At his state of the union on March 1st, President Biden emphasized on one central theme: unity. He encouraged unity in defending against Russia, curbing inflation, and moving forward through the pandemic.
In addition to the polarizing events listed, was a four-point “Unity Agenda” aiming to create lasting change that goes beyond partisan boundaries. The plan aims to improve veteran aid, curb the opioid epidemic, and finally cure cancer. The fourth point, and perhaps the most tangible to his administration, was a promise to “take on mental health.”
The plan is historic not only in its unique approach but also in its sheer existence. Mental health has not been addressed federally since the Carter administration 40 years ago. This gap in time occurred despite the country’s rapid decline in mental health. In 2020, over 20% of American adults experienced mental illness, with less than half of them receiving adequate treatment. Furthermore, 7.7 million adolescents experienced mental illness in 2020, and this number is expected to grow. Needless to say, the federal confrontation of mental health is long overdue.
Briefly, after his address, Biden’s administration published the details of their plan to improve national mental health care. The plan consists of four primary approaches to improving federal funding and resources. A notable example of this is insurance coverage for behavioral health visits. In taking this action, Biden hopes to create “full parity between physical and mental health.” Health insurance plans have historically disregarded mental health care, as behavioral health visits are five-times more likely to be out-of-plan than primary care appointments. Furthermore, patient qualifications for mental health coverage are overly restrictive, often denying behavioral care to those who need it. In the California class action case Wit v. United Behavioral Health, the court ruled in favor of individuals claiming to have been denied adequate mental health and substance abuse care despite the demonstrated need.
Despite these legal efforts, access to affordable mental healthcare remains restrictive and inadequate. To address this, the federal government will now require all health insurance plans to provide three behavioral health visits per year without a copay.
The second approach proposed by the plan involves the creation and the strengthening of mental health services across the country. This summer, the US Department of Health and Human Services will launch a national 988 crisis hotline, creating a more specialized line of urgent mental health care than 911.
The current use of the 911 line as a national resource for mental health requires callers to go through police before being connected with a professional. Furthermore, it is also difficult to navigate the system due to the existence of numerous other hotlines, that provide more specialized assistance, which may be a dealbreaker for those in need of urgent and immediate care. The 988 line, which will create 5 call centers in Massachusetts alone, immediately connects any caller to a specialized counselor anywhere in the country.
This approach also aims to invest five million dollars into the research and development of new practice models for mental healthcare. The administration seeks to create a permanent source of funding for Certified Community Behavioral Health Clinics (CCBHCs), which provide mental health and substance abuse care to communities regardless of financial status. These clinics, which historically rely on individual government grants, break down insurance and payment barriers that usually prevent underserved communities from receiving adequate care.
The third approach, proposed by the plan,aims to bolster the workforce that can provide these services. CCBHCs primarily rely on a network of peer counselors and “paraprofessionals” who can provide mental health services and alleviate some of the stress put on doctors and clinicians. Currently, the extensive certification needed for providing mental health care creates a slim pool of clinicians, concentrating the strain onto a few individuals. The plan not only expects to provide $225 million in peer-counseling services, but also establish a standardized certification process for these paraprofessionals.
Additionally, the approach will allocate $700 million to training programs which make becoming a mental health professional more affordable and accessible. The funding will prioritize student loan repayment and focus on rural and underserved populations, creating a more geographically equal pool of professionals. The plan also aims to improve mental health and stigmatization resources for these professionals to avoid burnout and create a more resilient workforce.
The final approach, according to the plan, “is not a medical one, but a societal one.” It emphasizes the importance of creating a healthy mental environment for America’s youth through educational reform. Because over half of all mental illnesses manifest before the age of 14, the administration plans to allocate millions of dollars in funding to early-intervention programs for schools and families. The plan will also more effectively allocate school funding to learning programs that address educational struggles caused by the pandemic.
Because of the plan’s extensiveness, as well as the universal urgency of mental health in America, the plan has received bipartisan support and is expected to get through congress without much resistance. It has already received bipartisan senate hearings from the finance, education, labor, and pensions committees.
Despite its thoroughness and support, many still wonder whether it is enough. Although it is comprehensive, its sustainability is questionable. As discussed before, this is the first comprehensive mental health plan since the Carter administration. If the government bailed so easily on mental health 40 years ago, the Biden administration must ensure the future of this plan through sustainable funding plans. The country’s mental health is expected to deteriorate even more post-pandemic, so extensive support is essential.
As of now, though, the administration seems to have it. This is the first time in years mental health has been prioritized by both congress and the white house. With the help of the federal government, mental health care is transforming and providing a hopeful future for the well being of all Americans.