Presidential Candidate’s Plan to Improve Mental Health Care

Presidential Candidate’s Plan to Improve Mental Health Care

One governor takes a bold, new direction.

A somewhat altered version of this post was published earlier in Psychology Today.

Governor Jay Inslee (D-WA) recently spearheaded and then signed into law in Washington state one of the most far-reaching mental health initiatives in recent history. HB 1388 provides a new way to address now terribly deficient mental health care, one that—for the first time—engages the root cause. As a Presidential candidate, his action introduces a new approach to the national level as well as raising consciousness of a severe, untended problem in U.S. health care.

In several of my previous posts I have summarized the poor state of modern mental health care and recommended the major change required to correct it—one Governor Inslee may be operationalizing according to recent reports from the Governor’s office and from the Associated Press. First, though, what is the problem? Only 25% of patients with known mental disorders receive any care at all, and nearly all (85%) of this care is provided by medical physicians who are not psychiatrists and who have received virtually no training in mental health care and, accordingly, have little interest and demonstrably sub-par expertise.

Congressman Jay Inslee (D-WA)

PD US Congress

What, then, is the major change needed that the Inslee plan can activate? The change is improved training of the physicians who provide mental health care. As obvious as this is, it rarely has appeared on the radar screen of modern medicine, much less been given voice at the national level. Now, it’s not entirely clear to me that Governor Inslee is proposing to go so far as training medical students and residents in mental care as the Institute of Medicine and I and many others have recommended. These are the people who will provide the care, so it makes sense to train them rather than concentrating only on existing mental health professionals. While Inslee’s focus may be more on the latter, he seems to leave open the opportunity of extending training to medical school students and graduates. How? A special mental health care teaching hospital is funded to train future clinicians. It is affiliated with the University of Washington, a well-recognized national leader in mental health education, research, and care. Training the physicians who will provide virtually all mental health care would greatly foster Governor Inslee’s goals of ensuring timely care, integrating mental health care into medical settings, and expanding the professional workforce.

This post is not a partisan political commentary, and I have no financial or other relationship to the Inslee campaign or to any candidate in either party. The important point I want to make, though, is that Governor Inslee’s actions highlight the role of politics in health care. They point to the much-needed attention required from the political arena if we are to improve mental health care in the U.S. Unlike the Inslee actions, most politicians tend to have short-term goals rather than the needed long-term, big picture approach,1,2 even though they are increasingly the greatest determinants of all health care. We see this every day in, for example, how political actions affect AIDS, drug prices, women’s health, and immigrant health.3

The long-term actions now signed into law in Washington state could be a model for the big picture approach needed at the national level by attacking the root cause of our mental health care problem: insufficient numbers of adequately trained clinicians, medical as well as mental health professionals, to provide now sorely lacking care for America’s most common health problem.

Copyright Robert C. Smith 2019


1. Mechanic D. From Advocacy to Allocation–the Evolving American Health Care System. New York: The Free Press; 1986.

2. Tomlinson M, Rudan I, Saxena S, Swartz L, Tsai AC, Patel V. Setting priorities for global mental health research. Bulletin of the World Health Organization 2009;87:438-46.

3. Mishori R. The Social Determinants of Health? Time to Focus on the Political Determinants of Health! Med Care 2019;57:491-3.