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September 1, 2007
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Our fields need to have a larger role in the 2008 election

As the 2008 presidential election looms ever closer, leaders in the mental health and substance use care fields recognize that important opportunities, perhaps once-in-a-lifetime opportunities, will be lost without effective collaboration between the two fields. In separate meetings held for mental health and substance use care leaders in Santa Fe, New Mexico, and Washington, D.C., respectively, participants enthusiastically endorsed new efforts to work together. The impetus comes from important developments at both the national and state levels.

Nationally, it is shocking that as of this writing, only two of the major presidential candidates—Barack Obama and John Edwards—have a stated position on mental health or substance use care or related insurance coverage. This deplorable situation demands our immediate action. Our national mental health and substance use care leaders recognize that the burden is squarely on us to work together to change this situation. We need to develop coordinated position papers on care and insurance that can be provided to the candidates. These position papers must be easily adaptable into each candidate's campaign. Simply stated, this requires that they be short, clear, and direct. Several key themes will need to be emphasized for both fields: Treatment works; recovery is common; a productive life is probable.

Position papers, however, are just a preliminary first step in a long journey. All of us—I repeat, all of us—must be active in the presidential race. We need to mobilize ourselves and our colleagues to attend and participate actively in campaign rallies; we need to support publicly both the reality and the promise of the mental health and substance use care fields; and we need to seek opportunities to give both formal and informal testimony that will move these fields forward. The mental health and substance use care fields may wish to endorse presidential candidates sympathetic to the issues our fields confront.

Another important step is participation in national advocacy coalitions that transcend our own fields. Traditionally, we have been isolated from coalitions that represent particular groups, such as the elderly, or that represent important actions, such as healthcare reform. We need to show that we have something to offer to these groups. Such actions will serve to break down stereotypes that these groups may hold about us. They also will help to put mental health and substance use care on the national agenda.

Many pundits already are calling the 2008 presidential election a major tipping point. Elements in play include the Iraq war, U.S. foreign policy, and a critical domestic agenda around healthcare, education, energy, etc. If we do not weigh in, then there is a strong likelihood that mental health and substance use care will never be recognized as a key part of the national health policy agenda, and will probably be forgotten or perhaps deliberately ignored.

In some respects, the policy fulcrum is moving from the national government to the states. This is clearly the case with universal health insurance. Recognizing that federal action is improbable and that the costs of inaction are unacceptable, several states have undertaken universal coverage initiatives.

As with the presidential campaign, it is critical that we have position papers on each of these state initiatives. The position papers should demand that mental health and substance use disorders be considered in the same manner as any other diseases; promote prevention and early intervention strategies; and endorse collaborative care approaches, led by a care manager who can be reimbursed for this essential activity. Success will require that we give formal testimony in state legislatures, work closely with governors, and ensure that mental health and substance use care be a visible part of the universal health insurance debate in each state.

What we learn in one state can be applied to other states. However, we need to promote the development of appropriate forums where such translation can take place. Major national meetings are an ideal locus for this.

The financial costs of healthcare are unsustainable if we do not develop universal health insurance coverage initiatives. Governors know that the absence of preventive interventions leads to much more costly acute care, that emergency room care is much more costly than clinic and physician care, and that future health disasters, such as avian flu, could be addressed successfully if healthcare is available for a state's entire population.

We have exceptional, one-time opportunities in 2008 to collaborate effectively to make badly needed advances in improving the quality of mental health and substance use care, as well as to promote universal health insurance coverage. Let's take advantage of it. We can have a very exciting year!

Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm Constella Group, LLC, worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board.

To contact Dr. Manderscheid, e-mail