Growing behavioral health needs and existing workforce inadequacies are amplifying calls for Congress to provide additional resources to address a national mental health crisis exacerbated by COVID-19, the economic recession, and social isolation.
The pandemic has stressed the nation’s behavioral health infrastructure at a time when the country has seen increases in overdose deaths, suicides, and reports of anxiety and depression.
A study published in JAMA Psychiatry this month on almost 190 million emergency visits during the pandemic found that visit rates for mental health conditions, suicide attempts, and drug overdoses were higher from mid-March through October 2020 than in the same period of 2019.
The authors say their findings suggest the need for prevention, screening, and interventions at all societal levels, and the importance of longitudinal surveillance to monitor the long-term impacts of COVID-19.
Public health experts, advocates and government officials have been sounding alarms about the secondary health effects of the pandemic and recession since early last year, and Centers for Disease Control and Prevention data underscored the pressing nature of the problem.
Shawn Ryan, chair of the Legislative Advocacy Committee at the American Society of Addiction Medicine, said that so far, the government has poured relatively small amounts of funding into a concern that requires a more sustained solution.
“In reality, you know, the state and federal federal initiatives to address this issue have not been commensurate with the substantial nature of the problem,” said Ryan.
A $1.9 trillion COVID-19 relief package proposed by President Joe Biden would provide $4 billion for the Substance Abuse and Mental Health Services Administration and the Health Resources and Services Administration.
That would build on $4.25 billion for mental health provided in the year-end spending package for fiscal 2021.
The 2021 appropriations funding included money for community mental health grants, Certified Community Behavioral Health Centers, and to support the National Suicide Prevention Lifeline (800-273-8255).
Congress provided a total of nearly $4.7 billion to SAMHSA last year for behavioral health, a House Appropriations Committee aide confirmed. That number includes $425 million from the second COVID-19 relief law and the $4.25 billion in the December supplemental.
The second COVID-19 relief law also included provider relief funding, and in October, the Department of Health and Human Services opened up $20 billion to support health care organizations including mental health and addiction recovery treatment providers.
This year, the most likely legislative vehicles for mental health and addiction-related provisions are COVID-19 relief proposals.
The House Energy and Commerce Committee held a budget reconciliation markup earlier this month for its portion of the package.
The public health portion of the package included elements of provisions pushed by Sen. Tim Kaine, D-Va., that would provide $80 million to increase training and strategies to address suicide and burnout among health care workers. It also contains $20 million for an educational CDC campaign on mental health care needs of providers and first care responders and $40 million for grants to promote mental health wellness among medical professionals.
The Medicaid portion of the Energy and Commerce package includes a provision from Rep. Paul Tonko, D-N.Y., that would restart Medicaid benefits for incarcerated individuals 30 days before release. Recently released individuals face an exponentially higher risk of dying of a drug overdose.
The Medicaid section would also include a provision that would incentivize state Medicaid programs to fund mobile crisis intervention services.
Medicaid is the largest payer of mental health services in the United States and also is critical in funding substance use disorder treatment.
Experts have also highlighted Biden's executive actions that would roll back restrictions on Medicaid, including initial steps earlier this month to block approvals for state Medicaid work requirements or state acceptance of capped funding for added flexibility.
“One of the challenges that we've had with mental health and substance use is, for most of our history, mental health and substance use has been a state's responsibility, financed mostly through state general funds and more recently Medicaid dollars,” said Chuck Ingoglia, president and CEO of the National Council for Behavioral Health.
David Lloyd, national policy adviser for The Kennedy Forum, a behavioral health nonprofit, emphasized that expanding Medicaid would increase access to treatment.
Focus on addiction
Some lawmakers have also pushed for more funding targeted specifically at addiction, as the number of overdose deaths has increased significantly during the pandemic.
Last year, a House-passed COVID-19 relief package that the Senate did not pass would have provided $8.5 billion for mental health, but some Democrats have sought more.
Some say there is a possibility for other avenues outside of reconciliation and appropriations packages to change policy.
“What I'm hearing from folks is there is broad recognition to do more about mental health and substance use,” said Ingoglia.
Andrew Kessler, founder of Slingshot Solutions, which specializes in behavioral health policy consulting, said that while a COVID-19 related package is the most likely vehicle, he sees an appetite for a substance use disorder package centered around larger policies such as legislation to build on a major 2016 addiction law known as the Comprehensive Addiction and Recovery Act.
Kessler suggested that the reintroduction of this legislation could serve as the catalyst for an even larger behavioral health package that could become law.
National Association of State Alcohol and Drug Abuse Directors Executive Director Rob Morrison also said it was important to re-examine existing drug policy laws to ensure they are working.
“I think going back to those provisions is important, some of which may not have been funded, some of which are expiring, which are just getting off the ground. And I think there's so much just to review. We think that's an important component of moving forward,” said Morrison.
There are many other moving pieces, including ways to expand the behavioral health workforce and ensure access to treatment.
Ryan said that includes policies such as loan repayment programs and funding that would make it easier for medical professionals to specialize in addiction medicine.
“We have a fairly significant workforce disparity,” he said. “Getting more folks directly involved in primarily treating substance disorder is going to require continued policy work and funding.”
Advocates also want to expand the Certified Community Behavioral Health Clinics program, which ensures patients receive services regardless of their ability to pay.
The Biden administration has shown signs that it sees a need for more policies related to mental health and drug addiction.
The White House has announced several senior staff but a permanent Office of National Drug Control Policy director has not been named, and is traditionally named after other high-level officials.
In February, the ONDCP identified five priorities for drug control policy for the first 100 days of the administration, signaling the importance of combating the drug crisis.
ONDCP sketched out plans to introduce policies to expand the addiction workforce, emphasize harm reduction strategies, increase prevention efforts, expand treatment, and confront issues related to racial equity.
“The Biden administration has been pretty clear that this is a priority,” said Kessler.