Although in recent months discussions about mental health have been associated with the impacts of COVID-19, Americans were already struggling with mental illness prior to the pandemic. Nineteen percent of adults experience symptoms of a mental illness, and almost 10 percent of youth struggle with “severe major depression.” The consequent isolation of the pandemic has only exacerbated the nation’s mental health crisis, with the Centers for Disease Control reporting that one in four young adults have had suicidal thoughts during the pandemic.
These recent societal changes have drawn attention to systemic problems already plaguing American society. Many of these issues, including that of mental health, have only worsened following the onset of the pandemic. America’s mental health crisis has necessitated legislative action for years. The new administration just may answer that decades-long call.
Desires for Change
The Biden administration has voiced intentions to expand the Affordable Care Act so that more Americans have effective health care. The administration has also emphasized that broader health issues, like addressing the opioid crisis through decriminalization efforts and increasing addiction treatment access, will be priorities. These policy goals build a foundation for hope towards the possibility of legislative progress during President Biden’s term, particularly regarding mental health. Considering the election of President Biden and the Democrat’s newfound congressional control, many anticipate that legislation to address mental health needs will be pushed over the next four years.
Addressing these mental health necessities has proven to be a bipartisan cause for young Americans. The Spring 2020 Harvard Youth Poll found that the desire for increased government action to improve mental health and healthcare services among young Americans (aged 18-29) crosses party lines. Notably, 84% of Democrats, 74% of those unaffiliated, and 64% of Republicans expressed a preference for greater government policy to improve mental health care services. This signifies the widespread public acknowledgement that increased federal action is necessary to address the mental wellbeing of Americans.
Devastating Disparities
Despite the fact that 92% of Americans had healthcare coverage as of 2019, a multitude of obstacles still prevent many individuals from receiving critical mental health treatment. The diverse disparities regarding access and affordability must be addressed legislatively in order for all Americans to be able to receive the treatment they need. The National Institute of Mental Health reported that “more than 60% of rural Americans live in mental health professional shortage areas”, and overall less than 10 percent of psychologists and psychiatrists work in non-metropolitan areas. This shortage has created a geographical disparity leaving individuals in rural communities either without care or having to travel long distances for treatment from mental health professionals already overwhelmed with high demand.
Increased mental health parity regarding healthcare coverage and affordability are also critical legislative needs. Despite federal legislation such as the 2008 Mental Health Parity and Addiction Equity Act, which ensures that individuals with healthcare can receive covered mental health services, there still are numerous loopholes that insurance companies have been able to exploit. Through such loopholes, including specified standards to determine what care is deemed medically necessary, insurance companies are able to limit how much treatment they cover. Some insurance companies may only cover a certain number of psychotherapy appointments per year, may require cheaper alternatives to be tried before a more effective (although often more expensive) treatment can be covered, or may have high deductibles. Or for instance, an insurance company might require the patient to have a certain Body Mass Index in order to actually cover inpatient eating disorder treatments.
Yet another problem that contributes to a lack of affordability is that mental health and addiction services are more likely to be out-of-network and therefore more expensive. In 2017, a report by the actuarial firm Milliman found that behavioral office visits were five times more likely to be out-of-network than primary care provider visits.
Will Needs Translate into Policy?
It is imperative that these disparities are addressed in the coming years by the Biden administration. In an interview with Mental Health For US, Biden’s team noted goals geared towards improving mental health care. This included developing community college and health center partnerships to encourage more individuals to pursue a career in the field and creating primary care training programs so providers are able to better serve struggling patients. They also voiced a goal of expanding federal loan and grant programs to fund and build more mental health clinics in rural communities. If followed through, these goals could greatly improve the accessibility of mental health services for rural Americans.
Further enforcement of mental health care insurance parity policies must also be implemented, and federal standards of what qualifies as essential mental health care must be established. Without these standards and proper methods of enforcement, insurance companies will continue to selectively determine which services are essential and must be covered. Although Biden’s official platform has expressed intentions to further enforce the Mental Health Parity and Addiction Act of 2008, his team has not explicitly addressed the creation of more specific federal standards to go with this.
Biden has also addressed a desire to ensure everyone has access to premium, free public health care, but his team has not taken a stance on the impacts high mental health deductibles have had on the American people. His administration has yet to voice any intention to address out-of-network mental health care affordability.
Given these stances President Biden has advocated for throughout his campaign, it can be expected that his administration will take steps toward bettering the accessibility and affordability of mental health care services. Despite this, the extent and efficacy of these changes remain to be known. Americans need effective legislative policy to counteract the manifold issues standing in the way of much-needed mental health services. Without it, we can only expect the disparities to continue, and likely worsen.
Image by Tim Mossholder is licensed under the Unsplash License.
