Funding barriers threaten 21st Century Cures Act's success in treating mental health

Federal lawmakers on Wednesday said their legislative attempts to improve the nation's mental healthcare system is unfulfilled because of a lack of of funding.

The 21st Century Cures Act was signed into law one year ago this month. The far-reaching law included provisions to create a new HHS assistant secretary position to oversee mental health and substance abuse disorder treatment services and ensure compliance with mental health parity rules; it also mandated funding for mental health block grants.

But at a Senate Health, Education, Labor and Pensions Committee hearing Wednesday, lawmakers acknowledged those goals have hit major hurdles.

"A law is not worth the paper it's written on if it's not implemented properly," committee Chairman Sen. Lamar Alexander (R-Tenn.) said. "I intend to ensure the 21st Century Cures Act is fully and properly implemented."

But Dr. Elinore McCance-Katz, the Substance Abuse and Mental Health Services Administration's first assistant secretary for Mental Health and Substance Use, said the agency has been hard at work identifying policy changes.

McCance-Katz said a committee established by the 21st Century Cures Act would this week release policy recommendations.

McCance-Katz said the bill "provided a blueprint" for behavioral health needs.

But movement on many aspects of the Cures Act have either been slow or stalled. Most notable is evidence that barriers still exist for many patients toward achieving mental health parity. A recent survey by the National Alliance on Mental Illness found that nearly 35% of respondents with private insurance had trouble finding a mental health therapist who would accept their insurance. Patients were more likely to pay out of pocket for their behavioral healthcare than when they visited a medical specialist.

The law called for Congress to allocate $1 billion over the next two years to support state healthcare efforts. About half of the funding has been distributed. But lawmakers in several of the hardest-hit areas of the country claim the money is unfairly sent to more populous states.

When asked whether SAMHSA would consider changing how the money is distributed, McCance-Katz said that would require states to re-apply and therefore was not something the agency was not looking to pursue.

Sen. Sheldon Whitehouse, a Democrat from Rhode Island, which had the fifth-highest overdose death rate in the nation in 2015, rebuked the statement.

"So for the sake of the process convenience, all the high-intensity states are going to pay the price?" Whitehouse asked.

Congress has delayed authorizing much of the 21st Century Cures Act funds as lawmakers work on passing a new budget. Some of those measures include $30 million for suicide prevention, $5 million to address maternal depression, and $12 million to expand crisis response.

"Congress has an awful habit of talking a really good game on mental health and addiction but then never being willing to actually meet our rhetoric with resources," Sen. Chris Murphy (D-Conn.) said during the hearing. Murphy was one of chief architects of the Senate version of the mental health provisions included in the law.

As GOP lawmakers look to cut domestic spending, behavioral health and substance abuse services will likely be on the chopping block.

President Donald Trump already slashed some funding. His fiscal 2018 budget calls for Community Mental Health Block Grant funding to be cut from $532 million in 2017 to $416 million next year.

Correction: Sen. Sheldon Whitehouse of Rhode Island is a Democrat. An earlier version of this story gave the incorrect party.

An edited version of this story can also be found in Modern Healthcare's Dec. 18 print edition.