Mental Health Voting in 2018

Obligatory voting selfie

Like a whole lot of the rest of the country, I've been hearing a ton about voting these days. 

It's midterm election season, of course, and races all over the country are being closely watched. I've been thinking and posting quite a bit about voting in order to work toward a better mental health system. As I've shared my story of mental health struggles and recovery over the past year, I've become increasingly aware of the need to challenge the systemic brokenness of our mental healthcare system in this country. We can't encourage people to challenge stigma by sharing their stories if we're not also working to break down the barriers to care that keep people sick and silent. 

And so as I shared on social media, I voted this year thinking about mental health, about protections for millions of people like myself with preexisting conditions, about the Medicaid expansion that I relied on for health care coverage during an important time of my life:

But what does it mean to vote for a better mental health system? NAMI, the National Alliance on Mental Illness, has some good information on their #Vote4MentalHealth website.  And while I'll be trying to articulate some more thorough responses to that question throughout this year as I work on my next book, Grace is a Preexisting Condition, I thought it would be important to share a few thoughts of my own during this midterm election week. Maybe many of you have already voted, as I have, in a state with early voting, but if you haven't, here's a few things to think about as you go to the polls.

Mental Health Voters in 2018 Should...

...Vote to protect coverage for preexisting conditions and parity in coverage for mental health. Bipolar disorder, like many other mental health conditions, is considered a preexisting condition. Prior to the ACA's protection of coverage for preexisting conditions, it was entirely legal for insurance companies to deny coverage based on preexisting conditions, including but not limited to mental health conditions. In fact, this was exactly my experience, as I've written about here. Any attempt to repeal or dismantle the ACA without a viable replacement that protects preexisting conditions will be harmful to folks with mental health struggles. And in fact, the federal government has joined with 20 states to argue in federal court against these protections, while at the same time allowing for healthcare plans which lack such protections and which also lack mental health parity, another issue that the ACA was designed to address. Mental health voters should challenge these attempts to return to the discriminatory policies of the past at the federal and state levels.

...Vote to expand Medicaid. 
As I mentioned earlier, I relied on expanded Medicaid to access mental and physical healthcare during a crucial time in my recovery. Many people with mental health struggles lack the resources to access care; the expansion of Medicaid, while not a magic fix, would provide coverage for millions more people including people with mental health struggles.

...Refuse to let mental health struggles be used as a scapegoat for difficult political conversations.
I've written more extensively about this topic here and here, but after acts of violence (particularly when the perpetrator of the violence is a white male), mental illness is often brought up as the "real issue" in order to avoid difficult political conversations around guns, extremism, gender, and race. This is in spite of the fact that people with mental illnesses are much more likely to be victims, rather than perpetrators, of violence in this country. Mental health voters in 2018 are willing to have a robust conversation about the importance of mental health care in creating a safer society for all, without allowing people with mental health struggles to be used as scapegoats by politicians who, often, turn out to not really be serious about the conversation around mental health care.

...Recognize that homelessness and mass incarceration have taken the place of a functioning mental health system in our country. 
I've written a bit here about institutions and deinstitutionalization. It's a complex topic in many ways, but one thing that is clear is that deinstitutionalization, while originally designed to end abuses and put more of a focus on care in community, has actually -- when paired with budget cuts to health care and community programs -- led to homelessness and an increase in mass incarceration. Mental health voters in 2018 will pay attention to rhetoric around homelessness, incarceration, and crime, knowing that often these conversations demonize people who are in fact struggling with mental health and trauma.

...Recognize that tax cuts for those with the most mean losses in care and services for those with the least.
Related to the last point, we'll pay attention to budget cuts -- often hidden under language about tax cuts -- which continue to make it difficult for people to receive the care they need, whether in a psychiatric bed or in a community setting.

...Recognize that behind headlines about drug overdoes and the opioid crisis are stories about mental health struggles, substance abuse disorders, and trauma. 
We ought to be talking about the public health crisis of opioid addiction -- as we ought previously to have talked about crack cocaine in terms of public health rather than crime (see the point above about language around incarceration and crime) -- and we ought to be talking about it in terms of underlying causes such as substance abuse disorders, trauma, and mental health struggles. If politicians are seeking to use the opioid crisis to bolster their campaigns but aren't talking about increasing resources for care and recovery while decreasing punitive measures and homelessness, we should raise questions. And if they're doing so while also talking about cutting taxes for those with the most, we ought to remind them of the previous point: tax cuts for those with the most mean losses in care and services for those with the least.

And finally, mental health voters in 2018 should refuse to shame or demonize people whose voting behavior is different than their own. 
I think it's really important to vote this year. I also think we shouldn't shame or demonize people who don't vote or who vote differently than us, especially when we're talking about mental health voting. For some people with severe mental illness, getting to the polls or accessing the polls is difficult under normal circumstances, much less in a time in which voting rights are being eroded by voter ID laws, the closing of polling places, and the purging of voter rolls. Rather than criticizing those who don't vote, we ought to be voting with those who can't get to the polls in mind, while helping cast an inspiring vision that can catch the hopes and interest of those who might, in the past, have stayed home out of disengagement and disinterest. Those of us with mental health struggles ought to understand, more than anyone, that feelings of disengagement and disconnection can be really powerful, and that shaming and demonizing language, far from motivating us, tends to drive us deeper into the corner. 

Obviously, there's many more aspects of this conversation to consider, but these are a few topics I've noticed rattling around in the political sphere this year. So if you are able to vote, consider these thoughts about mental health voting. The more we tell our stories, the more the system will have to change. The more the system changes, the more people will be able to access care. The more people are able to access care, the more sacred stories we will be privileged to hear.

My next book, Grace is a Preexisting Condition, will tackle conversations at the intersection of faith, practice, and the mental health system. You can learn more about my first book, Christ on the Psych Ward, here.