Vice President Kamala Harris has signaled that, if elected president, she’ll work to increase mental health care access — but she acknowledges that addressing what has become an increasingly complex issue could be a heavy lift.
The issue, she said in a podcast last month, “is probably one of the biggest public policy failures in our country.”
“We have acted as though the body starts from the neck down instead of understanding we need health care from the neck up,” she said during the Sept. 30 “All the Smoke” podcast hosted by former NBA players Matt Barnes and Stephen Jackson.
It’s a public policy issue that has grown in severity.
According to Mental Health America, nearly 1 in 5 American adults will have a diagnosable mental health condition in any given year, while nearly half of Americans, 46 percent, will meet the criteria for a diagnosable mental health condition sometime in their life. Nearly 43 million U.S. adults have reported anxiety disorders, while 46.5 million have a substance use disorder and 22.5 million U.S. adults have major depression.
Experts say the issue requires federal policy solutions that will address the shortage of mental health care providers, address health insurance and Medicaid issues, and increase access to equitable and affordable mental health coverage.
President Joe Biden has attempted to address access. In September 2024, the Biden administration finalized a rule that would require insurers to cover mental health care and addiction care the same as they cover medical services for physical conditions.
Biden also supported the passage of a 2022 gun violence law that included provisions to increase school behavioral health services. The administration also established maximum appointment wait times for Medicaid enrollees and implemented a rule to improve payment transparency for Medicaid providers.
Laudy Aron, a senior fellow at the Urban Institute, a nonpartisan policy think tank, said Biden’s efforts to improve access to mental health care could foreshadow some of what Harris could do on the issue if elected.
“These have been positive developments within the Biden administration, and my sense is that the Harris-Walz administration will build on them,” Aron said.
But she cautioned against the idea of a one-size-fits-all solution, saying the issue isn’t an easy one to fix.
“There’s no kind of one or two policy levers that could fix this,” Aron said.
Instead, she said, much of the work to address mental health systemically happens on the state level, so federal policies to solve the issue need to incentivize states to build comprehensive approaches to behavioral health. Bigger investments in public mental health infrastructure are also key, she said.
Harris has long worked on issues of mental health care access. As San Francisco district attorney, she advocated passage of a 2004 statewide proposition that expanded California’s behavioral health system for those with serious mental health issues. She also launched an initiative helping domestic violence survivors with mental health counseling.
As California’s attorney general, she backed legislation that created a four-year pilot program for elementary schools to provide mental health services to students, particularly in communities with high levels of childhood trauma, among other programs.
During the 2020 Democratic presidential primary, Harris, then a candidate, introduced a proposal to address the shortage of mental health and addiction care providers that would have doubled the number of treatment beds, addressed mental illness among vulnerable populations such as veterans and minorities, and focused on children affected by trauma.
Maternal mental health
Harris has also focused on maternal health, introducing several pieces of legislation focusing on the maternal mortality crisis in the United States while she was a U.S. senator. She co-sponsored a package of 13 bills aimed at improving maternal health, including mental health, specifically for Black women.
In September 2023, the Biden administration announced the creation of a task force on maternal mental health after the passage of a 2021 law aimed at addressing maternal mental health. The task force will sunset in 2027.
Joy Burkhard, the CEO of the Policy Center for Maternal Mental Health, said she hopes Harris would build on that task force’s work even further if she’s elected. She said what the next administration would do with future reports would be crucial for momentum on the issue but addressing the issue will require significant overhaul of the systems already in place.
“We can’t just keep talking about the problem. We need to do something robust and not just tinker around the edges, which is all we can do with our current system. We need something big and bold to help solve that fundamental crisis in providing maternal care,” Burkhard said.
In the United States, 1 in 5 women suffers from a mental health or substance use disorder in the perinatal period, which is during pregnancy or the year after birth, according to the American Psychiatric Association.
A bipartisan issue
Although former President Donald Trump has publicly disavowed the document, parts of the Heritage Foundation’s Project 2025 platform, which aims to create a policy document for future GOP presidents, would have mental health care implications. The document would, among other things, eliminate the 2010 health care law. It also proposes to limit Medicaid coverage of mental health care.
Additionally, Trump has also proposed a return to mental institutionalization, which would be a shift from long-standing policies for treatment.
“For those who are severely mentally ill and deeply disturbed, we will bring them back to mental institutions, where they belong,” he said in an April 2023 video.
Mental health care advocates say they worry that Trump might look to chip away at Medicaid coverage of behavioral health services. Medicaid is the country’s largest payer of such services.
“We want to make sure that some of the recent advancements in health insurance that do extend coverage to mental health and substance use care, does so in an equitable manner, continue to be available,” said Hannah Wesolowski, the chief advocacy officer at the National Alliance for Mental Illness.
Despite that, mental health access is considered a largely bipartisan policy area.
Wesolowski said the establishment of the 988 Suicide and Crisis Lifeline as a bipartisan item she hopes the next president continues to invest in. The bill creating the line was signed into law by Trump, with most of it being funded and implemented by the Biden administration.
“I think this is an opportunity for any future president to really see that through to fruition and make sure that every American knows about this lifesaving resource and continue to fund that and develop that as an alternative to 911 for mental health emergencies,” she said.
Regardless of who wins the White House, advocates said the current state of the U.S. mental health care system will require significant resources to move the needle in the right direction.
“We’ve never really had a real mental health system. It’s been cobbled together, and anyone who needs mental health care has to go through a lot of hoops,” Wesolowski said.
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