In his first State of the Union, the President will outline a unity agenda consisting of policy where there has historically been support from both Republicans and Democrats, and call on Congress to send bills to his desk to deliver progress for the American people. As part of this unity agenda, he will announce a strategy to address our national mental health crisis.
Our country faces an unprecedented mental health crisis among people of all ages. Two out of five adults report symptoms of anxiety or depression. And, Black and Brown communities are disproportionately undertreated – even as their burden of mental illness has continued to rise. Even before the pandemic, rates of depression and anxiety were inching higher. But the grief, trauma, and physical isolation of the last two years have driven Americans to a breaking point.
Our youth have been particularly impacted as losses from COVID and disruptions in routines and relationships have led to increased social isolation, anxiety, and learning loss. More than half of parents express concern over their children’s mental well-being. An early study has found that students are about five months behind in math and four months behind in reading, compared with students prior to the pandemic. In 2019, one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40 percent from 2009. Emergency department visits for attempted suicide have risen 51 percent among adolescent girls.
This youth mental health crisis has been accentuated by large social media platforms, which for years have been conducting a national experiment on our children and using their data to keep them clicking—with enormous consequences. While technology platforms have improved our lives in some ways, there is mounting evidence that social media is harmful to many kids’ and teens’ mental health, well-being, and development. As the Surgeon-General has said, “when not deployed responsibly and safely, these tools can pit us against each other, reinforce negative behaviors like bullying and exclusion, and undermine the safe and supportive environments young people need and deserve.” In the State of the Union, the President will call on Congress to strengthen privacy protections, ban targeted advertising to children, and demand technology companies stop collecting personal data on our children.
Strengthen System Capacity
At the center of our national mental health crisis is a severe shortage of behavioral health providers. More than one-third of Americans live in designated Mental Health Professional Shortage Areas, communities that have fewer mental health providers than the minimum their level of population would need. Even outside of these shortage areas, the fragmentation of the current system makes it hard for mental health providers to meet people where they are. We must dramatically expand the supply, diversity, and cultural competency of our mental health and substance use disorder workforce – from psychiatrists to psychologists, peers to paraprofessionals – and increase both opportunity and incentive for them to practice in areas of highest need. Our crisis response infrastructure must also be strengthened to ensure that those facing acute behavioral health challenges can be seamlessly connected to necessary services. We will:
- Invest in proven programs that bring providers into behavioral health. The President’s FY23 budget will invest $700 million in programs – like the National Health Service Corps, Behavioral Health Workforce Education and Training Program, and the Minority Fellowship Program – that provide training, access to scholarships and loan repayment to mental health and substance use disorder clinicians committed to practicing in rural and other underserved communities. These major new investments will both expand the pipeline of behavioral health providers and improve their geographic distribution to target areas with the greatest unmet need.
- Pilot new approaches to train a diverse group of paraprofessionals. Doctors, nurses, and other clinicians cannot do this work alone. In the fall of 2022, HHS expects to award over $225 million in training programs to increase the number of community health workers and other health support workers providing services, including behavioral health support, in underserved communities. The President’s FY23 budget will also propose major new multi-year funding to develop provider capacity and support mental health transformation.
- Build a national certification program for peer specialists. The Biden-Harris Administration will convene stakeholders, launch development, and support implementation of a national certified peer specialist certification program, which will accelerate universal adoption, recognition, and integration of the peer mental health workforce across all elements of the health care system.
- Promote the mental well-being of our frontline health workforce. Three-quarters of frontline health care workers report burnout, while more than half say they lack adequate supports to cope. The Administration has already dedicated $103 million in American Rescue Plan funding to address burnout and strengthen resiliency among health care workers. The President will strengthen this commitment by signing the bipartisan Dr. Lorna Breen Health Care Provider Protection Act into law, which will invest $135 million over three years into training health care providers on suicide prevention and behavioral health while launching an awareness campaign to address stigmatization, promote help-seeking and self-care among this workforce. In addition, HHS will continue grant programs to support health systems and provider groups to prevent burnout, relieve workplace stressors, administer stress first aid, and increase access to high-quality mental health care for the frontline health care workforce.
Connect Americans to Care
Less than half of Americans with mental health conditions receive treatment. The average delay from the onset of mental health symptoms to treatment is 11 years. Too often, costs prevent people from accessing care far. At the same time, those with mental illness are often misunderstood, mistreated, mislabeled, and misdirected to services. It is imperative that we promote better pathways to care and make it as easy as possible for all Americans with behavioral health needs – including common and pervasive conditions like anxiety and depression – to access the resources that will improve their well-being. We must fight to ensure that every American can access mental health and substance use disorder care through their insurance coverage, while integrating mental health services and supports into a variety of other settings, online and in the community. The Biden-Harris Administration will:
- Expand and strengthen parity. The 2008 Mental Health Parity and Addiction Equity Act called for mental health care benefits to be covered at the same level as physical health care benefits. The President’s fiscal year 2023 (FY23) budget will propose that all health plans cover robust behavioral health services with an adequate network of providers, including three behavioral health visits each year without cost-sharing.
- Integrate mental health and substance use treatment into primary care settings. Equipping primary care providers with the tools to identify, treat, and manage behavioral health conditions is a proven approach for delivering quality mental health and substance use care, particularly for individuals with depression. To facilitate adoption of these models, the President’s FY23 budget will double funding for primary and behavioral health integration programs. In addition, using existing authority, the Department of Health and Human Services (HHS) will test payment models that support the delivery of whole-person care through behavioral health integration and authorize Medicaid reimbursement of inter-professional consultations so that primary care providers can consult with a specialist and provide needed care for patients.
- Improve veterans’ access to same-day mental health care. Veterans are at higher risk for mental health and substance use challenges than the general population. Increasing their access to quality mental health care is the first step to closing this disparity. The Department of Veterans Affairs (VA) will reduce barriers to mental health access by fully implementing their Primary Care Mental Health Integration and Behavioral Health Interdisciplinary Program, which connect veterans to same-day mental health care and improve the integration of these services into primary care settings.