JFK's vision for mental health care languishing?

• The Community Mental Health Act became law 50 years ago
• Mental illness often prevents people from seeking treatment for other ailments
• Key regulation on mental health parity delayed by problems with HealthCare.gov website

WASHINGTON — On the eve of the 50th anniversary of John F. Kennedy's Community Mental Health Act, mental health proponents are pushing to make sure Kennedy's goals are finally realized.

"I've seen the people that I love the most suffer the indignities of the shame that their physical illness caused them to endure," former congressman Patrick Kennedy told USA TODAY, speaking of mental health illnesses. "These are not just medical issues, these are civil rights issues. There's no other area in health care that is so persistently discriminated against."

This year, advocates say, that could change — or at least begin to. Here's why:

• In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, which demands that mental illnesses be treated the same as other illnesses. Those who have cancer are not denied care after 10 visits if they are not healthy; those with depression should also not be denied care if they are not healthy.

• In 2010, President Obama signed the Affordable Care Act, which includes mental health parity as a requirement for insurers. Federal regulations for that portion of the law are expected next month.

• As more people receive care, it may decrease long-term health costs because mental health issues often hinder treatment for diabetes or heart disease. Failure to address those diseases costs more because it leads to hospitalization.

• The return of veterans from the wars in Iraq and Afghanistan who acknowledge mental health issues may make them role models for others to fight depression, anxiety, sleep disorders and traumatic brain injuries, experts say.

"I believe the test for the Mental Health Parity and Equity Act, which I was privileged to write with my father in the Senate, the test of whether that become a reality or not is whether we as a nation can change our attitudes toward these brain injuries and the experience of trauma that our servicemembers have experienced," Kennedy said.

Kennedy, who suffers from mental illness, was a Democratic House member from Rhode Island from 1995 to 2011. John F. Kennedy was his uncle, and his father, former senator Edward Kennedy of Massachusetts, was a longtime supporter of increased health care coverage for all Americans.

Kennedy is hosting a two-day mental health forum in Massachusetts on Wednesday and Thursday. Vice President Biden attended Wednesday's event.

A key part of mental health policy — the final rule on mental health parity — has been delayed, however, because of the government shutdown this month, said Jeffrey Lieberman, president of the American Psychiatric Association. Administration officials say the rule will be issued by the end of the year, and that it entered the final stage of review Monday.

The Affordable Care Act is a "pivotal moment" for mental health care, Lieberman said, because it will help with homelessness and crime, which are both driven by mental illness.

The 1963 law had the unintended effect of releasing people committed to mental institutions into communities that were unprepared for them, Lieberman said. The current structure of the American health insurance system makes it more difficult for people to receive mental health treatment, he said.

"It's not dealt with in the same way as infectious disease," Lieberman said. "The stigma is pervasive."

Next year will be a turning point, because "mental health has become too big to ignore," said Paul Summergrad, chair of the Department of Psychiatry at Tufts University School of Medicine. "These are problems that are just too common."

If someone goes to the emergency room for a heart attack, no one asks whether his health insurance covers it, Summergrad said. But if someone goes in for a psychiatric episode or a suicide attempt, doctors have to call the insurer to make sure the person is approved for care.

"That just doesn't happen anywhere else in clinical medicine," Summergrad said.

Few people talk about their personal stories because of the stigma associated with mental health issues, he said.

Society tends to ostracize people with mental illness, Kennedy said, rather than reach out and offer help.

"We call campus police and get him kicked out," Kennedy said. "That's what we do with all of these situations. And then we scratch our head and say, 'How did this happen? How did they get the gun?' We're not asking the right question."

For the law to work, the advocates say, several things must happen. Primary care doctors must learn how to refer patients for proper treatment; insurance companies must be transparent in how they handle mental health cases; communities must enforce existing laws; and mental health research must be funded as well as other health issues.

Veterans could become significant players in the debate, Kennedy said, because they are coming from a community that at least has been talking about mental health as they returned from war. Many of them will have civilian jobs that provide insurance, which, because of the new parity rules, could pick up where the Department of Veterans Affairs has fallen behind with hundreds of thousands of backlogged cases. About 22 veterans kill themselves every day.

"When I go to Arlington, I see my family buried there because they served their country, and I believe our veterans can be the ones who change this narrative," Kennedy said. "We need a way for this to change. We need to do this in a way that we embrace and celebrate, and there's no group in America that elicits that response more than our nation's veterans."