Since 1949, May has been designated as Mental Health Awareness Month to raise the nation's awareness and educate the public about mental illness. However, being aware of and addressing the adverse effects of stress, anxiety, depression, and COVID-19 on mental and behavioral health are an ongoing process that we should recognize each day.
Former First Lady Michelle Obama once said, “At the root of the dilemma is the way we view mental health in this country. Whether an illness affects your heart, your leg, or your brain, it is still an illness and there should be no distinction.” Recognizing mental health entails the individual acknowledging it and seeking help, society not stigmatizing those suffering from mental and behavioral disorders, and the nation providing adequate resources and personnel to address the problem. ACP has been championing the need for the country to address mental health issues that have escalated during the COVID-19 pandemic, provide adequate resources for treatment, and improve compliance with laws on mental health parity.
In general, during election years little gets done unless it's related to spending bills. However, there has been bipartisan support in Congress to discuss mental health issues during and following the pandemic and to pass mental health legislation. ACP applauded the passage of the bipartisan Dr. Lorna Breen Health Care Provider Protection Act, H.R. 1667, signed into law on March 18. The law helps prevent and reduce incidence of suicide, mental health conditions, substance use disorders (SUDs), and long-term stress through grants, education, and awareness campaigns that will help reduce stigma and identify health care clinicians seeking assistance.
Several congressional committees, including the House Ways and Means Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee, have held hearings to address the state of mental health in America. These hearings are a first step in getting mental health legislation heard and passed. The Ways and Means hearing focused on the growing crisis and stigma of Americans talking about mental health problems, how COVID-19 increased the number of people expressing symptoms of anxiety and depressive disorder, and how the pandemic has affected the mental health of health care clinicians.
The HELP Committee hearing focused on the need to address the mental health and SUD crises that have been worsened by the COVID-19 pandemic, as well as the mental health crisis among youth and the growing challenges to getting care to communities of color, tribal communities, and people with disabilities. A common theme of both hearings was that additional resources are needed to combat depression and substance use. In our statements to these committees, ACP advocated for policies that would reduce the mental strain on physicians due to the pandemic, promote the integration of primary and behavioral health, expand the physician workforce and patient access to telehealth services, and improve oversight and enforcement of mental health parity laws.
ACP supports the integration of behavioral health care into primary care and encourages our members to address behavioral health issues within the limits of their competencies and resources. We urged Congress to pass legislation, H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act, that would provide grants through the Department of Health and Human Services to primary care physicians who choose to deliver behavioral health care through the Collaborative Care Model. This model, which allows patients to receive behavioral health care through their primary care doctor working collaboratively with a psychiatric consultant and a care manager to manage the clinical care of behavioral health patient caseloads, is one of several approaches and models for integrating effective care.
The pandemic only worsened persistent mental health and SUD workforce shortages. Before the pandemic, the Health Resources and Services Administration found that by 2025, shortages of seven different types of mental health clinicians were anticipated, numbering 10,000 and above in some fields of practice. In addition, before the coronavirus crisis, the Association of American Medical Colleges (AAMC) estimated that there would be a shortage of 21,400 to 55,200 primary care physicians by 2033.
To help ensure an adequate workforce to address mental health, ACP advocated for legislation that would help increase the number of physicians who can provide resources in this country. ACP supports several pieces of legislation in the 117th Congress to assist medical graduates and the overall physician workforce, including the following.
- The Resident Physician Shortage Reduction Act of 2021 (H.R. 2256/S. 834) is bipartisan legislation to alleviate the physician shortage by gradually providing 14,000 new Medicare-supported graduate medical education (GME) positions.
- The Resident Education Deferred Interest Act (H.R. 4122) would make it possible for residents to defer interest on their loans.
- The Conrad State 30 and Physician Access Reauthorization Act (H.R. 3541/S. 948) and the Healthcare Workforce Resilience Act (H.R. 2255/S. 1024) would help with medical student loan forgiveness and support international medical graduates (IMGs) and their families by temporarily easing immigration-related restrictions.
- The Student Loan Forgiveness for Frontline Health Workers Act (H.R. 2418) would assist frontline clinicians as they provide care during the pandemic.
ACP has encouraged Congress to extend the telehealth flexibilities adopted during the public health emergency for at least two years. This would improve patient access to clinicians who can address both mental and physical health problems that are needed as the country emerges from the pandemic. Congress recently extended some of these flexibilities, including covering audio-only services, removing geographic restrictions, and extending telehealth services to federally qualified health centers and rural health care clinics until 151 days after the public health emergency ends. ACP has supported S. 3593, the Telehealth Extension and Evaluation Act, and H.R. 6202, the Telehealth Extension Act of 2021, which includes a provision to expand telehealth services, including Medicare coverage of audio-only telehealth services between physicians and patients, for an additional two years after the public health emergency ends.
In our statements to Congress, we said that federal and state governments and other stakeholders should take action to reduce the inequities in mental health parity. One of the barriers to true integrated primary and behavioral health care is noncompliance by insurance plans for mental and SUD coverage parity as required by federal law. While federal law requires parity for mental health and SUD coverage, state and federal oversight and compliance efforts have not been consistent. ACP strongly recommends that federal and state governments, insurance regulators, payers, and other stakeholders address behavioral health insurance coverage gaps that remain as barriers to integrated care. This includes strengthening and enforcing relevant nondiscrimination laws, including oversight and compliance efforts by federal and state agencies.
Finally, ACP expressed support for the 988 Suicide Prevention Lifeline Implementation Act, which provides additional resources to launch and modernize a 988 mental health hotline to respond to the needs of individuals in crisis. The legislation also provides additional funding for states to implement new treatment programs for behavioral health and improves access to and coverage of mental health and SUD crisis response services. Bipartisan legislation to improve the nation's mental and behavioral health will be an ask at ACP's upcoming Leadership Day, which is scheduled for May 17-18.