Inseparable: Building a Social Movement for Mental Health
America faced a mental health crisis before the coronavirus hit last year, and the stress and anxiety of the pandemic have only made that crisis worse, with low-income and at-risk communities often bearing a disproportionate brunt. A new mental health awareness organization, Inseparable, hopes to tap into that shared experience with a focus on rebranding mental health as intrinsically linked to physical health. Inseparable was founded by Bill Smith, a former political operative who worked with GOP consultant and former White House (George W. Bush) Deputy Chief of Staff Karl Rove before working in the marriage equality movement and helping found Civitas Public Affairs Group. Smith founded Inseparable after his own family’s experience with mental health struggles. Smith spoke recently to Spotlight; the transcript of that conversation has been lightly edited for length and clarity.
How did Inseparable get started?
I have to give you a little bit of personal background because it relates to the Inseparable background. I grew up in rural Alabama and started working in campaigns and elections right out of college. Through the political process, I got involved with Tim Gill and the Gill Action Fund and became his political director in the marriage equality fight. I spent ten or 12 years working across the country on marriage and while I was bouncing around working on all of that, on the personal side, my middle brother Jack was battling with really serious depression and bi-polar issues. We lost him to suicide three years ago this summer and that is what led me to become more active in working in the mental health space. And when I did, I was lucky to work with a family that was also trying to figure out, after their personal loss, what they could do to impact the space. As someone who is kind of a systems change person, I was able to go on this great tour and meet tons and tons of advocates, clinicians and others who were working in the mental health space. And then I started to try to look at the marriage equality movement and all the tools that we had at our disposal and the things that we built in order to create such a major policy shift there and I started looking at the policy changes that so many brilliant people know that we need in mental health. And I realized that they just didn’t have the power to make those a reality. So, we started Inseparable under a pretty basic premise: that you can’t separate the health of your mind from the health of your body and that’s what we’ve been doing to the mental health issue and the public policy process for a very long time. We wanted to take some of those lessons from the marriage equality movement and others and build a real movement for mental health, so that we can make the policy changes that we all know are needed.
And what are some of the specific lessons from the marriage equality movement, which is now viewed by everyone as one of the great narrative movements of our time.
I think the most obvious one is the work around changing hearts and minds. That’s the one that’s talked about quite a bit and there was a large amount of stigma and disapproval that was aimed at the LGBT community for a long, long time. And so, telling stories about who LGBT folks were and why they wanted to get married was really important in changing hearts and minds on that issue. And in the mental health space, stigma sits on top of everything. It impedes our public policy and it impedes us telling each other how we’re doing in life and when people are struggling, because of the perception. Luckily, that’s changing, but that’s the big one that people talk about.
There’s a second one that is a little bit more tactical. In the marriage movement, we systematically worked over a number of years to build the political power that we needed to change policy. We learned how to win ballot initiatives. We got savvy about state legislatures and passing legislation or blocking bad things. We engaged in electoral politics and we learned how to integrate things into a litigation strategy, looking at all those things as part of a holistic strategy on getting something done. That’s the piece that I really want to bring to the mental health space because there a lot of people doing great work around fighting stigma, but I think less attention has been paid to what are all the levers of power that you need to be able to operate in order to effect the change we want. And that’s something Inseparable’s trying to bring to the effort.
Are there specific short-term goals that you have?
They are long-term goals and short-term goals, but there are basically three big problems that we’re focused on.
The first one is there’s a giant gap between the number of people who need help and treatment and the number of people who are getting it; eliminating the treatment gap is the first big goal. We’re not going to do that immediately but there are immediate steps we can take. One thing is insurance parity, making sure insurance companies are truly paying for the coverage that people need. Another is increasing the workforce, as we need a far bigger workforce of people in mental health to give people access to care. And the third is integration – integrating mental health into your primary care so your regular doctor asks you how you’re doing and also just integrating mental health into the way that people show up in life. All those things relate to the treatment gap.
The second big one is that children in our country are in a crisis right now; we’ve certainly seen it in the pandemic and we knew it beforehand. We also know that mental health issues show up early in life. And so, one place we know that every kid in America has to go is schools, so we’re focused on putting what’s called comprehensive school mental health systems in every school in the country, which is a surround sound approach, if you will, to kids and their mental health. We think that has a huge potential not only to help a lot of people before they start to develop problems but also to raise a generation of resilient kids who know how to deal with adversity in the world.
