “serious” mental illness? And was all those subsequent hospital emergencies the result of the mental illness medication the child was undoubtedly given (most likely in continual doses for the ten years following) all which come with uncountable side effects? If increasing mental health care means increasing such medical doses then maybe this is the right direction?

  • It is distressing that our government, of so called intelligent men and women, republican and democrat, cannot sit down together and come up with a health care bill that will take care of all the people, in all states of wellness, mental and physical. I have supported President Trump through all, but now I am thinking he might not be the president I hoped for. I do not like his tax plan and I certainly don’t like limiting mental health coverage for people who are ill. Reagan put millions of mentally ill on the streets with no where to turn and we, the pubic, have suffered when they shot, killed, molested, etc., good people all across America. We need better,so get with it, you big shots. Also, Term Limits. A must. Balanced Budget, a must. Free two years of college/trade schools for every person at least once in their lives a must. Health Care a must.

    Where are the tax law changes that will bring back corporations to this country? Where is the wall? Why hasn’t a bill been proposed to stop our companies from leaving our shores? Why don’t foreign companies doing business in America have to pay tax, such as Target and Cruise/Tour companies? Why are movie stars allowed to buy off shore islands and evade taxes on money made in this country? Every cent earned in this country needs to be taxed, and that is for all. Why should someone making $50M a year pay less in percentages of gross than the little guy? What happened to a flat tax? That is what Americans’ want. With a tax credit for those making under 20,000. (Try to support a family on that and see where you will live.) Why don’t we have national laws requiring people to keep America clean, beautiful, and up-to-date? That would be all building of any kind and property, streets, highways, byways, etc. We went on an US tour and this country is in bad shape. Companies leave or close and walk off letting infrastructure sitting to rot in place. They should be responsible to convert those buildings into usable properties, or to sell them to other manufacturers who don’t need to make billions a year. Those state who do not comply, get no money federal. If you have been to Canada you can see the difference–clean and green. Here is an example: Glacier National Park – Canada – beautiful highways, parks, RV parking, etc. USA – roads build in the 1930s and 40s, unable to bring RVs in to park and must go through the park in your vehicle and then turn around and go back to where your RV parked. I could go on, but why. No one will read this and even if they do, no one but the average American Joe even cares. Finally, why are groups/individuals able to pay protestors to rally against the government. The last rally in Portland, OR had about 30 guys in black, ISIS looking hoods and jackets. I know they didn’t buy them. Where did the money come from and why are they able to protest in riot/ISIS like gear? Unacceptable and dangerous for our democracy.

  • Frankly, this is as much a state program as a national problem.

    (1) Massachusetts decided to cut budgets in 1990s by “privatizing facilities.” Now, people revolve into care and may be placed in facilities with little trained workers.

    (2) We allow “clinic licenses” that allow non-credentialed providers to get reimbursed. This especially happens in poor neighborhoods. This helps to keep pay low for behavioral health workers.

    (3) Lack of unionization

    (4) State exception for non-licensed workers in state positions (i.e. Department of Children and Family). Yes, the person who may take your kid out of your home may only have a history degree.

    (5) Overreliance on psychiatric medication–drugs over support for behavioral health. In this scenario, all you need is someone who can prescribe. It is cheaper and more profitable in the end for drug companies.

    (6) Lack of transparency on effective treatment in behavioral health: What hospitals are really the best. The only model that keeps people in treatment is the VA that gets blasted whereby we never hear if private psychiatric hospital is effective.

    (7) What are the real numbers and treatment approaches in prison mental health? Why is this privatized?

    These questions are state questions, not federal. Massachusetts and other states needs to look at themselves rather than fix blame on the federal system.

    (6)

  • Thank you for this article. I’ve worked in the mental health field for my entire professional career. I’ve seen hospitals close and beds decreased without enough money to provided community mental health providers to maintain these individuals in the community. I’ve watched shooting after shooting as people say “it’s not a gun problem, it’s a mental health problem”. And now..those very same people want to make it more difficult for individuals with a severe and persistent mental illness to access services? It’s devastating to me. Parity legislation provided so much hope for me in my field. Finally, people with a mental illness would not be as stigmatized in the health care profession. This bill, if it were to pass, will absolutely decrease the ability for individuals with a SMI to access care and the days of “gray zone” clients will begin again , where uninsured individuals will fight for a chance to see providers and others will be placed on a waiting list. So, thank you for being the public voice to this issue.

  • Thank you Joe, this is very worrisome, I hope a few Republicans can open their eyes long enough to see how bad this would be.

  • Having been involved in mental health care for more than four decades, I have lived through the destruction of the system. It is a very tragic picture. At this point in time, there are several specific layers which need massive overhaul. Obviously, there is a need to rebuild inpatient and outpatient services to make access possible to the vast extent that they are needed. This will entail a commitment to offering salaries to professionals which are commensurate with the skill, expertise, and demands of the work. Further, these salaries have to be competitive with other fields such as high tech. One of the other major areas that need to be addressed is effective legislative support for involuntary commitment. At this point in time, society is not being served well, and is not being given adequate safety, by the current standards for involuntary commitment. Both of these topics call for extensive discourse.

  • The mentally ill may not get the best health care from Trump or Republicans but they can have guns. So it’s kind of a trade off, right?

  • As an acute care hospital supervisor….a young woman arrived in our ER. She had nearly severed her left arm off after her unstable thoughts convinced her that her arm was demonized. No surgeon would take her (the delay would cause life long deficiencies to the limb) because of her mental instability. The mental health provider would not take her staying that her wound was beyond their ability. After six days in the ER, she eloped, later to be found curled up like a frightened animal on that cold winter winter night deep inside of an abandoned warehouse.
    God bless you and give you strength. Please deeply know that you are not alone!!!!!

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