Discussion: Presidential Agendas

Week 1- The Issue of Mental Healthcare Access

Main Question Post-Across America, people are suffering in silence and afraid to seek treatment or sometimes even afraid to tell anyone of their ailment. Mental illness is the ailment that- due to stigma, lack of access and other factors- many Americans are not being treated for. Past presidential administrations have addressed some of the concerns regarding mental health treatment but more progress needs to be made, especially in regards to access to mental health services.

Mental health access has been a significant health concern in the United States that continues to need addressing. According to a report from Mental Health America, “17% (over 7.5 million) of adults with a mental illness remain uninsured” and of those who did have insurance, 56.5% received no treatment in the past year (Mental Health America, 2020). The issue of mental healthcare access has many facets, including but not limited to provider shortage, high cost, insurance coverage disparity, social stigma and geographical barriers to offered care, such as living in a rural area (Cohen Veteran’s Network, 2018). Several presidential administrations have tried to address some of these concerns that lead to inadequate mental health access.

Under President George W. Bush, the New Freedom Commission on Mental Health was created in 2002, which outlined suggestions for improving services for those dealing with mental illnesses (Hart, 2016). This was an attempt for mental health experts to speak out and offer their opinions on how the government could best impact the wellness of those affected by mental illness and it also identified several barriers to access that could be addressed by the government (President’s New Freedom Commission on Mental Health, 2003). While the commission was useful in identifying areas of need and barriers, it fell short of leading to any immediate policy change. The Paul Wellstone and Pete Domenici Mental Health Parity and Addictions Equity Act was signed in 2008 by President Bush, which addressed access to care by stating that the coverage in health insurance for mental health had to be equal to the coverage for other medical conditions (Hart, 2016). Once again this was a step in the right direction but had no effect on the millions of Americans who were uninsured, living far from providers, unable to afford care nor did it address the stigma surrounding mental illness or its treatment.

President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law in 2010 which allowed Medicaid plans to include mental health, in addition to other health plans eligible in the ACA (Hart, 2016). While the affordable care act did provide some with insurance, the Census Bureau showed that In 2018 27.5 million people remained uninsured, a number which had increased since 2017 when the number was 25.6 million uninsured (Berchick, Barnett & Upton, 2019). In 2015, President Obama signed the Cures Act, which included a multifaceted approach to improving mental health care access. It helped increase mental health workers and providers, ensured health plans were held accountable to pay for mental health services under the parity law and increased resources for mental health services (Carlock, 2016).

More recently, in 2019 President Donald J. Trump increased health care, including mental health benefits, to veterans who otherwise would not have qualified for health insurance (Cronk, 2018). While this did not affect Americans as a whole, it was a much-needed lifeline to our veterans and transitioning service members. Since the Corona virus outbreak, President Trump has taken initiative to ensure those with mental illness can get care by expanding access to telemedicine for Medicare patients, ensuring those who are self-isolating, those in rural, hard to reach areas and those at highest risk can get the medical health services they need and the President urged insurance companies to also reevaluate their telemedicine benefits, as well (U.S. Centers for Medicare & Medicaid Services., 2020). Time will tell if these changes are permanent and what the new administration or second term of this current administration will enact for mental health access in the coming years.

While all three Presidents addressed mental health in their own way, the specific issue of access has yet to be resolved. I would have made a few changes, more along the lines of President Obama’s Cures Act. Anything that will address mental health care access will have to be a multipronged approach that does not only address the insurance portion of the problem. Just as important as coverage is the need for more mental healthcare providers, the regulation of care cost and, perhaps the most important, the stigma around mental illness and its treatment needs to be proactively addressed. I believe education and awareness will be the best tool for combating stigma and once that is done, the need for reforms and policy will naturally come about as the population at large becomes aware of the intense need.

