We are highlighting a few conversations from the Going Digital: Behavioral Health Tech Conference. We hosted a panel covering mental health policy featuring Pamela Greenberg, the President and CEO of the Association for Behavioral Health and Wellness, Charles “Chuck” Ingoglia, MSW, the President and CEO of the National Council for Mental Wellbeing, and Nathaniel Counts, the Senior Vice President of Behavioral Health Innovation at Mental Health America. We spoke about mental health policy in America and what they are excited about as we look beyond COVID-19.
Millions of Americans are affected by mental health each year. Provider shortages, long wait times, inadequate insurance coverage, and the trauma of the past few years have all accelerated a mental health crisis in this country. Unfortunately, 43% of Americans who needed mental health care and 43% of those who needed substance use care in the past year did not receive it, compared to 21% of those who needed primary care who did not receive it. Additionally, 61% of Americans think there are not enough providers trained to address issues related to race, ethnicity, sexual orientation, and socioeconomic status. There are many intertwined issues that make mental health policy in America complex.
Additionally, we are on the precipice of implementing 988 as the new number for suicide prevention and mental health crises, which people can call or text for immediate help. This number will route to the National Suicide Prevention Lifeline and goes live everywhere on July 16, 2022, one of the most significant mental health policy changes to take place in recent years.
Chuck mentions that the number one mental health concern he hears from people around the country is “the workforce shortage…the number one issue that organizations are confronting is a lack of available clinicians in order to deliver care, not just clinicians, but staff at all levels.” As leaders think about how to mitigate this provider shortage, many are thinking about how to maintain the expanded licensing rules in response to COVID-19 that have allowed mental health providers to treat patients across state lines through telehealth. As Chuck mentions, “How do we make it easier for individuals to practice in our area, so looking at regulatory and licensing barriers and burdens, getting rid of unnecessary paperwork or other administrative barriers that take people away from clinical care. And then how do we grow the pipeline?” Another way to expand access for people around the country is, as Pamela mentions, “we are advocating for coverage of licensed marriage and family therapists and clinical social workers and peers by Medicare.” Expanding coverage for therapists is a great tool to expand access.
In addition to expanding access to mental health services, it’s also important to meet people where they are and think about where people are trying to access care. One way of doing this is by expanding collaborative care, a model of combining primary care and behavioral health care. Nathaniel goes even further and says, “people mentioned collaborative care, and I think we’re also looking at access through schools and places, [trying to] meet people where they are.”
One of the main COVID-era policy changes that seem to have broad appeal is the expansion of telehealth access and the ability for providers to work across state lines. As Chuck explains, “there are many bills introduced in Congress around extending telehealth flexibility as there are members of Congress, and yet we seem to have had very little progress. Everybody wants to offer their support and… I think it’s gonna vary considerably also by payer type. Medicaid, Medicare, and private insurance all have different policies.” It’s promising that so many people are offering their support, but real action must be taken to solidify the expanded telehealth access.
Pamela continues, “the question is, for how long? An extension helps because it gives you a glide path if you need to make a change. But I think, Solome, you’re really trying to get at, are we going to keep these flexibilities?… A two-year extension is good, but we actually want them for longer than that.” The telehealth extension has been incredibly beneficial, but in order to make a real difference, it needs to be a permanent change.
Nathaniel mentions his excitement for new ways to engage different types of providers to create a community of support. He explains that he wants there to be a “broad array of providers, so peer support specialists, community health workers, a much deeper engagement of what this could look like. I think that will be critical both for improving access to care, but also engaging more people in the process of delivering care.” Engaging different types of behavioral health providers will expand access to care and could potentially create a more complete behavioral health system.
Pamela mentions that she’s excited to “see a future where we are paying for outcomes. Where we have some sort of alternative payment model [that] is much more common than a fee for service type model of payment.” Many speakers at the Going Digital: Behavioral Health Tech conference have mentioned the idea of having a different payment model that is outcome focused.
And finally, Chuck expresses excitement about the growing consensus around “strengthening the behavioral health safety net, ensuring there are standards, that there is a certain minimum level of expectation in terms of service delivery, care coordination capacity, partnership through certified behavioral health clinics… You should have access to effective evidence-based care no matter where you live.” We are seeing a growing call for effective, outcome-focused care across the nation.
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