Moving forward on mental health

I first met Timothy O’ Clair at a little league game in 2001. Timothy was a bright and energetic youngster with the whole world ahead of him. Unfortunately, Timothy also suffered from a debilitating mental illness. When Timothy’s insurance would no longer cover his treatment, his parents were forced to disown him in order to get treatment. Unable to receive the appropriate care, at the age of 12, Timothy tragically completed suicide. Timothy’s struggle to get the care he needed is what first led me down the path of working to improve the mental health system in America.

Fourteen years later, I am ashamed to admit that there are still far too many stories like Timothy’s across our country. Whether these events make the headlines, or are one of the quiet tragedies that affect countless individuals and families, no one can credibly examine the status quo in mental health and say that it’s working.  I witness this struggle daily – through the bipolar young woman who is wrestling with her demons while trying to hold down a steady job – through the family who is agonizing over their schizophrenic son who is about to turn 18 – and through the many individuals who only accessed mental health treatment for the first time after they were locked up in jail. 

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Despite the pain that I hear coming from individuals and families in the throes of mental illness, I have reason for optimism. In recent years, there has been a robust debate in Congress among passionate and committed members from both sides of the aisle who want to better the lives of those living with mental illness. However, this debate has often been constrained by a narrow focus on crisis points in the mental health system. Yes, we absolutely have to do a much better job at handling mental health crises. Everyone agrees that emergency rooms and jails are not the proper venue to handle these events. Whether it’s through mental health first aid training, the creation of real-time hospital bed registries, or increased investments in crisis stabilization services, a multitude of potential options exist to address these acute issues.

More fundamentally though, we have to address the reality that we utterly fail at addressing mental illness in America before it reaches a crisis point. Even though we know that mental illness can be more effectively managed when addressed early, the delay between the first symptoms of mental illness and the first treatment contact can average almost a decade. To reduce actual human suffering and to make more cost-effective investments, we must do everything possible to narrow this gap. This means supporting mental health programs in our schools and colleges where the first signs of mental illness often manifest. This means embracing policies that continue the trend of integrating behavioral health with physical health, so that during your annual physical every person is given a checkup from the neck-up. This means supporting a public health approach to mental illness that tries to address nagging issues like stigma and minority health disparities. And while I agree that we can’t simply throw more money unconditionally at a failing system, we have to acknowledge that the current dysfunction stems in part from decades of broken promises and a chronic underinvestment in community based mental health services. These are problems that won’t be solved by a politics of austerity cloaked in the guise of reform.

I won’t pretend that the answers to fixing our mental health system are easy or uncontentious – because they are not. I do know, however, that a sustainable solution for our mental health system will only emerge when frank discussion and tough choices allow us to find a lasting and hard-earned consensus among all parties. Forging a path ahead will require all involved to critically engage with the reality that while the status quo is unsustainable, the solution is not to tear down, but to build up. I look forward to doing the necessary hard work with my colleagues in the 114th Congress to build this better tomorrow – in Timothy’s memory and for all the individuals and families struggling with mental health battles in America.

Tonko has represented congressional districts in New York's Capital District since 2009.