Biden plan would address chronic gaps in mental health care

Unveiled as part of his State of the Union address, Biden’s plan aims to close the chronic care gap in the United States between illnesses of the body and those of the mind. Health insurance plans should cover three mental health visits per year at no additional cost to patients.

But for such a big move, Biden needs to win the support of lawmakers in both parties. Mental health and addiction are linked issues in every congressional district, with rising rates of depression and anxiety amid the coronavirus pandemic. Some senior Republicans have expressed principled support for the government’s action, but it’s too early to tell where they will end up.

“And let’s get all Americans the mental health services they need,” Biden said in his speech Tuesday night. “More people can ask 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 for nearly 25 years, said Hannah Wesolowski of the National Alliance on Mental Illness. “This represents an important program that impacts every American,” Wesolowski said, referring to Biden’s plan.

For months, lawmakers have shown interest. In the Senate, the Finance Committee and the Committee on Health, Education, Labor and Pensions held bipartisan hearings. In the House, the Energy and Commerce Committee and the Ways and Means Committee also held hearings. These four panels do most of Congress’ work on health care.

Such sustained attention is rare, say supporters. “I can’t remember a time when every jurisdictional committee held mental health hearings,” said Charles Ingoglia, president of the National Council for Mental Wellbeing. “Sometimes we’ve gone years between mental health hearings.”

Now the White House is trying to drag lawmakers out, weaving elements of the Capitol Hill debate into an ambitious package and adding its own priorities.

“I think he pointed out a few key areas where we have good work to do,” Republican Senator Lisa Murkowski of Alaska said in her reaction to Biden’s speech.

“He talked about the issue of mental health and what remains to be done,” she added.

Biden’s plan includes a particular focus on school-aged youth. Children adapted differently to remote learning in 2020, the first year of the pandemic, and those who lacked technological resources risked falling behind. The isolation was hard on the teenagers. The White House has said Biden’s next budget will seek $1 billion to help schools hire counselors, psychologists and other health workers. The budget will also propose $5 million for research into the effects of social media on children. Supporting bipartisan sentiment in Congress, Biden calls for limiting the ability of social media companies to collect data on children.

Health insurance plan coverage policies would also receive more attention. The White House says Biden’s budget will ask insurers to cover “robust behavioral health services with an adequate network of providers.” Three free behavioral health visits per year would be part of this.

In July, the government will launch a new suicide prevention hotline — 988. Biden’s plan includes nearly $700 million to bolster local crisis centers that can handle aftercare. The idea is to address basics such as hours of operation and staffing in preparation for an expected increase in calls when three-digit dialing comes into effect.

The plan also includes making permanent an experimental program that has expanded access to 24/7 mental health and addictions services. It’s called Certified Community Behavioral Health Clinics, modeled on federally funded community health centers that have become a base for basic medical care in low-income communities. Behavioral health centers rely on peer counselors who have survived their own trauma to lift others out of crisis. The approach enjoys bipartisan support.

Biden’s basic plan is an effort to increase the number of mental health professionals by committing $700 million to programs that provide training, scholarships and educational loan repayment. Expanding the mental health workforce was a focus of the Senate Finance Committee hearings. Biden also wants to set professional standards for peer advisers, filling an emerging frontline role.

If it all comes together, Dr. Megan Ranney says she would expect to see some relief for the emergency rooms where she practices in Providence, Rhode Island. People with mental health and addiction issues would have more ways to get help before things spiral out of control and police or a relative have to take them to hospital as a last resort.

“Crisis doesn’t happen overnight,” Ranney said. “It’s usually something that’s been brewing for a while. And then, when it gets bad enough, they have nowhere to go and they end up spending days or even weeks in the emergency room.

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