Congress is Getting Serious About America’s Mental Health Challenges
The Bipartisan Safer Communities Act (BSCA) (P.L. 117-159) that President Biden signed on June 25 is one of the largest stand-alone mental health funding bills in recent history—and the President and Congress deserve great credit in bringing it to fruition. With reported incidences of mental health and substance use disorder higher than ever, however, there are more options for closing the access gap between those who desperately need behavioral health care services and those who can provide it.
Before COVID-19, nearly one in five adults suffered with a mental illness at any given time, statistics show. During the pandemic, this figure jumped to about 40%, the Kaiser Family Foundation found. Unfortunately, more than half of those with mental illness remain untreated, and studies found the percentage is even higher among those struggling with substance use disorder.
At the same time, and for those without challenges in access to care, many options for the treatment of mental illness and substance use disorder exist. These options include talk therapies such as cognitive behavioral therapy, as well as medications such as selective serotonin reuptake inhibitors and medications for opioid use disorder.
Dr. Thomas Insel, former director of the National Institute of Mental Health, says that when it comes to mental illness, we have a “crisis of care”—and the solutions are not just medical but social and political as well. In tackling the social challenge to addressing behavioral health (essentially, the stigma associated with it), the nation has made great strides. Policymakers now must address the political challenge, which is to gather the necessary support from policymakers to enact comprehensive mental health legislation that will give millions more people access to the care they need.
To be sure, policymakers made great progress in enacting the BSCA. It provided $800 million for the Substance Abuse and Mental Health Services Administration (SAMHSA) for programs that expand access to services, thereby helping to close the access gap. Of this money, $150 million is going to the National Suicide Prevention Lifeline—which is now the 988 Suicide & Crisis Lifeline—to increase call center capacity. These dollars are essential because, with a new, easy-to-remember number, calls to the Lifeline are expected to more than double over the next year. This new number also offers an unprecedented opportunity to connect Americans to the behavioral health care services they need and, thus, an opportunity to further close the access gap.
Nevertheless, and as outlined in our June 2022 report, Answering the Call—988: A New Vision for Crisis Response, the Lifeline suffers from a lack of sustained, authorized appropriations. That is why we recommend that the administration (i.e., SAMHSA) and Congress continue to evaluate the Lifeline’s utilization needs to determine its appropriate ongoing funding. BPC also recommends that SAMHSA establish a scorecard to assess crisis system performance so that program managers can evaluate the extent to which states are implementing their 988 programs and can track progress over time.
Furthermore, the availability and reliability of 988 services beyond call centers—including mobile crisis response teams and crisis stabilization services—vary across states and even within them, with many localities struggling to effectively build out and coordinate their crisis systems. As such, BPC also recommends that SAMHSA, the Centers for Medicare & Medicaid Services, and the Centers for Disease Control and Prevention use their existing resources to provide technical assistance to states to identify their own funding mechanisms to finance and build out their crisis continuums of care.
The BSCA also provides $60 million and $80 million, respectively, for the Health Resource Services Administration’s Primary Care Training and Enhancement Program and Pediatric Mental Health Care Access grant program. Together, the funding is designed to help pediatric primary care providers integrate primary and mental health care by giving them the resources to identify, diagnose, treat, and refer patients who need additional behavioral health care supports. That’s precisely the type of grant funding we proposed in our March 2021 report, Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration. Integrating primary and behavioral health care will help ensure that individuals with behavioral health conditions can access care and treatment, further closing the access gap.
While BSCA funding for these programs will go specifically to pediatric providers, it represents a concerted, bipartisan step forward in recognizing the importance of training primary care providers to screen and treat mild to moderate behavioral health conditions and, we hope, accelerates efforts to further integrate care for patients of all ages. In fact, as we recommend in our March 2021 report, the President and Congress can build on this funding by establishing core service and quality standards to improve accountability for integrating care. We also recommend updating network performance standards across payers and health plans to ensure adequate specialty care for referral and support for primary care providers.
Moreover, and despite a connection between drug overdose and “firearm injury” (i.e., gun-related deaths and injuries), the BSCA did little to address the nation’s opioid crisis. As explained in our April 2022 report, Combating the Opioid Crisis—‘Smarter Spending’ to Enhance the Federal Response, we still do not know whether the substantial federal investments of over $6 billion per year in grant spending from 2018 to 2020—in addition to the estimated $23 billion in Medicaid spending—have improved patient outcomes. Recent CDC data, however, suggest that they have not: the nation still experienced a 30% increase in drug overdose deaths from 2019 to 2020, and racial disparities have worsened, plaguing communities—like Black and Native American—that are also the most impacted by gun-related injuries and deaths.
The BSCA also did not address other gaps in existing policies. For instance, as per our March 2021 and April and June 2022 reports, BPC continues to call for enforcing and ensuring parity for mental health and substance use disorder services. Beyond that, and as outlined in our April 2022 report, we urge the White House and Congress, working with federal agencies, to “braid” (i.e., coordinate) opioid-related appropriations funding streams from across executive departments to ensure that agencies with similar goals and programs work more closely together. Programs across and within different agencies would formally collaborate and share expertise, personnel, resource, and data to maximize federal dollars.
Finally, the BSCA wisely expands the Certified Community Behavioral Health Clinic demonstration program, which plays an important role in crisis response, primary care integration, and the treatment of substance use disorders. It also appropriates $250 million for SAMHSA’s Community Mental Health Block Grant, which states distribute to local governments and nongovernmental organizations to provide community-based services to individuals in need. Breaking down barriers to behavioral health care at the community level is where treatment and recovery starts, and BPC applauds the President and Congress for recognizing this need.
While not nearly enough to close the gap between need and care, the BSCA’s funding represents a large leap forward. We celebrate this bipartisan achievement and encourage policymakers to take further steps to help millions of Americans.
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