Debbie Stabenow stood in the well of the U.S. Senate a few weeks ago, reminiscing about her half-century in politics as she prepared to finish out her last term in office.
The 74-year-old Democrat from Michigan talked about her first campaign, as a graduate student running for county commission in the 1970s, and the barriers she broke along the way to Washington, like being the first legislator in Lansing to have a baby while in office. She spoke about her pride in Michigan’s natural resources and still-mighty auto industry, and mentioned her work on behalf of small farmers while serving on the Senate Agriculture Committee.
But the most important part of her address was about her father. And while it’s not uncommon to mention family members in a farewell speech, Stabenow’s reference was more than the usual loving tribute. It was a recollection of how his life had influenced her thinking on a key policy area and led, eventually, to her most important legislative achievement ― a program that is among the more potentially transformative domestic policy initiatives in recent memory, even though most Americans have never heard of it.
Stabenow’s father had bipolar disorder, the psychiatric condition known for its dramatic, sometimes sudden swings between feverish euphoria and debilitating depression. It wasn’t until Stabenow was in college, when her father was in his 40s, that he finally got the care he needed. The reasons had less to do with policy than with a lack of scientific understanding of the condition back then. But the experience convinced Stabenow of the need to treat mental illnesses more like we do physical maladies ― to “treat health care above the neck the same as health care below the neck,” as she likes to say.
She spent much of her career trying to make that possible. Eventually those efforts culminated in legislation to create the Certified Community Behavioral Health Clinic (CCBHC) initiative. Funded by Washington, administered by states, the program underwrites comprehensive mental health care — everything from routine therapy to 24-hour crisis response — through public and private organizations that will serve anyone regardless of insurance status or ability to pay. Versions now operate in most states.
The evidence so far suggests the program is making a real difference, both for many of the estimated 6% of Americans who have a serious mental illness and for their families and communities as well. But the program is not only interesting for what it might be doing. There’s also the story of how it came to be — a story of bipartisan compromise that feels altogether out of place in today’s political environment.
It is a reminder that meaningful, broadly supported congressional action is still possible when interest in good governance isn’t confined to one side of the political aisle ― and when there are leaders with the patience to pursue their cause over the course of many years.
A Family’s Struggles With Mental Illness
One of Stabenow’s more indelible memories from childhood is the time the police came to her house to take her father to the hospital.
At the time, Stabenow was in junior high. She remembers her mother gathering her and her two younger brothers on the couch to explain what was happening and why, and promising that their father was going to be OK. She also remembers her father crying because he didn’t want to go.
“I loved my dad and didn’t want him to be hurt,” Stabenow told HuffPost in a recent interview. “But I trusted my mom knew that she wouldn’t do anything that she didn’t think was best for him.”
Debbie Stabenow was Debbie Greer back then, the daughter of Anna and Robert. They lived in Clare, a small city in the middle of Michigan’s Lower Peninsula, where the family owned and operated an Oldsmobile dealership. Sometimes it seemed like all of Clare’s roughly 2,500 residents knew Robert, who had a reputation for cutting maybe a few too many generous deals because he didn’t want to take advantage of neighbors ― and who had a habit of inviting the occasional buyer home for dinner when they seemed nice or needed help.
Stabenow says that attitude had a lot to do with his strong sense of faith. But it was also, she realizes now, among the ways the manic side of his condition expressed itself. Another was the constant stream of ideas he had ― he spoke frequently of the books he planned to write ― and the way he would keep Anna up all night so he could tell her about it. “It was like his brain was moving so fast, he couldn’t keep up with it,” Stabenow recalled.
It took a toll on Anna, who worked as the director of nursing at a local hospital. And that was on top of the responsibility she shouldered for managing and supporting the family when her husband was in what’s now understood to be bipolar disorder’s depressive stage. “He was never a danger to himself or to anybody else,” Stabenow said. “But this had gone on for a long time and was not getting better … His mood swings were getting more severe, and there was just nothing available in the community.”
The idea that Robert could benefit from a stay at a psychiatric hospital made plenty of sense. These institutions had been around for more than a century, as part of the 19th-century “asylum” movement. Historically, they’d done little more than provide a place to live away from mainstream society ― sometimes under nurturing conditions, sometimes under abusive ones. But the introduction of the drug Thorazine in the 1950s had rekindled hopes of making it possible to “cure” patients, or at least to prevent their psychiatric conditions from being so debilitating.
