Senators eye workforce fixes to improve mental health access

More needs to be done to bolster the health workforce in response to a growing mental health and substance use crisis that the pandemic worsened, senators said during a hearing on Capitol Hill Tuesday.

Lawmakers hope to pass legislation this year to address gaps in the behavioral healthcare system. A growing body of evidence shows the existing workforce is insufficient to meet the public's needs. The status quo especially underserves children and young adults at a time when the rate of deaths by suicide among those groups was rising even before COVID-19 surfaced.

"Our mental health and substance use disorder workforce is stretched too thin to meet the needs of our kids, let alone our communities at large," said Sen. Patty Murray (D-Wash.), chair of the Senate Health, Education, Labor and Pensions Committee. "If we keep stretching without taking action, something is going to break."

Lawmakers have not yet issued a mental health bill, but it will likely address barriers to care including high costs, the dearth of health professionals and health insurance practices that limit access.

Primary care and mental health need to be better integrated and telehealth usage should be broadened, senators said. Other congressional committees plan hearings on behavioral health this month.

More than 30% of U.S. adults with mental illnesses—and nearly half those with serious mental health conditions—reported unmet mental health needs in the previous year, according to survey findings the Substance Abuse and Mental Health Services Administration published in October. Costs, uncertainty about where to receive care, anxiety about being committed to psychiatric hospitals and worry about medications were among the obstacles survey respondents cited as barriers to treatment.

Nearly 130 million people live in parts of the country designated as mental healthcare professional shortage areas by the federal government.

"My hope is that we build out a package with a focus on mental health, we really key in on the workforce issues," Sen. Lisa Murkowski (R-Alaska.) said. "In all of our states, we are sorely, sorely lacking."

The lack of behavioral health specialists is overwhelming psychiatric hospitals and hospital emergency departments, Mitch Prinstein, chief science officer for the American Psychological Association, told the committee. "We haven't provided the workforce necessary to make sure we can provide outpatient treatment before we reach that crisis stage," he said.

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Part of the problem is behavioral health providers are least likely among specialists to accept Medicare and Medicaid, which clinicians attribute to low reimbursement rates. Provider and advocacy groups have called on Congress to address pay rates in the legislation.

Medicare should offer more student loan repayments help to psychological residents and require Medicare pay them for their work, something that is currently done for medical residents, Prinstein said.

Witnesses also asked for more funding for grants that enable community organizations to offer mental health services.

Senators and witnesses also pointed to insurance company practices as barriers to care, especially for people with serious mental illnesses.

"What happens in the emergency room, for example, we have to get prior authorization before sending someone to an inpatient psychiatric facility," said Michelle Durham, a professor of psychiatry and pediatrics at Boston Medical Center. That can take several hours, and if denied, doctors have to find alternatives, she said.

Health insurance companies are accused of not complying with mental health parity laws that require them to cover mental health on par with medical and surgical services. The federal government is currently investigating several insurance carriers about their adherence to those statutes.

Senators also promoted lifting restrictions on Medicare coverage of telehealth as a way to expand access to behavioral healthcare. Sen. Bill Cassidy (R-La.), a medical doctor who sits on the health committee, authored a bipartisan bill that would that enable Medicare beneficiaries to receive mental healthcare via telemedicine without having to visit a physical location, as the rules currently require.