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Independent Living News & Policy from the National Council on Independent Living

Key Principles for Mental Health Platforms

A number of presidential campaigns have issued platforms dedicated specifically to mental health. Access to the right kinds of mental health services is important not only for purposes of health but also as a matter of liberty and civil rights. These services help ensure that people can live in their own homes and have jobs, families, and opportunities to participate fully in their communities. Mental health platforms should reflect those goals.

It is also critically important that such platforms be developed in consultation with individuals who have lived experience with mental health disabilities and organizations representing their interests. The interests of these individuals—who are directly affected by mental health services—should be paramount. Our organizations represent people with mental health and other disabilities, and work to advance their rights and interests. Collectively, we represent millions of individuals with disabilities. We offer these key principles to help guide the development of mental health policy proposals by campaigns.

Treat mental health disabilities like other disabilities: Campaign platforms concerning mental health should be addressed within the larger framework of disability rights, and mental health disabilities should be treated the same way as other disabilities.

Expand community services: Proposals to expand mental health services should focus on community-based services, such as supported housing, mobile crisis, supported employment, peer support services, and children’s wraparound services. This is consistent with the Americans with Disabilities Act’s “integration mandate” and the Supreme Court’s Olmstead decision, as well as with good practice. Moreover, expanding community services reduces incarceration and psychiatric hospital admissions, decreasing the need for emergency services and acute inpatient care.

Reduce institutional services: Services in segregated and/or restrictive settings (including psychiatric hospitals, nursing homes, board and care homes, and other congregate settings) should be reduced, not expanded. Medicaid encourages states to provide mental health services in the community and should not be changed to pay for more institutional care.

Focus on voluntary services: Proposals to expand mental health services should focus on voluntary services. Individuals benefit most from services when they can choose the care they receive. Involuntary outpatient commitment (sometimes known as “assisted outpatient treatment”) is not supported by evidence and should not be a part of campaign platforms.

Support privacy rights: Privacy rights are critically important to ensure that individuals can seek mental health services without fear that the information they share will be disclosed to others without permission. The Health Insurance Portability and Accountability Act (HIPAA) must be respected and enforced. HIPAA already provides exceptions to non-disclosure obligations in appropriate circumstances, including when disclosure is necessary to avert a danger or when a person lacks the capacity to consent or object to disclosure.

Enforce the ADA: Any campaign platform concerning mental health should include a promise to ensure robust enforcement of the Americans with Disabilities Act (ADA), including its integration mandate, so that individuals with disabilities—including mental health disabilities—can live, work, be educated, and receive services in the most integrated setting appropriate, and be protected from discriminatory treatment in the workplace, in schools (including elementary and secondary education as well as postsecondary education), and in public services and places of public accommodation.

Address trauma: Trauma plays a significant role in the development of psychiatric disabilities and affects health across individuals’ lifespans. Ensuring that mental health services reflect principles of trauma-informed care and trauma-responsive practice is an important goal.

Expand inclusive school-based services: Mental health services for children in school should be voluntary, individualized, and available to all students. They should provide students with tools to support their emotional regulation, academic success, social inclusion, self-determination, and transition to adulthood. This requires services to be trauma-informed, culturally competent, respectful of student privacy, and focused on positive behavior support. Services should support students to be educated in regular classrooms alongside their non-disabled peers.

Avoid law enforcement responses to mental health crises: Responses to mental health crises should include mobile crisis services, crisis apartments, and peer-run crisis centers and avoid law enforcement involvement absent a serious public safety concern.

Prevent needless incarceration: Needless incarceration of individuals with mental health disabilities has become far too common. Expansion of community-based services and housing, including in jail diversion programs, is key to reducing incarceration. Building more psychiatric institutions is the wrong way to address incarceration.

Enforce parity: More robust enforcement of the federal mental health parity law, and greater transparency requirements for health insurers so that parity violations can be readily identified, are needed to ensure timely access to needed services.

Promote psychiatric advanced directives: Psychiatric advanced directives are an important tool to ensure that services can be delivered consistent with individuals’ wishes and reduce involuntary treatment in emergency situations.

Address racial and ethnic disparities: People of color who experience mental health crises are disproportionately subjected to coercive and punitive responses, including involuntary inpatient and outpatient treatment. Ensuring that voluntary community services are culturally and linguistically appropriate and easily accessible to people of color should be a priority.

Promote autonomy and inclusion: Campaign platforms concerning mental health should serve the goals of promoting the autonomy, dignity, self-determination, and inclusion of individuals with psychiatric disabilities. Goals should include increasing job opportunities in competitive integrated employment; ensuring a quality education alongside non-disabled peers; supporting individuals to live in their own homes and communities and make their own choices; preserving families; and maximizing independence and self-sufficiency.