Last year’s presidential election was an emotionally-charged and pivotal period of time. Trump supporters saw his victory as a step toward revitalizing the economy and guiding the country in the right direction. Others believed his victory signaled a retreat from social progress and inclusivity, and a stark reminder of our country’s ideological divides. With a new president leading the U.S., Americans began to consider what their future might look like with Donald J. Trump in charge.
Trump ran his campaign on the promise of repealing the Affordable Care Act (Obamacare) and used controversial rhetoric deriding many communities that differed from most of his supporters as dangers to “making America great again.” So it’s not a stretch to say that the Trump administration’s actions and intentions could potentially affect the mental health and wellbeing of people with behavioral health issues - as any change in regime could - from a self-care and policy standpoint. The sense of stability and support from the Affordable Care Act has been particularly disrupted, making daily life and hope for the future less certain.
Trump’s attitude towards minorities - concerning race, religion, gender identity, sexual orientation, and behavioral health differences - certainly has elicited concern across the nation and beyond. He has almost unapologetically positioned himself as a provocateur who courts controversy. His personality and leadership style potentially trigger stress and anxiety due to the chaos he often literally promises and the increased uncertainty about how his actions and reactions will impact individuals and the country. Every new tweet, public appearance, or quote in an article brings the potential for major change - for better or worse - to people’s lives.
The data supports this collective anxiety. The American Psychology Association (APA) conducted two studies: one prior to the election in 2016, and one in January 2017. The APA’s research shows that stress levels had been trending downward prior to the election, but spiked after, with 66 percent of Americans attributing their stress to the future of the nation, 57 percent to the political climate, and 49 percent to the election outcome. People affiliated with both major political parties cited election-related reasons as a significant source of stress - with 76 percent of Democrats identifying the election outcome as a significant stressor, and 59 percent of Republicans identifying the future of the nation as theirs. Furthermore, the majority of minority groups and Millennials indicated an increase in stress levels due to the election, and 34 percent of all people surveyed indicated an increased concern over their personal safety in the wake of the election - a 5 percent increase from the year before.
Though the APA broadly surveyed all demographics of Americans, people with behavioral health issues seem to feel the anxiety of the Trump election and presidency most acutely. Americans have flocked to therapists ever since Trump was elected. In an article from Vitals from Lifehacker, therapists noted that leading up to the election clients were identifying the election as a source of their anxiety. Since then, those feelings have become more deeply depressive and hopeless. Many behavioral health professionals, therapists, and social workers have all cited this Trump-related concern as “pervasive” among their clients, and noted an uptick in clients attending sessions, with many specifically citing him as a trigger. According to experts, Trump’s commentary and tweets can resemble remarks of a predator or bully, which often is a trigger, especially for trauma survivors. Triggers occur when something happens that resembles an emotional memory, especially when that memory is related to a sexual or abusive trauma. Take Trump’s comments and history related to sexual assault, for example. He has been accused of sexual assault by 20 women, and has commented on the recent allegations of sexual misconduct by Harvey Weinstein, Roy Moore, and Matt Lauer (among others), seemingly siding with the alleged perpetrators. When the president makes a comment, he draws these experiences to the forefront, and those who have experienced sexual trauma are then suddenly confronted with their related distress. These comments are affecting many individuals’ personal well being and sense of safety, as many therapists have noted.
Trump’s presidency does more than just impact the personal wellbeing and management of behavioral health issues; it impacts the policies related to receiving care. In an opinion article written by Richard A. Friedman for the The New York Times, Friedman, a clinical psychiatry professor, explains that Obamacare “provides medical coverage to an estimated 20 million Americans and specifically included mental health and substance abuse treatment as one of 10 ‘essential benefits’ that all private insurers and Medicaid have to cover.” Friedman’s own patients approached him asking if they would have insurance and if their medications would be covered, in light of the election. Because Obamacare classifies mental health and substance abuse treatment in the same way as illnesses like cancer or heart disease, it allows “the 43.6 million Americans living with a psychiatric illness and the 16.3 million who have an alcohol use disorder” to have health care - affordable healthcare. People with behavioral health issues no longer have had to worry about reaching lifetime limits or being denied health insurance due to their pre-existing condition, allowing them to focus on self-care and wellbeing.
All of that is potentially at risk. Trump’s campaign and subsequent actions as President, with the support of a Republican-controlled Congress, could affect those comprehensive benefits. Trump has long wanted to repeal Obamacare, and Congress has attempted to repeal and/or replace it multiple times since his election. While they failed to repeal it fully, the tax bill passed by the House and Senate and signed by the president in December actually eliminates Obamacare’s individual mandate, which will drive up premiums by 10% and cause 13 million Americans to lose coverage.
The tax bill does more than just get rid of penalties for people who do not buy health insurance though. The Washington Post states that the plan could “unleash a budgetary sequence of events cutting billions of dollars from Medicare and public health services,” meaning even fewer people will have access to the resources they need. As a result of these changes to the healthcare system, both people with and without behavioral health issues could lose their healthcare, and countless others will battle rocketing premiums. This makes receiving affordable, quality, and comprehensive behavioral healthcare not only difficult, but in some cases, impossible.
The general wellbeing of people with behavioral health issues is potentially uncertain amidst the many changes emerging from this unprecedented administration. So, for those with behavioral health issues, therapists recommend a number of actions, including unplugging from social media and technology, or adhering to an information diet, in addition to speaking with a professional. With breaking “Trump news” almost every day, limiting this intake and avoiding social overload can alleviate some anxiety or stress. Additionally, therapists recommend finding ways to get involved. Through activism, volunteering, or even just making donations, people can feel good that they are taking steps to protect policies, organizations, and causes they believe in and need. With years to go in Trump’s presidency, let’s work to understand how some of the new and future changes could affect people living with behavioral health issues and support them through the next few years.