NURS 6050 assignment: Agenda Comparison Grid and Fact Sheet or Talking Points Brief Assignment
I will be discussing the topic of mental health and its role at the presidential level, discuss how different presidential administrations addressed it and what I would have done differently.
Identify the Population Health concern you selected: Mental Health
Describe the Population Health concern you selected: Mental health refers to a person’s emotional, psychological, and social well-being. It affects how we think, feel, and act. Mental health concerns can include a wide range of conditions, such as depression, anxiety, and post-traumatic stress disorder. Factors that can contribute to mental health concerns include stress, trauma, genetic predisposition, and social determinants of health.
Administration (President Name)
-Current Administration (President Joe Biden)
-Previous Administration 1 (President Donald Trump)
-Previous Administration 2 (President Barack Obama)
I will discuss the Obama, the Trump, and the Biden administrations. Mental Health According to the National Institute of Mental Health (n.d.), nearly one out of every five United States adults live with a mental illness. However, the average delay between the onset of symptoms in those experiencing a mental health illness and receiving treatment and/or counseling is 11 years (NAMI,2021). The issue of suicide and mental health began its climb up the political ladder in the mid-1990s when a small, lower-level group replicated the United Nation’s guidelines to encourage a national strategy addressing mental health (U.S. Dept. of Health and Human Services, Office of the Surgeon General, National Action Alliance for Suicide Prevention, 2012). This effort birthed two Congressional Resolutions that placed suicide a national problem and its prevention a national priority (U.S. Dept. of Health and Human Services, Office of the Surgeon General, National Action Alliance for Suicide Prevention, 2012). Since then, there has been an ebb inflow in the level of public attention or directed national reforms in mental health. Nonetheless, progress was never halted with new legislative achievements including acts providing grants to implement suicide prevention, suicide prevention programs for veterans, and the establishment of the National Suicide Prevention Line. In the following sections, I will evaluate the different presidential agencies’ strategies and progression in mental health reform, acts, and improvements.
The Obama Administration
The Obama administration demonstrated major leaps in many areas of healthcare reform. In 2010, President Obama placed the Affordable Care Act into action. This act required all small-group health plans starting January 2014 to cover ten essential health benefits in which mental health and addiction treatment were included (Norris, 2021). Although the act could not require large-group plans to cover the ten essential health benefits if they did provide mental health or addiction services the coverage rates had to be in parity with medical/surgical benefits (Norris, 2021). In December of 2016, the Obama administration signed the 21st Century Cures act into place. This Act not only supported major mental health and substance abuse treatment but also recruitment, training, and keeping the mental health workforce through grants for those who practiced psychiatry and/or addiction in underserved communities (Levin, 2017). The drive to form and implement these acts is sourced from a noted strong deficit in healthcare coverage or affordable healthcare. With the acknowledgment of the low percentage of healthcare coverage in the lower economic status, a lack of support for mental health providers, and the noticed under-recognized mental illness, lobbyists and healthcare reformers were eager to seek attention and seize the open window of a change in administration Just as John W. Kingdon (2001) describes in his stream analogy when a problem is recognized, a solution is recognized and the political environment is right, the three metaphorical streams are joined and conditions to successfully push proposals are made. Mental health activists successfully lobbied for their identified problems and when the Obama administration opened the ‘window’ they were able to set reform into place.
The Trump Administration
With another change in the political climate, the Trump administration had its own reforms in contrast to the Affordable Care Act. The Trump administration sought to repeal the ACA formerly put into place. This would retract the security that the ACA set of equal parity requirements in the small-group and Medicaid health coverage (Nuzum & Abrams, 2020). In doing this, access to mental health services became limited to a large percentage of the lower socioeconomic status population and the older population. Although the act was not completely repealed, changes were made so that those covered were affected and the requirements to have coverage were altered. This modification, however, came with demand and recognition of lobbyists during a time of ‘open window’ at the change of administration. The start of a pandemic sparked a different type of ‘change’ availability. In response, the Trump administration signed an order that had the potential to increase mental health services to those suffering from symptoms that were worsened by the global pandemic. This order spawned the Coronavirus Mental Health Working Group which collaborates with the public, stakeholders, and agencies to help people in crisis (Le, 2020). However, there was a noticed shortage of mental health providers which demanded action and recognition as well. In 2021 the Trump administration presented a 24% increase in the budget for behavioral health workforce programs (Nuzum & Abrams, 2020). President Trump also set an executive order laying the pandemic-related mental health needs as a national priority (Nuzum & Abrams, 2020). In this administration’s time frame, we can directly see the correlation between identified problems, proposed solutions, and the opportunities created by ‘open windows’ of different types (change in administration, the onset of pandemic setting).