But while Thorazine could be effective at controlling delusions and other kinds of psychosis, especially those associated with schizophrenia, it was less effective at treating the full range of symptoms Robert had. It could also have side effects, including involuntary physical movements. Many patients refused to take the medication, or wouldn’t stay on it once they started. Robert was one of those. “His legs would shake, his hands would shake … He just couldn’t function,” Stabenow said. “And then he would just stop taking it.”
“There was still no diagnosis, there was no term ‘bipolar.’ There was no knowledge or understanding of what he had.”
– Sen. Debbie Stabenow (D-Mich.), on her father’s situation when she was a child.
This cycle of treatment and relapse went on for several years, and on multiple occasions Robert returned to the same psychiatric hospital, which was almost two hours away in Traverse City. It was a clean facility with attentive staff, Stabenow said, but patients like her father were under constant sedation and didn’t seem to be getting better. “He wasn’t getting the treatment he needed,” Stabenow said. “There was still no diagnosis, there was no term ‘bipolar.’ There was no knowledge or understanding of what he had, no medication for it.”
Then, during her first year at Michigan State University, Stabenow heard a lecturing psychiatrist describe new insights into a condition that doctors were calling “manic depression” and would later call bipolar disorder. Stabenow recognized it immediately as her father’s. “There was a relief, finally, because I felt for the first time, ‘OK, that’s what this is,’” Stabenow said. She introduced herself to the psychiatrist, who helped place Robert in a different hospital where doctors gave him lithium, the drug they were deploying as a “mood stabilizer” to mitigate the condition’s ups and downs.
The lithium was more effective than the Thorazine had been, Stabenow said, and in her father’s case it had fewer side effects too: “It was night and day. My dad was able to get back to work, and really get his life back.”
Stabenow’s father would live until 1983. And he’d never need another psychiatric hospital stay, Stabenow said.
A Generational Change In Psychiatric Care
The new understanding of bipolar disorder, and the introduction of lithium as a treatment for it, weren’t the only big changes in psychiatry during the 1960s and 1970s. This was also the era of “deinstitutionalization” ― the push to get people with serious mental illness out of long-term stays in large psychiatric hospitals, precisely because there were now psychotropic drugs that made it possible for them to live on their own, in their homes and communities.
The big policy change that helped set off this transformation was the Community Mental Health Act of 1963, the last major bill that President John F. Kennedy signed into law. Its goal was to set up outpatient clinics to provide the support and treatment that people with serious mental illness needed to stay out of those large institutions. But the funding for Kennedy’s program ran out after a few years.
In 1980, Jimmy Carter picked up the cause and signed the Mental Health Systems Act, which its champions hoped would allocate more money and make the funding permanent. It didn’t happen, because one year later Ronald Reagan and his allies gutted the initiative as part of their campaign to slash federal spending on social programs.
The failure to replace the old institutions with new community providers meant even more unmet need for mental health care in communities across the country. And fiscally strapped states generally couldn’t do a lot on their own, though officials like Stabenow tried to do what they could under the circumstances.
As a member of the state legislature from 1979 to 1994, including a stint as chair of the House’s mental health committee, Stabenow led the fight for laws improving children’s access to psychiatric care and a program to subsidize parents caring for children with behavioral impairments. Stabenow continued to champion the cause of better mental health when she got to the U.S. House in 1997, and then to the Senate in 2001, where she joined the fight for mental health “parity” laws designed to prevent private health insurers from treating mental and physical illness differently.
In 2009, Stabenow was on the Finance Committee when it took up and passed legislation that became a template for the Affordable Care Act, the sweeping health care reform law that Congress passed and President Barack Obama signed in 2010. One of the successful amendments she co-sponsored guaranteed that private plans available through the new law would be subject to the same parity requirements as other private insurance policies. When Democratic senators gave leadership their lists of “asks” for what would go in the final legislation, Stabenow was one of only three to mention mental health, according to internal documents HuffPost was able to obtain years later.
“We want to create community services that are equal to and have parity with what we do for physical health care.”
– Stabenow in 2013
Until that point, the Senate’s leader on improving mental health care had been Ted Kennedy, the Massachusetts Democrat. When he died in 2009, Stabenow took up the mantle. Her next big cause was the one that had animated Kennedy and Carter and all of their allies: building up community mental health providers and support programs, in order to follow through ― finally ― on the promise of deinstitutionalization.