And the third big thing is that one of the only medical conditions that we routinely criminalize in the United States is mental illness. And we think that we have to stop that immediately and revamp the crisis response system that we have in our country so that we’re getting people where they need to get help. One alarming fact is that the largest mental health provider in the United States is the L.A. County Jail. That just means that we’re doing something really, really wrong with people who are in need of medical treatment.
We really think those three big problems are things that folks can understand, relate to and rally around and that’s what we’re focused on doing.
And does that begin by focusing on interesting practices at the state and local level and trying to give them more visibility? Or is it both a state and local and federal process?
It really has to be an all of the above approach. And at the federal level, we’re looking at executive actions that the Biden administration can take that don’t necessarily require congressional approval. We’re also going to be advocating with Congress to spend more money on things like school mental health. At the state level, there are a whole host of policies as well. Right now, we’re pushing in Illinois for a parity law, as I was referring to, that says that insurance companies have to pay for treatment of mental illness. They’re legally required to under federal law but it’s pretty routinely ignored, so we’re pushing legislation that would really detail what mental health coverage looks like to make sure it’s treated fairly.
And this is one of the few remaining bipartisan issues. Do you still find that? That there is bipartisan support for this?
There is and growing up in a rural part of a red state, I can tell you that mental health is not a red issue or a blue issue. Everyone has folks in their family that they can tell you have been in need of treatment or had specific conditions. I’ve never seen something like the experience since we’ve started Inseparable and the people and the stories just come out of the woodwork. People tell us that they’re so grateful that we’re focused on this and they’re across every demographic and from every part of the country.
Throughout the poverty and opportunity space, we see organizations grabbling with negative narratives. Are there specific tools that you use in terms of trying to deal with the stigma of mental illness?
The most important thing is to talk about it and normalize conversations about health and well-being and saying mental health is health and encourage people to talk about treatment. From a poverty perspective, I would be remiss if I didn’t talk about the gross inequities that exist within our health system that disproportionately impact poor folks and people of color, LGBT people and veterans, postpartum moms. There are some really discrete populations that have seen disparate impacts that we have to talk about and it’s part and parcel of the reforms we need writ large for our health care system.
Has the experience of the pandemic brought any kind of reset when it comes to mental illness, given that the visibility of these issues has been so much higher?
Last May, when the pandemic was just a few months old here in the United States, I said that I didn’t know one person who hadn’t experienced some kind of anxiety or depression through the context of this, whether they’re worried about someone else or their job or from being isolated physically or from their kids and how they’re faring with distanced learning. We were in a mental health crisis before the pandemic, but what this now allows is more conversation with people about these issues and opens up more of a dialogue.
From an outcomes perspective, we know that something like the pandemic will have significant negative consequences on a lot of people’s mental health and we’ll be dealing with that even after the pandemic. But there are some bright spots, such as telehealth. People using Zoom and phone calls and Skype to get access to therapy has been terrific and it has made things like no-show rates go down and increased access. It’s one of those things that we think should be a permanent takeaway from the pandemic, that we take down some of these barriers for people to get the treatment that they need, because they are artificial. If people have the ability to have access to the internet, they should have access to care and insurance should cover that, whether it’s public or private insurance.
I know some clinicians worry that you lose something when you don’t see a patient in person. Do you still believe telehealth access is a net positive?
It’s really about having more tools in the toolkit. When you come at this from the lived experience of someone in your family and you’re desperate to get them care, you know that some care is better than perfect care. There will always be things that clinicians will tell us are the optimal ways to treat people but what I’m concerned about is the people who are getting no treatment at all or extremely limited treatment. Anything we can do to get people closer to the help they need in my view is a good thing.
Bill, is there anything you’d like to add before we end?
We really are trying to build a social movement for mental health. It’s easy to go immediately to the policy solutions and things that we seek, but we also are trying to do is to change the conversation around this issue in such a way that we build a community of people who are impacted by it, they come together, and make the change. It’s one of those things where you have to go back and forth between doing the policy work and also the broader work with the public to have a conversation and then get involved – because that’s how we’re going to change the system.