President Joe Biden’s new plan to expand mental health and drug abuse treatment would pour hundreds of millions of dollars into suicide prevention, mental health services for youth, and community clinics providing 24/7 access to people in crisis.
Unveiled as part of his State of the Union speech, Biden’s plan seeks to shrink America’s chronic gap in care between diseases of the body and those of the mind. Health insurance plans would have to cover three mental health visits a year at no added cost to patients.
But for such a big move, Biden must win backing from lawmakers of both parties. Mental health and substance abuse are linked problems in every congressional district, with rising rates of depression and anxiety in the coronavirus pandemic. Some senior Republicans have expressed support in principle for government action, but it’s too early to say where they’ll end up.
“And let’s get all Americans the mental health services they need,” Biden said in his speech Tuesday night. “More people can turn for help. And full parity between physical and mental health care if we treat it that way in our insurance.” That’s been the unrealized goal of federal health care laws dating back nearly 25 years, said Hannah Wesolowski of the National Alliance on Mental Illness. “This represents an important agenda that impacts every American,” said Wesolowski, referring to Biden’s plan. For months, lawmakers have been signalling interest. In the Senate, the Finance Committee and the Health, Education, Labor, and Pensions Committee have held hearings with a bipartisan focus. In the House, the Energy and Commerce Committee and the Ways and Means Committee also held hearings. Those four panels do most of the work of Congress on health care. Such sustained attention is rare, advocates say. “I cannot remember a time when every committee of jurisdiction has held hearings on mental health,” said Charles Ingoglia, president of the National Council for Mental Wellbeing. “Sometimes we have gone years between dedicated hearings on mental health.” Now the White House is trying to draw lawmakers out, weaving strands from the Capitol Hill debate into an ambitious package, and adding its own priorities.
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“I think he highlighted a few key areas where we have good work to do,” Republican Sen. Lisa Murkowski of Alaska said in her reaction to Biden’s speech. “He spoke to the issue of mental health and what more needs to be done,” she added.
Biden’s plan includes a special focus on school-age youth. Kids adapted differently to remote learning in 2020, the first year of the pandemic, and those who lacked technology resources were in danger of falling behind. Isolation was hard on teenagers. The White House says Biden’s upcoming budget will call for $1 billion to help schools hire counselors, psychologists and other health workers. The budget will also propose $5 million for research on the effects of social media on kids. Seconding bipartisan sentiment in Congress, Biden is calling for curbs on social media companies’ ability to collect data on children.
The coverage policies of health insurance plans would also get closer attention. The White House says Biden’s budget will call for insurers to cover “robust behavioral health services with an adequate network of providers.” Three free behavioral health visits a year would be part of it.
This July, the government will launch a new suicide prevention hotline number — 988. Biden’s plan calls for nearly $700 million to bolster local crisis centers that can handle follow-up. The idea is to address such basics as operating hours and staffing in preparation for an expected increase in calls when three-digit dialing takes effect.
The plan also calls for making permanent an experimental program that has expanded access to 24/7 mental health and substance abuse services. It’s called Certified Community Behavioral Health Clinics, modelled on federally funded community health centres that have become a foundation for basic medical care in low-income communities. The behavioral health centres rely on peer counsellors who have survived their own trauma to pull others out of crisis. The approach has bipartisan support. Undergirding Biden’s plan is an effort to increase the number of mental health professionals by devoting $700 million to programs that provide training, scholarships and educational loan repayment. Expanding the mental health workforce was a focus of Senate Finance Committee hearings. Biden also wants to establish professional standards for peer counsellors, filling an emerging frontline role.
If it all comes together, Dr. Megan Ranney says she would expect to see relief for the emergency rooms where she practices in Providence, Rhode Island. People with mental health and substance abuse problems would have more ways to get help before things escalate out of control and the police or a relative have to bring them to the hospital as a last resort.
“The crisis doesn’t happen overnight,” said Ranney. “It’s usually something that has been smoldering for a while. And then when it does get bad enough, they have nowhere to go and they end up spending days to weeks in the emergency department.”