Resources

Berchick, E.R., Barnett, J.C., and Upton, R.D. (2019, November 9). Health Insurance Coverage in the United States: 2018. Report number P60-267 (RV). https://www.census.gov/library/publications/2019/demo/p60-267.html

Carlock, H. (2016, December 16). Signed, Sealed, Delivered: Mental Health Reform is a Law. National Alliance on Mental Illness (NAMI). https://www.nami.org/Blogs/NAMI-Blog/December-2016/Signed-Sealed-Delivered-Mental-Health-Reform-is

Cohen Veteran’s Network. (2018). America’s Mental Health 2018: Attitudes and Access to Care [Infographic]. https://www.cohenveteransnetwork.org/wp-content/uploads/2018/10/CVN_Infographic_10.8.18_1045am.pdf

Cronk, T.M. (2018, January 10). President Trump signs order to improve mental health care for transitioning veterans. US Army. https://www.army.mil/article/198936/president_trump_signs_order_to_improve_mental_health_care_for_transitioning_veterans

Hart, J.W. (2016, February 15). How Presidents Have Shaped Mental Health Care. National Alliance on Mental Illness (NAMI). https://www.nami.org/Blogs/NAMI-Blog/February-2016/How-Presidents-Have-Shaped-Mental-Health-Care

Final Report for the President’s New Freedom Commission on Mental Health, SMA 03-3832, (May 2003). https://govinfo.library.unt.edu/mentalhealthcommission/index.html

Mental Health America. (2020). The 2020 State of Mental Health Report. Mental Health America. https://www.mhanational.org/issues/state-mental-health-america

U.S. Centers for Medicare & Medicaid Services. (2020, March 17). President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak [Press Release]. https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak

Response

I appreciate you initiating a discussion on mental illness. When we think of someone being “healthy,” we think of the physical being of that individual. We associate obesity, hypertension, diabetes, etc. as being unhealthy. However, maintaining mental health is just as important as physical health. I often think people assume that mental health conditions, such as anxiety and depression, are self-made and, therefore, should be self-controlled. I wholeheartedly agree that the stigma of mental health begins with a lack of knowledge of how powerful the brain is. It’s a harsh reality that people with mental health issues don’t receive the same support as someone with cancer or any other chronic or acute illness. In fact, “many people with a mental illness report the associated stigma being as bad, if not worse, than the illness itself” (Shann, C. et al., 2019). While I agree that mental health services’ accessibility needs to be expanded, I believe the fight starts with attacking the stigma of mental health illness through education.

References

Shann, C., Martin, A., Chester, A., & Ruddock, S. (2019). Effectiveness and application of an online leadership intervention to promote mental health and reduce depression-related stigma in organizations.

Journal of Occupational Health Psychology, 24(1), 20–35. https://doi-org.ezp.waldenulibrary.org/10.1037/ocp0000110

Discussion: Presidential Agendas

Regardless of political affiliation, every citizen has a stake in healthcare policy decisions. Hence, it is little wonder why healthcare items become such high-profile components of presidential agendas. It is also little wonder why they become such hotly debated agenda items.

Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

To Prepare:

Review the Resources and reflect on the importance of agenda setting.
Consider how federal agendas promote healthcare issues and how these healthcare issues become agenda priorities.

By Day 3 of Week 1

Post your response to the discussion question: Consider a topic that rises to the presidential level. How did each of the presidents (Trump, Obama, and Bush) handle the problem? What would you do differently?

By Day 6 of Week 1

Respond to at least two of your colleagues* on two different days by expanding on their response and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

NURS_6050_Module01_Week01_Discussion_Rubric

	Excellent	Good	Fair	Poor
Main Posting	45 (45%) – 50 (50%) Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	40 (40%) – 44 (44%) Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	35 (35%) – 39 (39%) Responds to some of the discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	0 (0%) – 34 (34%) Does not respond to the discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness	10 (10%) – 10 (10%) Posts main post by day 3.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not post by day 3.
First Response	17 (17%) – 18 (18%) Response exhibits synthesis, critical thinking, and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Response is effectively written in standard, edited English.	15 (15%) – 16 (16%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	13 (13%) – 14 (14%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 12 (12%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response	16 (16%) – 17 (17%) Response exhibits synthesis, critical thinking, and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of learning objectives. Response is effectively written in standard, edited English.	14 (14%) – 15 (15%) Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	12 (12%) – 13 (13%) Response is on topic and may have some depth. Responses posted in the discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	0 (0%) – 11 (11%) Response may not be on topic and lacks depth. Responses posted in the discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation	5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	0 (0%) – 0 (0%)	0 (0%) – 0 (0%)	0 (0%) – 0 (0%) Does not meet requirements for participation by posting on 3 different days.

