Has there been conversation about mental health in this year’s presidential race? Sure. Has it been substantive and thorough? That’s open for debate. The remaining candidates have, for the most part, only scratched the surface of the issue, often treating it as part of larger and more heated debates surrounding topics such as veterans’ issues and gun control. While it is an occasional topic of conversation and is featured in some sections of the candidate’s official platforms, mental health has largely been a second tier issue this election cycle, taking a back seat to hot-button issues such as immigration, taxation, race relations, and, yes, the size of certain candidates’ hands. This begs several important questions. Firstly, is this a reflection of the candidates’ stances on the current system and the need for reform, or do they simply not see raising the topic of mental health as an expedient way to propel their campaigns through an intense election cycle?

Here is an in-depth guide to the current candidates’ platforms, statements, and legislative history regarding mental health:

Hillary Clinton (D)

Clinton’s official campaign website calls for increased funding for research on Alzheimer’s and similar disorders, promising to work toward a cure for Alzheimer’s by 2025. The former secretary of state and current Democratic frontrunner also mentions the need for comprehensive counseling and health care for survivors of sexual assault on college campuses. Her site’s criminal justice reform page promises to prioritize “treatment and rehabilitation — rather than incarceration — for low-level, nonviolent drug offenders”, and substance use disorder and addiction is part of Clinton’s platform. She said in September that “drug and alcohol addiction is a disease, not a moral failing — and we must treat it as such”. Her gun violence prevention page notes the need to keep guns out of the hands of the severely mentally ill. Clinton’s veterans’ affairs plan mentions the need for increased access to mental health services for veterans.

Bernie Sanders (D)

Sanders’s proposed federally administered single-payer system would include mental health and substance abuse services and would eliminate out-of-pocket fees including copays and deductibles. Fighting for disability rights is featured as part of the Vermont senator’s platform. While not explicitly mentioning mental health conditions, his plan calls for expansion of the Social Security Disability Insurance Program and increased educational and employment opportunities for disabled individuals. Sanders’ racial justice issues page states: “Police officers need to be trained to de-escalate confrontations and to humanely interact with people who have mental illnesses. We need to invest in drug courts as well as medical and mental health interventions for people with substance abuse problems, so that people struggling with addiction do not end up in prison, they end up in treatment.” Additionally, last year, Sanders spearheaded the Veterans Access, Choice, and Accountability Act, which, among other things, provided $5 billion to hire doctors, including mental health specialists, to care for veterans, and improved care for survivors of sexual trauma while serving in the military. His site also touts his history of championing outreach programs in Vermont that ensure veterans know about and receive the health care and mental health counseling they need.

Donald Trump (R)

Trump’s website simply alludes to the need to reform mental health programs and institutions, stating that there are “promising reforms being developed in Congress that should receive bi-partisan support”. His plan for Veterans Administration reform calls for supporting “the whole veteran, not just their physical health care, but also by addressing their invisible wounds”. Trump recently expressed his support of addressing mental health as opposed to tightening gun control.

Although Republican Ted Cruz is no longer in the race, it is interesting to note that the Texas senator’s campaign site made no explicit mention of mental health issues. Like Trump, he expressed that the government should go after people with serious mental illness” rather than enact gun control measures.

Cruz did prove to have a unique and highly personal vantage point on the subject, one that could have led to much needed dialogue. After Trump, his rival for the Republican nod at the time, made a bizarre and cryptic tweet claiming that he had “beans to spill” on Cruz’s wife, Heidi, accounts began to resurface of a 2005 incident in Austin. According to a report made public last year, the Austin Police responded to a call from a passerby about a woman sitting near the MoPac Expressway with her head in her hands and no sign of a nearby vehicle. That woman was Heidi Cruz. An adviser to Cruz, who was serving as Texas solicitor general at the time, explained: “About a decade ago, when Mrs. Cruz returned from D.C. to Texas and faced a significant professional transition, she experienced a brief bout of depression. Like millions of Americans, she came through that struggle with prayer, Christian counseling, and the love and support of her husband and family.”

While a presidential candidate acknowledging this kind of direct experience with mental illness could possibly help advance the national conversation on the subject, it is obviously the prerogative of the Cruz family to decide whether something so personal should be discussed on the national stage. Unfortunately, the Cruz family was not given the chance to make the decision. Rather, Trump’s camp dug up the incident as a means of smearing Cruz. Memes began circulating among Trump supporters online — ones that erroneously accuse Mrs. Cruz of having a drug problem, ones that feature pictures with giant, tabloid-esque captions reading MENTALLY UNSTABLE” and that refer to Cruz’s bout with depression as baggage and drama”.

The most harrowing takeaway from this situation, frankly, is the idea that in 2016, a presidential candidate’s wife’s decade-old struggle with depression is fair game, and that it somehow has any effect on that candidate’s credentials. It perpetuates the incredibly harmful idea that one’s struggle with mental illness is something for others to look down upon, that any mental illness makes the sufferer a villain worthy of public mockery and disdain. This is the stigma that persists in the United States today. This is the stigma that will persist as long as our leaders shy away from a real conversation regarding mental health.

According to a recent study by the Anxiety and Depression Association of America, 90 percent of Americans believe that mental health is just as important as physical health, one third report having trouble accessing mental health care, and over 40 percent see cost as a barrier for treatment. So, what gives? In an election cycle where much of the rhetoric coming from campaigns is deemed by many as “dangerous”, the tepid commentary on mental health is notable. It is surprising how rarely mental health, an issue that affects an overwhelming majority of Americans in some manner, is addressed as a serious, stand-alone issue in national politics. Stigma cannot be defeated in this manner. The dialogue around mental health must be embraced, even spearheaded, by our leaders if there is to be any hope of a real conversation that permeates all levels of society.

It is the duty of a nation’s leaders to address the wellbeing of the citizenry. In an America where suicide is the 2nd leading cause of death for 15-20 year olds and the 10th leading cause of death overall, where a struggling economy and increasing workplace stress have led to rising rates of anxiety and depression, and where more than 45 million adults have a diagnosable mental disorder, is it time to demand that our potential leaders be more outspoken on this issue? Can 2016 be the year when mental health comes out of the shadow of stigma and enters the mainstream political and societal conversation?