Mental health policy is a major deciding factor for voters, new study finds

A part of the 2024 Cooperative Election Study examined how important mental health policy is to voter choice relative to nine other salient policy issues, including border security, abortion, and student loan forgiveness. The results suggested that mental health is of substantial importance, especially to liberals, higher-income people, and those in relatively poor health. The paper was published in PLOS One.

Mental health is an increasingly important policy issue in the United States because the incidence of mental health problems has grown in recent years. This was particularly the case during the COVID-19 pandemic. Access to mental health care remains uneven, and many people with mental health conditions do not receive treatment. The barriers include cost, inadequate insurance coverage, shortages of behavioral-health professionals, long waiting times, and the unequal geographic distribution of services.

Furthermore, survey evidence indicates 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 the U.S.

Also, a 2024 Gallup poll found that only 9% of Americans gave the American health system a grade of “A” or “B” for its performance on mental health, compared to 57% for “D” or “F.” This suggests that the broad goal of improving mental health enjoys almost universal support among Americans, even if they disagree about specific policy solutions.

Study author Jake Haselswerdt investigated the demographic and political correlates of mental health issue importance. He used a research approach often used in marketing called conjoint survey methodology to examine the relative importance of a mental health coverage and access proposal based on a real one (the Better Mental Health Care for Americans Act of 2023) compared to other salient political issues.

Conjoint survey methodology is an experimental survey approach in which respondents choose between hypothetical alternatives with randomly varied characteristics, allowing researchers to estimate how much each characteristic influences their preferences or decisions. It is commonly used in marketing and product development to identify how important specific features of a product are to users.

The author of this study implemented a conjoint experiment on a nationally representative module of 1,000 respondents on the 2024 Cooperative Election Study (CES), conducted in late 2024. Run by the survey firm YouGov, the CES (formerly the Cooperative Congressional Election Study) recruits samples of American adults using advanced sampling methodology and applies tailored statistical procedures to produce estimates of the views of the U.S. population on examined issues.

Haselswerdt introduced an original question asking: “Do you support or oppose the following proposal? Change health insurance rules and reimbursement rates to improve access to mental health care for all, including lower-income people, children, and the elderly.” This format parallels a series of support/oppose items on the Common Content questionnaire that cover a wide range of issues.

For this study, he incorporated responses to nine of those items, for a total of 10 policy issues, including mental health. The issues included were border security, abortion access, regulating carbon dioxide emissions, affordable housing, repealing the Affordable Care Act (ACA), student debt forgiveness, infrastructure investment, a “billionaire tax,” and banning TikTok.

In the conjoint experiment, respondents were presented with pairs of hypothetical political candidates and were asked to choose between them. The only information provided about the candidates was their randomly assigned positions (support or oppose) on two of the 10 policy proposals. By tracking which candidate the respondents chose based on their own policy preferences, Haselswerdt could determine which issues carried the most weight in the voting booth.

Results indicated an estimated 91% overall support for the mental health proposal. Haselswerdt calculated how much agreement with a hypothetical political candidate increased the likelihood that a voter would choose that candidate. He found that agreement with the candidate on the mental health proposal increased this probability by 27 percentage points.

This puts the mental health question roughly alongside infrastructure spending and ACA repeal in importance and slightly below student debt forgiveness and abortion access. Issues where agreement had a lower estimated effect on voter decisions included border security, banning TikTok, affordable housing, and carbon emissions. The importance of the mental health question was especially high for liberals, higher-income people, and those in relatively poor health.

“These findings suggest that championing action on mental health could bring political rewards to policymakers,” the study author concluded.

The study contributes to the scientific understanding of the current political views of Americans. However, the study author notes that the findings of this study might be specific to the content or wording of the included proposals. The results of studies using different wording for proposals in the same general area might differ. Additionally, the study used dichotomous answer options (support/oppose, rather than asking about the level of agreement), eliminating the possibility of discovering nuanced patterns of relationships between proposals.

The paper, “Who cares about mental health? Benchmarking the issue importance of mental health for American voters,” was authored by Jake Haselswerdt.