Improving Behavioral Health | Regulatory Review

One in five American adults has a clinically significant mental or addiction disorder. In recent years, the prevalence and intensity of these conditions have increased among children and adolescents, a trend exacerbated by the COVID-19 pandemic.

Located within the United States Department of Health and Human Services (HHS), the Substance Abuse and Mental Health Services Administration (SAMHSA) aims to improve the quality and availability of treatment and rehabilitation services for behavioral health issues. Although SAMHSA oversees the enforcement of behavioral health provisions in a range of federal laws and regulations, it delegates authority for many of its programs and services to states, tribes, territories, and local and community organizations. Despite this widespread decentralization, gaps in behavioral health care persist.

With more than 46 million undiagnosed behavioral health cases and many millions more without access to quality, assured care, the United States faces serious and complex challenges in providing adequate services. behavioral health. Individuals report limited insurance coverage, an undersized mental health workforce, lack of available treatment, disconnect between primary care and behavioral health systems, and insufficient resources to cover treatment as barriers to accessing assistance. Other barriers to care include social stigma, prejudice, and discrimination against people with behavioral health conditions.

Because of these systemic barriers, racial and ethnic minorities, as well as underresourced and vulnerable populations experience mental health issues at higher rates. To address these disparities, policymakers, practitioners, and community advocates are turning to behavioral health integration—which would allow primary care providers to deliver behavioral health care—the expansion of Medicaid, and the behavioral workforce growth, among other means. The delivery of mental health care and addiction treatment via telehealth services has also increased since the onset of the COVID-19 pandemic, which has highlighted the scarcity and inequity of behavioral health resources.

In this week’s Saturday seminar, we feature the work of experts discussing regulatory solutions to the behavioral health crisis.

• The United States faces a shortage of licensed behavioral health care providers as rates of mental illness and addiction in the country rise, explain Michele Gilbert and several co-authors in a report for the Bipartisan Policy Center. They note that the limited availability of providers who participate in insurance networks limits the availability of treatment, especially for marginalized communities who cannot afford treatment out of pocket. To close this access gap, policymakers and legislators should cover behavioral health specialists under Medicare and Medicaid and institute a pipeline program to increase their licensing, Gilbert and his co-authors argue. Additionally, they recommend that the Centers for Medicare and Medicaid Services leverage underutilized community resources by establishing a demonstration program for funding community-initiated care.
• In a recent article published in Psychiatric services, Amy G. Bonilla of the Veterans Health Administration and several co-authors investigated the relationship between the presence of mental health personnel in primary care settings and mental health treatment rates. Bonilla and coauthors found that low-income, uninsured patients who saw a physician in health centers with at least one full-time mental health staff member had a higher likelihood of receiving mental health treatment by compared to patients in unstaffed health centres. In light of their findings, they argue that employing mental health staff in health centers can help low-income and uninsured patients access treatment. They suggest that SAMHSA’s Integrated Solutions Center and the Health Resources and Services Administration provide “financial incentives” and “technical assistance” to encourage health centers to employ mental health staff.
• In an article published in Mental Health Administration and Policy and Mental Health Services Research, Elizabeth M. Stone of the Johns Hopkins Bloomberg School of Public Health and several co-authors examine the barriers to implementing behavioral health homes in Maryland. Behavioral health homes, explain Stone and his co-authors, are health care programs that focus on integrating mental health and primary care services for patients with serious mental illnesses. In these programs, specialized mental health services coordinate with primary care providers to provide physical care to their patients, they describe. They find that barriers to implementing these programs include staffing shortages and coordination with external providers. To overcome these challenges, Stone and his co-authors argue for the establishment of financial incentives to encourage key providers to coordinate with behavioral health houses. They also advise regulators to develop policies focused on holding behavioral health homes “accountable for participant outcomes” to promote quality care for people with high needs.
• In an article published in Temple Law Review, Taleed El-Sabawi of Elon University School of Law and Jennifer J. Carroll of Elon University propose the Model Behavioral Health Response Team Act to help policymakers create new institutions to address housing, mental health and addiction crises. The central goal of the model law, according to El-Sabawi and Carroll, is to develop crisis call centers and behavioral health crisis response teams that would replace state and local reliance on law enforcement and police institutions. El-Sabawi and Carroll point out that this model law must expressly authorize local governments to establish these programs without law enforcement staffing, in part because such teams are not intended to facilitate the institutionalization or incarceration. The model law would therefore avoid reproducing historically racist institutions by preventing the “co-optation” of public health policy by law enforcement, argue El-Sabawi and Carroll.
• In a report released by the Behavioral Health Workforce Advisory Committee, experts explain that HHS is seeking to increase the number of professions eligible for certification through the alternative substance use disorder (SUD) training pathway. The committee describes how HHS created this training path for new licensed mental health practitioners, including social workers, psychologists and physicians, after finding that there were not enough providers with a double certification in mental health and in the SOUTH to meet the needs of populations suffering from several conditions. . Despite the successful use of the SUD alternative training route, the committee argues that SUD accreditation regulations have created significant barriers, such as high fees, that necessitate exploring other accreditation models.
• In a report for The Century Foundation, Jamila Taylor of the National Association of Women, Infants and Children (WIC) explains the danger of reducing Medicaid coverage for millions of low-income people, especially black women, during pregnancy and the postpartum period. In 2020, Medicaid coverage ended sixty days after birth, depriving mothers of essential health services, including mental and behavioral care for postpartum depression, Taylor argues. She argues that by losing health insurance so early, mothers caring for newborns while struggling to get medical care for their own behavioral health issues become especially vulnerable to negative health outcomes, such as chronic diseases and mortality. Taylor recommends expanding Medicaid coverage in every state to one year after birth to promote maternal behavioral health outcomes.