You have been elected as the outsider and someone who is expected to “drain the swamp.” You were elected because of your direct and unconventional ideas that alter the national discussion on many issues. You, along with the Senate and the House, have an opportunity to address and ultimately reform two major issues that have been swept under the rug and received little to no attention during the presidential election- mental health care in this country and the growing heroin and opioid epidemic that is ravaging our communities. As a mental health professional who works with drug addicts, I have seen the failures of the current system. Too many addicts are cut off from adequate, long term care that they need and deserve. Insurance companies are dictating treatment and not providing the necessary coverage for those in residential drug treatment programs. Low-income addicts with no or poor insurance coverage are left to fend for themselves because they cannot afford the existing treatment centers and because as a country, we do not provide sufficient care to the “have nots.” Families are mortgaging their homes, selling family heirlooms and dipping into savings just to pay for a child to go to rehab, usually on multiple occasions. While the insurance companies are deciding the length of care, our pharmaceutical companies are pumping pain pills out at an unimaginable rate, leading doctors to over-prescribe highly-addictive pills that are expensive and lead many individuals to find a cheaper source of pain relief, heroin. While most of the heroin in this country is brought into the country from cartels south of the border, the real issue is the demand, not the supply. There will always be groups willing to step in and provide drugs.
Additionally, mental health care in this country is deplorable (to borrow a term from the election). Community mental health centers are poorly run, understaffed and driven by managed care. The services they provide are inadequate, as sessions are limited, professionals undertrained, managers underpaid and susceptible to quick burn out. The VA is a mess, as countless veterans wait for mental health care and benefits. Local hospitals are overrun with psychiatric emergencies and overdoses and are becoming overwhelmed in providing care.
As a clinician, the current state of care is sad and something needs to change. In this regard, I have outlined proposals that will address the issues listed above.
- Reign in pharmaceutical companies ability to continue over-selling pain medications, particularly opioids, and lay out a 5-10 year plan where pain management doctors MUST find alternate measures to treat pain.
- The department of Health and Human Services should track the amount of pain pills doctors prescribe to a patient and ensure over-medicating patients is not happening.
- Label fentanyl a Class A or B drug. This highly addictive pain pills is being used by heroin addicts and is 100 times stronger than heroin. If police catch someone with fentanyl, they cannot do anything. Empower police and local authorities to rid the drug from our communities.
- Create a task force that will allow states to set up outpatient mental health and substance abuse programs at local hospitals to alleviate the emergency rooms. The outpatient care should be fully staffed with qualified mental health professionals and offer comprehensive care. These facilities will offer care to patients with Medicaid and private insurance. The care can be contracted out to private practitioners through a complete vetting process.
- Cut the red tape at the VA and allow veterans to access private mental health clinics and providers.
- Ensure that drug and alcohol rehabs are held to strict guidelines that ensure patients’ psychiatric and substance abuse care is treated properly. Along these lines, sober homes need very strict regulations
- Empower school districts to hire full-time mental health professionals to provide on-site mental health care to students.
These are just some of the core suggestions that you, Mr. President-elect should consider. Your administration has a tremendous opportunity to tackle these issues. I hope you act boldly.