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BPC New Report: America’s Mental Health and Substance Use Crisis Requires Integrated Care

Headshot of Joann Donnellan
Joann Donnellan

Washington, DC – The COVID-19 pandemic has accelerated an already overwhelming mental health and substance use crisis in the United States. Even before this spike, many people went untreated. A new report released today by the Bipartisan Policy Center’s Behavioral Health Integration Task Force calls for the Biden administration and Congress to advance the integration of primary care and mental health and substance use services to close the treatment gap that is expected to persist long after the pandemic.

Over the past year, symptoms of anxiety and depression in adults have increased nearly fourfold, drug overdose deaths have skyrocketed, and 25% of young adults have seriously considered suicide. Increasing integration will go a long way toward addressing this crisis. Research shows that integrated care enhances access to treatment, improves patient outcomes, and reduces health disparities in communities across the country.

BPC’s task force is co-chaired by former Sen. John E. Sununu; former Rep. Patrick J. Kennedy, founder of The Kennedy Forum; Sheila P. Burke, BPC fellow and chair of government relations and public policy at Baker Donelson Berman & Berkowitz; and Richard G. Frank, Margaret T. Morris professor of health economics at Harvard University.

Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration was developed over the past year by BPC’s task force of former lawmakers, former executive branch officials, and health care experts in consultation with an advisory council. The report’s recommendations focus on four key areas: 1) Establishing core, minimum standards essential for integration; 2) Driving integration in new and existing value-based payment structures in Medicare and Medicaid; 3) Expanding, training, and diversifying the workforce for integrated care teams; and 4) Promoting the use of electronic health records, telehealth, and other technology to support integrated care.

The recommendations would enable primary care clinicians to handle treatment for more of their patients with mild to moderate mental health and substance use conditions by providing them with training, technical assistance, compensation, and better access to behavioral health providers for both consultations and referrals. While some primary care providers already do this, they report feeling ill-equipped to do it properly.

Key to success will be tackling the enormous mental health and substance use provider shortage. The task force recommends extending federal health care program coverage to additional types of providers such as peer support specialists and increasing grant funding for statewide psychiatric consultation services. The recommendations would also tighten network adequacy rules to ensure enough behavioral health providers in health plan networks are available to take new patients.

“COVID-19 has fueled America’s mental health and substance use crisis in unimaginable ways, exposing a staggering unmet need for treatment that existed long before the pandemic,” said former Rep. Kennedy. “We must prioritize integrated care that treats the body AND the mind to truly recover. That means empowering primary care doctors with tools and financial incentives—in addition to increasing access to diverse behavioral health providers for patient consults and referrals.”

Since the pandemic began, outpatient telehealth visits have increased from 7% to 16% due to temporary waivers by Congress. The task force recommends permanently expanding Medicare coverage of telehealth services that advance integration. Proposals would also remove restrictions on site of service, established patient rules, and geographic and clinical setting demands which prevent patients from receiving care from their homes. BPC also recommends that behavioral health providers receive financial assistance to adopt electronic health records and share information between providers.

“Expanding telehealth access permanently would eliminate access disparities and address the digital divide,” said former Sen. Sununu. “Telehealth will help treat far more people faster and in their own homes. Removing the telehealth video requirement would also enable those without broadband, video technology, or an understanding of how to use it, to access care from afar.”

To drive integration in Medicare and Medicaid, the task force recommends creating new financial incentives so more primary care providers will evolve their practices to deliver integrated, comprehensive care. These federal health care programs already have well-defined quality metrics and standards to apply, enforce, and incentivize integration.

“Payment arrangements that promote integration will drive our nation’s health care system towards better and more efficient care for behavioral health problems,” said Frank. “The evidence shows that integration of behavioral health and general medical care produces cost effective treatment.”

“Integrating primary care with behavioral health services is necessary to ensure that individuals with behavioral health conditions and comorbid physical health problems receive high-quality access to care,” said Burke. “Treating people holistically will ensure meaningful progress toward a higher-quality, more cost-effective health care system.”

Even before COVID-19, more than half of adults with mental health conditions did not receive services in 2020, and the percentage was even lower in Black and Latino communities. In 2019, nearly 90% of people with a substance use disorder failed to receive treatment.

“Our nation’s rising mental health and substance use crisis sends a strong message that it is time to rethink the federal role in integrating care to close the treatment gap for millions of Americans,” said Marilyn Serafini, BPC health project director. “We need new, long-term structural changes to increase and sustain accessible behavioral health care services for all people in need.”

The American Rescue Plan Act provides investments in the nation’s mental health and substance use crisis response. It is critical that whenever possible, the administration leverages BPC’s recommendations to promote integration while addressing this national challenge. Several states are already moving toward integration, demonstrating positive results, and lowering costs through Medicaid including Illinois, Missouri, Arizona, Colorado, and Washington. For example, Colorado’s State Innovation Model program saved an estimated $178.6 million from 2016 to 2017.

BPC contracted with Health Management Associates to assess many of the recommendations in this report. The overall net cost to the federal government totals $2.2 billion over 10 years. That includes $6.9 billion in new federal spending and $4.7 billion in savings. BPC’s recommendations would benefit an estimated 1 million Americans.

Task force members include:

  • Nella Domenici, CFO and Member of Executive Committee, Dataminr; Former CFO and Member of Management Committee, Bridgewater Associates
  • Regina Benjamin, M.D., Founder and CEO, BayouClinic, Inc.; 18th U.S. Surgeon General
  • Kenna Chic, Former President, Project Lighthouse Peer-Support System
  • Charles Curie, Principal, The Curie Group, LLC; Former Administrator, Substance Abuse and Mental Health Services Administration
  • Erik Paulsen, Former U.S. Representative, Minnesota
  • Ted Strickland, Former U.S. Representative and Governor, Ohio
  • Vikki Wachino, Principal, Viaduct Consulting, LLC; Former Deputy Administrator and Director of the Center for Medicaid and CHIP Services, Centers for Medicare & Medicaid Services

BPC’s report was supported by grants from Well Being Trust, the Sunflower Foundation, and the New York Community Trust.

Read the full report and infographic.

Read Sen. Sununu and Rep. Kennedy’s op-ed in The Hill.

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