To do that, Stabenow proposed creating a new system for funding mental health providers. The federal government would make money available to states, through the Department of Health and Human Services. States would get the money by demonstrating it would go to providers who would provide a wide array of mental health services, available to anybody.
A key part of the program would be making sure the funding would be there indefinitely, rather than as time-limited grants ― and that the funding would be relatively flexible, rather than tied to specific kinds of services ― as long as states and their providers lived up to the program’s ideals. A rough model for the initiative was the way the federal government had long funded community clinics providing physical medical care for uninsured and low-income Americans. The program name, Certified Community Health Benefit Clinics, was a homage of sorts.
“We want to create community services that are equal to and have parity with what we do for physical health care,” Stabenow said.
A Bipartisan Effort In A Partisan Era
The timing for such an ambitious endeavor did not seem ideal. A meaningful investment in community mental health programs would require some serious new spending, at a time when Republicans were gaining seats in Congress ― and were as opposed to new federal spending as ever.
But in 2010, one of the Republicans who won a seat in the Senate was Roy Blunt of Missouri. He and Stabenow had first met about two decades before, when they were both honored for their respective work in state government. (Blunt at the time was serving as Missouri’s secretary of state.) They met again in 1997, after they both won their first elections to the U.S. House and spotted each other at an orientation for freshman members. From there, they struck up a friendship and in the ensuing years collaborated on issues like farm legislation, where their shared interest in helping rural constituencies transcended partisanship.
“I think Sen. Stabenow and I both saw that there was a connectedness to mental health and all other health that was underappreciated ― and maybe not even understood.”
– Former Sen. Roy Blunt (R-Mo.)
When Blunt got to the Senate in 2011, Stabenow approached him as a potential partner on the community mental health clinic legislation. And it didn’t take much convincing. Blunt didn’t have the kind of personal exposure to mental illness that Stabenow had, he told HuffPost in a recent interview, but he’d seen how the issue can affect individuals, families and communities as a state official and, later, as a university president.
“I think Sen. Stabenow and I both saw that there was a connectedness to mental health and all other health that was underappreciated ― and maybe not even understood ― by many of our colleagues,” said Blunt, who left the Senate in 2023. And though he was as determined as his fellow Republicans to cut federal spending, he said, he thought mental health clinics were the kind of investment that could pay off in the long run, by reducing the need for spending on other programs.
The pair’s first chance to push the legislation came in early 2013, following the massacre at Sandy Hook Elementary School in Connecticut. Stabenow and Blunt hoped to introduce the measure as an amendment to a gun safety bill under consideration, arguing that improving mental health was something Democrats and Republicans alike could support despite their traditional differences over firearm restrictions.
“This isn’t something that has a partisan divide,” Stabenow said at the time. “All our families are touched by this in some way.”
The amendment never got a chance, because the gun bill never passed. But they kept pushing, and in the fall, on the 50-year anniversary of Kennedy signing his landmark bill, Stabenow and Blunt held a colloquy on the Senate floor to discuss their proposal and why it was so important. “The time is now,” Blunt said. “Actually we are probably beyond the time we should have done this.”
Stabenow and Blunt worked their colleagues one by one, with Stabenow relentlessly pigeonholing fellow senators on the floor. She also worked closely with outside advocates ― especially the National Council for Mental Wellbeing, which had developed and introduced a version of the concept back in 2007 ― and together they brought in some celebrity help.
The actor Glenn Close, who has become a mental health care advocate because her sister has bipolar disorder, made an pitch for the initiative on Capitol Hill. So did the director and screenwriter David O. Russell, who has cited his son’s experiences with bipolar disorder as inspiration for the movie “Silver Linings Playbook.”
The efforts paid off when Stabenow and Blunt were able to attach a version of their proposal to some other, must-pass health care legislation. And while it was only a pilot version of the initiative, with enough money for just 10 states to launch the programs in their states, Stabenow and Blunt kept campaigning for more ― and finally got another chance after yet another school shooting, the 2022 massacre in Uvalde, Texas.
Once again, Stabenow and Blunt touted their mental health proposal as common ground for both supporters and opponents of new gun restrictions. And because the pilot version had been in place for a few years, this time they had real-world data to demonstrate its impact. Early, tentative studies suggested that communities implementing the program had seen a 72% reduction in psychiatric hospitalizations and a 40.7% reduction in homelessness.