Total Points: 100

Mental Health Accessibility and Knowledgeable Treatment

My topic for discussion is the need for adequate mental health accessibility and the proper treatment to all those in need. The mental health care crisis continues to be a topic that effects the community. The Center of Disease Control (2018) states that individuals with mental health disorders face an increase risk of physical health issues such as heart disease, diabetes and HIV. Those individuals have a decrease in life expectancy by 25 years largely due to treatable illnesses.

The Bush agenda was to understand the need for mental health care within the United States. An executive order was signed in 2002 to further investigate the need for mental health care. The interim order was for a six-month period of research for the delegated official to present the barriers to the unmet needs, yet to come with evidence-based strategies that were successful. According to National Institute of Medicine (2005), in 2004 Bush set an agenda for individuals living with mental illness to be viewed as more acceptable.

During the Obama administration his agenda was to look at mental health not only for veterans, and adults, but for the undiagnosed youth as well. The Mental Health and Substance Abuse Parity Act was signed in 2008. This offered individuals with mental health disorders to have their care treated and paid for through insurance equally as it would have been for other healthcare services. During a health conference (2013) former President Barak Obama stated that less than 40% of individuals with mental health issues seek treatment. He went on to make a very thought-provoking statement that if one had a broken limb, they would seek medical attention what is so different? If something needs repair, we seek help.

Trumps current agenda is to tackle mental health among veterans. The agenda is to encourage outright mental health for veterans, through organizations looking into those with mental health disorders instead of leaving the responsibility on the veteran themselves. A fact sheet from Whitehouse.gov (2019), stated that veterans often sustain physical or emotional traumatic experiences that cause them to experience mental health issues. The article goes on to state that there are 20 veterans on average in 2016 that commit suicide daily.

Each administration sought out to focus on one or more parts of the mental health puzzle. Most did not key in on the educational aspect for those who need it most teachers, nurses, law enforcement, doctors, and community organizations emphasizing the need for the children and families of those living with individuals undiagnosed or diagnosed with mental or behavioral illness that actively effect the ability to be successful in society. Currently I am with a nonbiological child that I have found it to be difficult to have resources that are knowledgeable in providing help to combat her illness. This has become more of an issue for myself and family ultimately effecting my income and mental health as well. This should be a focus the health of a family unit dealing with individuals with mental/behavioral health disorders.

Center of Disease Control. (2018). Learn about Mental Health. Retrieved from: https://www.cdc.gov/mentalhealth/learn/

Fact Sheets. President Donald J. Trump Issues a National Call to Action to Empower Veterans and End the National Tragedy of Veteran Suicide. (2019). Retrieved May 31, 2020 from: https://www.whitehouse.gov/briefings-statements/president-donald-j-trump-issues-national-call-action-empower-veterans-end-national-tragedy-veteran-suicide/

Lenzer J. (2005). Bush unveils mental health action plan. BMJ: British Medical Journal, 331(7517), 592.

Obama B. (2013, June 5). Remarks by the President at National Conference on Mental Health. President Obama Speaks at the National Conference on Mental Health, East Room. https://obamawhitehouse.archives.gov/photos-and-video/video/2013/06/03/president-obama-speaks-national-conference-mental-health#transcript

Discussion: Presidential Agendas

Discussion: Presidential Agendas

By Day 3 of Week 1

By Day 6 of Week 1

NURS_6050_Module01_Week01_Discussion_Rubric

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