Federal Mental Health Legislation during the Trump Administration

Background:

Despite the proven effectiveness of mental health (MH) interventions, funding remains limited, as only 6% of the federal healthcare budget is reserved for mental health. Social workers have repeatedly advocated for increased MH services and funding, but gaps persist. Disparities could be addressed through the policy process, but critical proposals often do not pass. One of the biggest barriers is the concept of stigma, which could extend into legislatures and influence voting on bills that affect stigmatized populations. Factors that influence legislator voting behavior are found in the literature, but studies have not explicitly focused on MH-specific voting outcomes. Findings could assist social workers in affecting the legislative process and organizing targeted advocacy efforts. Thus, study aims were (1) to examine and synthesize the characteristics of federal MH bills as well as (2) determine factors that influence MH voting outcomes.

Methods:

Data collection was completed using BillTrack50, a database that allows users to search all introduced bills based on topic, date, status, etc. Bills included in the study’s dataset were introduced at the federal level, between January 2017- October 2019 (the Trump administration), and included one of the search terms (i.e., mental health, mental illness, or psychiatry). 586 bills were found and downloaded into excel (N = 8,808 sponsors). Analyses were completed by using chi-square to determine relationships between categorical predictors (gender, sponsor political party, ethnicity, chamber majority/minority) and a categorical outcome (a bill’s current status). Further, logistic regression was used to determine if one or more factors explained variations in whether a bill passed or failed.

Results:

The majority of legislators that introduced MH bills were White/Caucasian (66%), male (66%), democrat (79%), and/or members of their state’s majority party (71%). Further, the overwhelming majority of MH bills failed to pass (90%). Current status was significantly associated with gender, X² (1, N = 8808) = 8.41, p = .004; majority/minority, X² (1, N = 8808) = 37.92, p < .001; political party, X² (1, N = 8750) = 124.80, p < .001; and ethnicity, X² (1, N = 8808) = 49.08, p < .001. Finally, age (OR = .998, p = .025), political party (OR = .493, p < .001), and ethnicity (OR = .697, p < .001) were all significant predictors of current bill status in the model.

Conclusion:

Social workers are ethically required to be politically active, yet the majority are not. Understanding what influences MH-specific legislation could enhance advocacy efforts and assist in addressing the MH coverage gap. Consistent with past research, this study found that legislator-specific factors (gender, chamber majority/minority, party, and ethnicity) were significantly associated with current bill status. Further, political party, ethnicity, and age were all significant predictors of whether a MH bill passed or failed. Specifically, MH bills were more likely to pass if sponsored by legislators who were republican, white, and young(er). Proponents of MH legislation in the literature tend to be liberal and female, but these results suggest that MH advocates consider alternate avenues when searching for proposal sponsorship.