Hillary’s Theory of Change: On Mental Health Parity

Clinton has worked on this one hard-fought step at a time.

As I mentioned on Monday, Hillary Clinton announced a proposal to address mental health issues this week. As she has done throughout this campaign, it is comprehensive and thorough. You can read the whole thing at her website, but here are the bullet points:

* Promote early diagnosis and intervention, including launching a national initiative for suicide prevention.
* Integrate our nation’s mental and physical health care systems so that health care delivery focuses on the “whole person,” and significantly enhance community-based treatment
* Improve criminal justice outcomes by training law enforcement officers in crisis intervention, and prioritizing treatment over jail for non-violent, low-level offenders.
* Enforce mental health parity to the full extent of the law.
* Improve access to housing and job opportunities.
* Invest in brain and behavioral research and developing safe and effective treatments.

Beyond those specifics though, this is an opportune time to revisit a discussion that got a lot of attention during the Democratic primary: what is Hillary Clinton’s theory of change? Greg Sargent did an excellent job of highlighting that in the June/July/August 2016 edition of the Washington Monthly.

Sargent notes that, as First Lady in the 1990’s, Clinton included mental health parity into her work on health care reform. But when that failed, she continued that work in smaller increments over the next two decades. That included:

  1. Work on passage of the Mental Health Parity Act of 1996
  2. Organizing the first-ever White House Conference on Mental Health in 1999
  3. Pushing for various mental health care reforms that would have impacted the treatment of mentally ill juveniles in the justice system during her time as the Senator from New York
  4. Cosponsored the Mental Health Parity and Addiction Equity Act of 2008
  5. In 2008, ran for president behind a health care plan that featured mental health parity, along with coverage for substance abuse treatment

Here is how Sargent concluded that article:

The current Democratic primaries have been framed as a choice between a candidate with a bold vision (Bernie Sanders) and one promising only incremental reforms (Hillary Clinton). But in the case of mental health, at least, Clinton has revealed that she harbors a vision that is quite bold indeed, but, tempered by experience, she has also demonstrated the value of advancing incrementally toward it, one hard-fought step at a time.

Because Clinton has demonstrated her proficiency with this kind of long-term incremental progress on a whole host of issues, she is often criticized for lacking a bold vision for change. But that is a binary that misses the forest for the trees. What we see in this example is that, since she was First Lady, Hillary Clinton has been working towards a vision: “that the government should require insurance plans to offer coverage on an equal basis to both physical and mental illness.” When a comprehensive approach was called for – she proposed one. But when those failed, she doggedly continued to fight for every bit of progress she could find.

I suspect that we would find exactly the same approach to almost any issue Clinton has fought for over the years, because that is precisely her theory of change. As she has often pointed out during this campaign, it is summed up well by this Methodist saying, “Do all the good you can, for all the people you can, for as long as you can.”

Nancy LeTourneau

Nancy LeTourneau is a contributing writer for the Washington Monthly.