How the U.S. is responding to our national mental health crisis
As you probably know, the U.S. is experiencing a mental health crisis. The COVID-19 pandemic hasn’t exactly helped the growing number of people suffering from mental health conditions, either. So, how is our current administration planning to combat this crisis? In this article I discuss the national strategy for 2022-2023 to improve mental health care access and quality so that more people get the help they need.
You may have heard the exciting news that the Suicide & Crisis Lifeline dialing code ‘988’ has been launched, effective July 16th, 2022. This is, no doubt, a win for the mental health community. The designation of 988 as the suicide lifeline number will make it easier for individuals in crisis to remember the emergency number and will send their call directly to mental health professionals instead of to the police. ‘988’ is the product of a bill called the National Suicide Hotline Designation Act, which was introduced in the House of Representatives back in August of 2019 [1]. The follow-through on this Act is just one component of the Biden-Harris administration’s strategy to address the mental health crisis in the U.S. [2] With support from both sides of the political aisle, the agenda outlines three main goals for fiscal year 2023 (FY23):
1. Strengthen system capacity
The U.S. suffers from a shortage of behavioral health care workers to meet the high demands of the population. From my friends’ accounts and my own experience, we know all too well the potential months-long wait time to get an appointment with a counselor or psychiatrist as a new patient. Delays in mental health treatment increase the risk of poor outcomes, can exacerbate mental health conditions, and increase the likelihood that patients won’t keep their appointments [3].
One of the proposed initiatives to combat the shortage of behavioral health workers is to invest in existing programs proven to bring mental health clinicians into the workforce where they’re needed most, such as rural and underserved communities. Plus, in fall 2022, the Department of Health and Human Services (HHS) will award hundreds of millions of dollars to pilot training programs to increase the number of diverse community health workers who can help alleviate the burden on mental health care professionals.
It's important to not only increase the number of behavioral health care workers, but also to ensure that their own mental health is protected so they can continue to help people. President Biden signed the Dr. Lorna Breen Health Care Provider Protection Act into law, which will launch an awareness campaign to address stigmatization and promote help-seeking and self-care among this workforce.
The designation of 988 as the national suicide lifeline number will also strengthen the U.S. mental health system capacity by creating a network of local crisis centers fortified by national back-up centers to answer calls and texts. The FY23 budget has allocated an additional $700 million to ensure that these local crisis centers are staffed and efficient in their ability to get people help when they need it – not months later.
2. Connect people to care
So, let’s say that you’ve decided you need mental health care. But then you realize that you don’t even know where to go for treatment, let alone whether your insurance will cover it. The administration’s next goal for improving behavioral health care in the U.S. is to help people navigate treatment options and get coverage for mental health services. Part of this is to integrate mental health and substance use treatment into primary care settings. The Bipartisan Policy Center in D.C. has already compiled a set of recommendations on primary care integration, including transforming the payment and delivery of integrated care, expanding and training the workforce, and promoting technology and telehealth support [4].
I feel that the education and training arm of the goal to integrate behavioral health into primary care is particularly important, and unfortunately it is not specifically addressed in the outline of our administration’s plan [2]. Stigma associated with mental health is one of the main reasons that someone may choose not to seek treatment for their condition [5,6,7]. If that stigma is affirmed by their primary care physician, then not only will the patient feel invalidated and ashamed, but they are less likely to be referred by that physician to a specialist who can give them the care they need [8]. To combat stigma in the primary care setting, “Continuing Education” programs on mental health will be crucial. These post-degree training programs allow both new graduates and experienced physicians to expand their skillset, and can be updated with the ever-changing field of behavioral health. Accessible training programs for providers need to cover topics such as common mental health conditions they are likely to encounter in their practice, misconceptions about mental health, treatment options for individuals living with mental illness, and mental health literacy (i.e., the appropriate language to use when discussing mental health).
3. Create environments that promote mental health
The third and final arm of the U.S. strategy to address the mental health crisis is to foster a culture and environment that broadly promotes mental wellness and recovery [2]. Much of this goal focuses on protecting the mental health of young people by increasing children’s online privacy, investing in research on the impact of social media, expanding early childhood and school-based intervention support, and requiring that online platforms and digital service providers prioritize the health and safety of children before profit and revenue.
Importantly, the administration aims to increase mental health resources for justice-involved populations. Currently, jails in New York, Los Angeles, and Chicago are the three largest institutions providing psychiatric care in the U.S. [9] There is no question that people who find themselves in a jail or correctional facility need access to comprehensive mental health services. Thus, in FY23, the Department of Justice will expand funding and technical assistance to local communities and corrections systems to provide behavioral health care, case management services, family services, and other transitional programming for adults returning from incarceration into their community [2].
The current administration is making big strides to combat the nation’s mental health crisis through medical and societal means. They are investing where it counts: to increase and diversify the behavioral health workforce, to ensure that mental health care is accessible and cost-friendly, and to expand mental health interventions in vulnerable populations, such as children and those involved in the justice system. Hopefully these investments will have a large payoff and, as the administration envisions it, transform how mental health is understood, perceived, accessed, and treated in the U.S.
To learn more about the new 988 Lifeline, check out the website here.
References
H.R.4194 - National Suicide Hotline Designation Act of 2019. Congress.gov. Available at: https://www.congress.gov/bill/116th-congress/house-bill/4194
FACT SHEET: President Biden to Announce Strategy to Address Our National Mental Health Crisis, As Part of Unity Agenda in his First State of the Union. March 1, 2022. Available at: https://www.whitehouse.gov/briefing-room/statements-releases/2022/03/01/fact-sheet-president-biden-to-announce-strategy-to-address-our-national-mental-health-crisis-as-part-of-unity-agenda-in-his-first-state-of-the-union/
Steinman, KJ, Shoben, AB, Dembe, AE et al. How Long Do Adolescents Wait for Psychiatry Appointments? Community Ment Health Journal. 51, 782–789 (2015). https://doi.org/10.1007/s10597-015-9897-x
Bipartisan Policy Center. Tackling America’s Mental Health and Addiction Crisis Through Primary Care Integration. March, 2021. Available at: https://bipartisanpolicy.org/download/?file=/wp-content/uploads/2021/03/BPC_Behavioral-Health-Integration-report_R03.pdf.
Stigma, Prejudice and Discrimination Against People with Mental Illness. August, 2020. Available at: https://www.psychiatry.org/patients-families/stigma-and-discrimination
Heath, S. Understanding Stigma as a Mental Healthcare Barrier. 2017. Available at: https://patientengagementhit.com/news/understanding-stigma-as-a-mental-healthcare-barrier?utm_content=b1281c3eaa9e820f79ecee0fe1311937&utm_campaign=MHD%25206%252F8%252F17&utm_source=Robly.com&utm_medi
Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. American Journal of Public Health. 2013 May;103(5):777-80. doi: 10.2105/AJPH.2012.301056.
Corrigan PW, Mittal D, Reaves CM, et al. Mental health stigma and primary health care decisions. Psychiatry Research. 2014 Aug 15;218(1-2):35-8. doi: 10.1016/j.psychres.2014.04.028.
Chang, A. 'Insane': America's 3 Largest Psychiatric Facilities Are Jails. 2018. Available at: https://www.npr.org/sections/health-shots/2018/04/25/605666107/insane-americas-3-largest-psychiatric-facilities-are-jails