Unlike the gun bill Congress took up after Sandy Hook, the post-Uvalde legislation became law. And although it was the firearms provisions that got all the public attention, it was the mental health investment ― which should amount to $8 billion in just the first decade of the program’s existence ― that could have the most lasting effects.
Charles Ingoglia, president of the National Council, told HuffPost he thinks the initiative could be part of a transformation that history remembers alongside the creation of the asylums and then deinstitutionalization. “I see it as the third major shakeup of the mental health system since the beginning of the United States,” Ingoglia said.
The Program In Stabenow’s Home State
States have lots of flexibility over which agencies and organizations deliver mental health services under the CCBHC program. Michigan’s approach is to designate one provider in each county. One of those providers is Integrated Services of Kalamazoo, in the southwest part of the state, and it’s as good a place as any to see how the initiative works.
Integrated Services was already in the business of addressing behavioral health even before the CCBHC program came along. But with the extra funds, it’s been able to add facilities and services, including an urgent care center that is open 24 hours a day, seven days a week. Integrated Services has also hired new therapists, outreach workers and peer addiction counselors. Overall, the organization’s staff has nearly doubled in size in the past few years ― mostly, its leaders say, because of that new federal money.
One way those extra resources help is by cutting down on the delays that were common before, when people had to wait for assessments or treatments because they’d have to go to some other, outside provider who might not have time right away. This was especially problematic for people who were struggling with substance abuse, director of clinical services Beth Ann Meints told HuffPost. “As soon as you start a delay like that, even if it’s two hours, a person with substance use can very quickly go and say… ‘It’s easier for me just to leave. I’m just gonna go. I’m over that now.’”
“I kind of see it as the third major shakeup of the mental health system since the beginning of the United States.”
– Charles Ingoglia, president of the National Council for Mental Wellbeing
Meints said another big change is that, with the new federal funding, the organization can see patients for a wide variety of mental health services. That’s different from the past, when they frequently had to turn away people who were not in acute distress, even if they had underlying problems that would likely lead to more severe issues later.
In fact, according to CEO Jeff Patton, Integrated Services has seen an uptick in patients who have insurance (and whose insurance will still pay their bills) because shortages of mental health care providers have made it difficult for them to get care. “They’ve started knocking on our doors, and we’re saying, ‘Well, yes, we can serve you now,’ because we’re able to do that,” Patton said.
The program’s biggest booster may be the Kalamazoo County sheriff, Richard Fuller. He can point to ways the new program is helping his officers directly ― by, for example, funding mental health crisis specialists who respond to calls with police. But the bigger impact, he says, has been on the people Integrated Services now reaches early on, helping them to avoid the spiral of homelessness, addiction and sometimes crime that would otherwise draw law enforcement’s attention.
“I’ve had to say that, for the longest time, we have the largest mental health facility in the county right here… at the jail,” Fuller told HuffPost. “It shouldn’t be that way, and that’s what this work is helping us to do ― finding alternatives, helping people not come to jail in the first place.”
It’s impossible to know how well such impressions convey the full picture of what’s happening in Kalamazoo, or anywhere else implementing the federal program. The key challenge with any promising pilot program is figuring out how to get the same results at large scale.
And it’s going to be years before data allows researchers to draw definitive conclusions about this initiative’s success, according to Amanda Mauri, a New York University fellow and assistant professor who has studied it closely. But, she told HuffPost, “I think it looks really promising” even if “my guess is we’ll have roadblocks along the way.”
Stabenow agrees there’s still a lot of work to do ― on implementing the new initiative, and on improving mental health care more generally. The Biden administration promoted and expanded the program; it’s not clear whether the Trump administration will too. Meanwhile, roughly 1 in 3 Americans with a serious mental illness doesn’t get treatment, according to recent estimates. The CCHBC program, however ambitious by historical standards, won’t come close to fixing that alone.
But Stabenow also thinks things have gotten a lot better, in ways that would have helped her father if he’d been going through his struggles today rather than half a century ago.
“It would have made all the difference in the world,” she said. “Instead of my dad going in and out of hospitals and not getting the help he needed for 10 years of his life, he would have been able to manage his disease and go on with his life.”
Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.