Author of federal mental health law has advice for California

Mental health has been at the center of former U.S. Rep. Patrick J. Kennedy’s personal journey to recovery from addiction as well as his public career as a policymaker, author and advocate. 

In 2008, while representing Rhode Island in the U.S. House of Representatives, Kennedy was the lead author of the Mental Health Parity and Addiction Equity Act, a federal law that requires health insurance companies to provide equal coverage for mental health and addiction care and general physical health care, such as diabetes or cancer treatment.

Kennedy, who has long been vocal about pursuing treatment for his substance use and bipolar disorder, remains an advocate for greater access to mental health care.  Earlier this year, he published his book “Profiles in Mental Health Courage” — a reference to his late uncle and former President John F. Kennedy’s classic “Profiles in Courage” — detailing how people from diverse backgrounds across the country have taken on mental illness and addiction. In October, he was a keynote speaker at the annual student wellness conference Wellness Together in Anaheim, where he spoke about his advocacy as founder of the mental health policy nonprofit The Kennedy Forum.

“As we turn the corner on stigma related to suicide and overdose, we need to finally focus a lot more on solutions early on in a person’s life,” Kennedy said in an interview with EdSource. Not only are young people less likely to seek help due to stigma, but are also less likely to be properly insured, incurring high out-of-pocket costs for treatment when they need it.

For Kennedy, the key to addressing the youth mental health and addiction crisis is increasing and sustaining funding for care on the local, state and federal levels. He emphasized that schools desperately need the bulk of that funding, given that early intervention significantly reduces a child’s chance of developing a serious mental illness in adulthood.

California has, in recent years, invested heavily in expanding mental health support for children and adolescents. The state’s next challenge, Kennedy said, is sustaining these crucial services. 

In 2019, the state embarked on a $4.7 billion Children and Youth Behavioral Health Initiative, focused mainly on recruiting and training new mental health providers across the state’s school system. To help sustain these programs, the state Department of Health Care Services plans to make new public school-based mental health services billable to both Medi-Cal and commercial health insurance, making California’s multi-payer fee schedule one of the largest school reimbursement programs in the country. 

EdSource interviewed Kennedy about expanding mental health care for students and families. His remarks have been edited for length and clarity. 

How do we address the enduring impact of stigma on our health and education systems?

We need greater literacy (regarding mental health) across the board. Many don’t know these mental illnesses as brain illnesses, and they don’t understand that they’re treatable. If we knew we could treat them successfully, which we can, especially if we go in early, how can we think about them differently? We don’t let cancer get to stage four to treat it. We screen it, screen it, screen it. It’s embedded in my medical chart. My doctor asks me 15 ways about my risk for stroke and cancer. We need to do that with mental health. 

We could address so much of this if we just incorporated better mental health services within our community. So many families have their mental health symptoms exacerbated by lack of stable housing, no supportive employment and a lack of community to help. They become isolated, which is the worst thing for those struggling with their mental health.

Why does the Mental Health Parity and Addiction Equity Act matter for young people today?

It used to be the case where, if you had a mental illness, you had to pay higher co-pays, premiums and deductibles to get mental health treatment than you would to get diabetes treatment or asthma treatment. Unlike for physical illnesses, insurance companies would cap the total of dollars you could spend as a patient on mental health. The Mental Health Parity and Addiction Equity Act established that insurance companies could not discriminate and treat the brain any differently than any other organ of the body. 

Ultimately, we can’t treat everyone based upon bake sales. We have to change the metrics of what constitutes value in our mental health system. We have to get this embedded in regular insurance. 

How can California ensure that new school-based coverage for mental health care is effective in the long term?

We have to figure out how to reorient the insurance process so that there’s a way of capturing the return on investment from an earlier investment. The state is the one that has the most to say about overall state coverage for mental health early on, in order to reduce future obligations on the state’s part, which means picking up the pieces of a broken population that hasn’t properly been supported by coverage through early intervention services. 

We need to get organized as voters. There’s not a family out there that doesn’t have these issues affecting a member of their family, who hasn’t lost a loved one to suicide or overdose. There’s a huge need for mental health treatment because we keep waiting till people are in a crisis. Why not make this a public health issue and really embed resources in elementary and secondary schools so students can take care of themselves? 

What role should the federal government play in addressing youth mental health?

We need to have Federally Qualified Health Centers in every public school in America. They could open satellites in each of the schools that can help treat kids where they are. A lot of kids, particularly from minority communities, are not going to get mental health care after school. You could bring tele-mental health into a school nurse’s office, so it’s not just where you get an aspirin, but a real clinic in the school where you could be meeting kids’ health needs writ large. You’d also need ongoing intensive care to connect them to the community health center outside. 

We already fund Federally Qualified Health Centers. It’s supported on a bipartisan basis. It covers the uninsured as well as the insured. These centers and Certified Community Behavioral Health Centers cover a lot of rural areas and health deserts, and they can provide general counseling and support services. They have a board of directors, who are all people in the community who know the resources in the community and can pull together a more wraparound, holistic approach. 

So many kids come to school from homes where there’s violence, addiction or mental illness. We need to reach the whole family. In many states where Republicans don’t have good benefits for their people, the centers provide a valuable safety valve for their constituents to get health care. We just need to take that model to scale in schools. The easiest thing is to run all of these through existing bureaucracies, so you’re not trying to create a new system from whole cloth.

How can students help address mental health? 

I would say to young people that there are two major ways they can really help the system. One, they can learn about how to prevent mental health challenges themselves through learning about their own brain and learning coping skills and problem-solving skills. We can focus on a lot more upstream, or proactive, mechanisms early in a student’s life, when they can start to build different coping skills and learn how to manage their emotions. 

And second, if they’re interested in going into the mental health space, they can create a much better track to get into the mental health field. We just don’t have enough hands on deck to really meet the enormity of the need for those who desperately need treatment. Not only do we need to build that infrastructure and access, but also build a workforce pipeline for those trying to go into the field in greater numbers. 

It’s got everything to do with young people. These are illnesses where 50% of them occur before the age of 14, and 75% occur before the age of 25. They’re illnesses of the young; they can take you hostage and take out whole parts of your life, when, ordinarily, you’d be in the most productive period in your life as a young person.