Bipartisan push on mental health crisis made worse by COVID

COVID-19 has laid bare the need.

An analysis of government data found that about 4 in 10 adults reported symptoms of anxiety or depression in the first year of the pandemic, compared with about 1 in 10 before then. More than 100,000 people died from drug overdoses between May 2020 and April 2021, a record fatality rate, according to the Centers for Disease Control and Prevention.

Seeking to translate need into action, the Senate Finance Committee and the Senate Health, Education, Labor and Pensions Committee are working to produce bipartisan legislation this summer.

Finance Committee leaders have enlisted pairs of senators, one Democrat and one Republican, to develop policy ideas in five broad areas. The committee has jurisdiction over the major government health insurance programs, while the other committee oversees private insurance and public health.

“I think everyone understands the challenge of threading the needle in a 50-50 Senate,” said Senate Finance Committee Chairman Sen. Ron Wyden, D-Ore. But, he added, “the biggest takeaway for me is that the urgency is different … more people are being left behind.”

President Joe Biden appears to be on the same page.

It launched a comprehensive mental health and drug treatment plan as part of its State of the Union message. “Artificial distinctions between physical health and mental health are really not sustainable or relevant in the 21st century,” White House domestic policy adviser Susan Rice said in a recent speech at the Brookings Institution.

House committees are also working.

“There’s a very nonpartisan aspect to this, I wouldn’t even say bipartisan,” said policy expert Hannah Wesolowski of the National Alliance on Mental Illness. “The need for a rapid expansion of mental health services is one of the few issues where the parties can come together.”

It’s happening as the government plans to roll out 988, the new three-digit number for the National Suicide Prevention Lifeline, in July.

While lawmakers acknowledge the need for government action, the details remain contentious. The Democrats want bold blows. Republicans are wary of new federal mandates and seek to restrain costs.

“This committee has a strong track record of generating consensus-based bills,” Sen. Mike Crapo of Idaho, the top Republican on the Senate Finance Committee, said earlier this year. “I really think we can replicate that success here.”

A key player is elusive.

The office of Senate Republican Leader Mitch McConnell of Kentucky had no comment on efforts in that committee. If McConnell were to oppose the legislation, that would greatly complicate the prospects.

Nothing seems to have unsettled politicians more than a sharp rise in mental health problems among young people. Isolation and loss in the pandemic compounded the usual trials of coming of age. Emergency room visits for suspected suicide attempts are up, especially for teen girls, according to the CDC.

Since illicit drugs are routinely laced with potent fentanyl, new research shows a startling rise in overdose deaths among 14-18 year olds.

The Finance Committee is considering increased spending on school-based mental health services, broader use of telehealth for youth, and more financial support to train youth mental health workers. Young people from rural areas and minority communities have a harder time getting services. Biden’s plan calls for more money for school services, along with new safety measures for children on social media, another topic of interest on Capitol Hill.

A general focus for both the White House and lawmakers is the widely acknowledged shortage of mental health professionals. The plans would invest billions in developing the workforce by supporting training and education, but that could take years. There is talk of immediately increasing the supply of counselors by allowing a broader range of professionals, including marriage and family therapists, to bill government health programs.

There is also support for Certified Community Behavioral Health Clinics, a relatively new model of care that offers 24/7 services to people facing drug and mental health crises. The centers rely on peer counselors, often in recovery from their own addictions.

One glaring inconsistency lawmakers want to address is the coverage gap between mental health and physical conditions. US law requires parity, but the reality can be very different. Some insurers honor parity only on paper, maintaining “ghost networks” of mental health providers who won’t accept new patients: a dead end. Even Medicare falls short of parity. The program is limited to 190 days for inpatient psychiatric care.

Many Democrats would like to spell out the mental health coverage requirements for private health insurance. But Republicans do not support new mandates. A compromise could result in civil penalties for insurers who ignore legal obligations to cover mental health care.

One area where there doesn’t seem to be much disagreement is telehealth, which has been expanded during the pandemic. Video counseling and even voice-only sessions are becoming standard tools for mental health and drug treatment counseling. Making that coverage permanent would incur a cost. But legislators, particularly in rural areas, like the flexibility.

Although there is a clear momentum, that does not guarantee results in Congress. “I don’t know how it’s going to end,” said Reyna Taylor, chief of policy and advocacy for the National Council for Mental Wellness. “What I’m glad to see is all the communication that’s going on between the jurisdiction committees.”

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