Part of the 2024 Joint Election Study looked at how important mental health policy is to voters’ choices compared to nine other salient policy issues, including border security, abortion, and student loan forgiveness. The results suggest that mental health is very important, especially for liberals, people with high incomes, and people in relatively poor health. The paper was published in pro swan.
Mental health has become an increasingly important policy issue in the United States as the incidence of mental health problems has increased in recent years. This has been especially true during the COVID-19 pandemic. Access to mental health care remains uneven, with many people with mental health problems not receiving treatment. Barriers include cost, inadequate insurance coverage, lack of behavioral health professionals, long wait times, and unequal geographic distribution of services.
Furthermore, research evidence shows broad agreement that the United States is facing a mental health crisis. For example, a 2022 Kaiser Family Foundation/CNN poll found that 90% of Americans agree that there is a mental health crisis in America.
Additionally, in a 2024 Gallup poll, only 9% of Americans gave the U.S. health care system an “A” or “B” grade for its performance on mental health, while 57% gave it a “D” or “F.” This suggests that the broad goal of improving mental health enjoys near-universal support among the American public, even if opinions differ on specific policy solutions.
Study author Jake Haselsveldt examined the demographic and political correlates of the importance of mental health issues. He used a research approach commonly used in marketing called conjoint research methodology to examine the relative importance of a mental health coverage and access proposal based on a real-world proposal (the Americans’ Mental Health Care Improvement Act of 2023) compared to other salient political issues.
Conjoint survey methodology is an experimental survey approach in which respondents choose between hypothetical options with randomly varied characteristics, allowing researchers to estimate how much each characteristic influences their preferences and decisions. This is often used in marketing and product development to identify how important certain features of a product are to users.
The authors of this study conducted a collaborative experiment on a module of 1,000 nationally representative respondents from the 2024 Cooperative Election Survey (CES) conducted at the end of 2024. Operated by the research firm YouGov, the CES (formerly known as the Cooperative Congressional Election Survey) uses sophisticated sampling techniques to recruit a sample of American adults and applies tailored statistical procedures to generate estimates of the American public’s views on the issues surveyed.
Haselswerdt introduced a unique question: “Do you support or oppose the following proposal? Change health insurance rules and reimbursement rates to improve access to mental health care for all people, including low-income people, children, and the elderly.” This format is similar to the set of support/disagree items in the Common Content Survey, which cover a wide range of issues.
This study included responses to 9 of these items for a total of 10 policy issues, including mental health. Issues included include border security, access to abortion, carbon emissions regulations, affordable housing, repeal of the Affordable Care Act (ACA), student debt forgiveness, infrastructure investment, the “billionaire tax” and banning TikTok.
In a joint experiment, respondents were presented with a pair of hypothetical political candidates and asked to choose between them. The only information provided about the candidates was their randomly assigned position (support or opposition) on two of the ten policy proposals. By tracking which candidates respondents chose based on their policy preferences, Haselsveldt was able to determine which issues were most important at the voting booth.
Results showed overall support for the mental health proposals was estimated at 91%. Haselsveldt calculated how much agreement with a hypothetical political candidate would make voters more likely to choose that candidate. He found that agreeing with candidates on mental health proposals increased this likelihood by 27 percentage points.
This puts mental health issues almost as important as infrastructure spending and repealing the ACA, and slightly less important than student debt forgiveness and abortion access. Issues where the agreement is estimated to have a low impact on voters’ decisions include border security, banning TikTok, affordable housing, and carbon emissions. The importance of mental health issues was especially high for liberals, people with high incomes, and people with relatively poor health.
“These findings suggest that championing mental health behaviors may have political benefits for policymakers,” the study authors concluded.
This study contributes to the scientific understanding of Americans’ current political views. However, study authors note that the study’s results may be specific to the content or wording of the proposals included. Studies using different wording for the same general field proposal may yield different results. Additionally, this study uses dichotomous response options (support/disagree rather than asking about level of agreement), which precludes the possibility of discovering subtle patterns of relationships between propositions.
This paper, “Who Cares About Mental Health? Benchmarking the Importance of Mental Health Issues to American Voters,” was authored by Jake Haselswerdt.
