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Nashville and the rest of the nation heard from Sens. John McCain and Barack Obama about many topics during the recent presidential debate here, but one critical subject was missing: America's mental health.

One in four Americans experience mental health problems in any given year. One in 17 lives with serious conditions like major depression, bipolar disorder or schizophrenia. The death rate from heart disease and diabetes for Americans living with mental illnesses is two to three times greater than that of the rest of the population. But where is the sense of urgency for addressing mental illness as a public health crisis?

In 2003, President Bush's New Freedom Commission on Mental Health called the nation's mental health care system a fragmented "system in shambles."

In a subsequent report, the National Alliance on Mental Illness (NAMI) found that the national average grade for publicly funded state systems was a D. If Senators McCain or Obama ever needed to seek help from the public mental health care systems in their home states, they probably would be appalled. Arizona received a D+; Illinois, an F. Tennessee earned a C-. As a nation, we can do better.

So what are our candidates going to do to fix it?

When 32 faculty and students were tragically killed at Virginia Tech two years ago by a young man with a severe mental illness, Arkansas Gov. Mike Huckabee declared: "The real issue is not whether gun control would have prevented this tragedy, [it's] whether people have better access to mental health treatment. That's really the discussion we need to be having."

Tennessee continues to starve the mental health system. TennCare has stopped paying for mental health crisis services for the non-TennCare clients. If plans proceed, those with Medicare, private insurance or no insurance will not get mental health crisis care once the stop-gap funding runs out. That's like saying the fire department will only come to homes that have homeowners insurance. In January, income limits will be placed on the Mental Health Safety Net for people with mental illness who lost TennCare in 2005. That means 2,700 people who have been turned down for private insurance because of pre-existing conditions will lose the mental health services they were promised.

Mental illness is treatable. It doesn't discriminate. It affects Democrats and Republicans. It can strike anyone at any time. Between now and Election Day, I hope we hear more from McCain and Obama about what they will do specifically to advocate for every American who confronts mental illness.

- Opinion, Sita Diehl, executive director of the National Alliance on Mental Illness, NAMI Tennessee
(The Tennessean, October 15, 2008)