The Biden Administration
Once again, in a very distinct political battle, the figurative window for policy change was opened again. The Biden administration quickly placed an executive order that opened a special enrollment time frame for citizens and reeled back Trump’s constraints on the ACA and Medicaid (NAMI, 2021). The demand for another healthcare reform inspired expansions of the ACA. This expansion was part of the American Rescue Plan Act (ARPA) which gave $10.7 million to expand pediatric mental health access (Department of Health and Human Services, 2021). The ARPA also gave $2.5 billion to the states to address the mental illness and addiction crisis in the nation, $20 million toward programs for mental health professionals and first responders, $20 million to carry out Youth Suicide Prevention Programs, $100 million for mental health education grants and much more (Le, 2021).
What Would I Do Differently?
In studying the different administrations and the reactions to political and social influence, I was both encouraged and slightly concerned about the lengthy and sometimes politically biased process reform has to go through to come to action. Although, I understand different platforms of perspectives on social, economic, and most recently pandemic change; the interruption of progress strikes me as anti-progressive. As a healthcare professional, my ideal strategy to keep a flow of progressing solutions would be to present my addressed problem/topic (mental health) that was appealing to multiple ‘open window’ scenarios. Keeping my mental health problem at the forefront and making sure my proposed solutions are sustainable through different political stances would be my strategy to keep it from faltering in progression through partisan changes. Federal Agenda and Healthcare IssuesHealthcare issues become political agenda priorities through a system of defining problems, finding solutions, promoting those solutions to policymakers, and through the mechanism of politics, those solutions become policies, laws, or regulations. (Laureate Education, 2018). The timing and readiness of policymakers are imperative to the effectiveness of the presentation of a proposed problem and solution. Any change in administration, social crisis, or pandemic can represent a change or opening in the federal agenda. When this change or opening occurs, lobbyists and representatives must be quick and ready to briefly yet effectively present. Just as DeMarco & Tufts (2014) describe, a policy brief is a condensed report containing information that can be understood quickly, provide findings and offer recommendations to those who may not be an expert in the proposed field. Therefore, healthcare issues become federal agenda priorities through identification, preparedness, and correct timing and opportunity of information provided, and in return, the federal agenda promotes healthcare issues by bringing awareness of the problem to those, not healthcare professionals and seeking a solution to implement by way of policy, laws or regulations.
References
Department of Health and Human Services. (2021, August 27). Biden-Harris Administration invests $10.7 million in American rescue plan funds to expand Pediatric Mental Health Care Access. HHS.gov. https://www.hhs.gov/about/news/2021/08/27/biden-harris-admin-invests-nearly-11-million-for-pediatric-mental-health-access.html
DeMarco, R., & Tufts, K. A. (2014). The mechanics of writing a policy brief. Nursing Outlook,62(3), 219-224. DOI: 10.1016/j.outlook.2014.04.002
Kingdon, J.W. (2001). A model of agenda-setting with the application. Law Review M.S.U.-D.C.L., 2(331)
Laureate Education (Producer). (2018). The Policy Process [Video file]. Baltimore, MD: Author.
Le, D. (2021, March 12). President Biden Signs American Rescue Plan Into Law. American Counseling Association. https://www.counseling.org/news/updates/2021/03/12/president-biden-signs-american-rescue-plan-into-law.
Le, D. (2020, October 6). Latest news from ACA. American Counseling Association. https://www.counseling.org/news/updates/2020/10/06/president-trump-issues-executive-order-on-behavioral-health.
Levin, A. (2016). Obama signs landmark legislation with major mental health provisions. Psychiatric News, 52(1), 1-1. https://doi.org/10.1176/appi.pn.2017.1a10
National Alliance on Mental Illness (2021) Mental health by the numbers. NAMI. https://www.nami.org/mhstats.National Alliance on Mental Illness. (2021, January 28).
NAMI Applauds President Biden’s Efforts to Strengthen Access to Quality, Affordable Health Care [Press release]. https://www.nami.org/Press-Media/Press-Releases/2021/NAMI-Applauds-President-Biden-s-Efforts-to-Quality-Affordable-Health-CareNational Institute of Mental Health (n.d.). Mental Illness.
National Institute of Mental Health. https://www.nimh.nih.gov/health/statistics/mental-illness.
Norris, L. (2021, March 30). How Obamacare improved mental health coverage. health insurance.org.https://www.healthinsurance.org/obamacare/how-obamacare-improved-mental-health-coverage/
Nuzum, R., & Abrams, M. (2020, October 14). Health care in the 2020 presidential election: Mental health and substance use disorders. Commonwealth Fund. https://www.commonwealthfund.org/blog/2020/health-care-2020-presidential-election-mental-health-and-substance-use-disorders.
U.S. Dept. of Health and Human Services, Office of the Surgeon General, National Action Alliance for Suicide Prevention. (2012). 2012 National Strategy for Suicide Prevention: Goals and Objectives For Action: A Report of the U.S. surgeon general and of the National Action Alliance for Suicide Prevention.
