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Mental Health Awareness Month – What You Need To Know

Behavioral Health Workforce

At the center of our national mental health crisis is a severe shortage of behavioral health-trained providers. Over one-third of Americans live in designated Mental Health Professional Shortage Areas, areas that have fewer mental health providers than the minimum their population would need. The historical challenges in recruiting and retaining these and other essential health workers have been exacerbated by the COVID-19 pandemic. Recent studies indicate elevated levels of burnout among health care workers, along with depression and other mental health challenges.

What We’ve Accomplished
American Rescue Plan

  • Awarded $22 million through the Health Resources and Services Administration (HRSA) to grow the behavioral health workforce and place trainees at health centers and other community-based settings, where behavioral health services are most urgently needed.
  • Awarded $1 billion total in National Health Service Corps, Nurse Corps, and Substance Use Disorder Treatment and Recovery Loan Repayment Program, achieving the largest field strength in history for these loan repayment and scholarship programs, with more than 11,900 members working in behavioral health disciplines.
  • Awarded $103 million to 45 health care organizations to reduce health care provider burnout and support health care workers’ mental health and wellness.
  • Announced the availability of $226.5 million to launch the Community Health Worker (CHW) Training Program, which will increase the number of CHWs who play a critical role in connecting people to care, including mental health and substance use disorder prevention, treatment, and recovery services.
  • Authorized enhanced federal reimbursement of certain Medicaid home and community-based services, including behavioral health services; encouraged – PDF states to invest these funds into enhancing and strengthening behavioral health services, including through temporary rate increases for behavioral health providers.

Expanding and Strengthening the Behavioral Health Workforce

  • Congress provided significant behavioral health workforce investments in FY 2022 appropriations, including nearly $225 million for behavioral health professional and paraprofessional education.
  • SAMHSA is supporting the development of a Behavioral Health Workforce Tracker exit disclaimer icon, a new database of over 1 million behavioral health providers. The tracker will allow users to visualize the availability of behavioral health providers by geography, provider type, and Medicaid acceptance status.
  • The Centers for Disease Control and Prevention (CDC) is funding the Association of State and Territorial Health Officials’ Public Health, Equity, Resilience, and Opportunity Program (PH-HERO exit disclaimer icon), which aims to address workforce burnout, resiliency, and morale.

Crisis Care And Suicide Prevention

Suicide remains the second leading cause of death among youth aged 10 to 14 and adults aged 24 to 35. While suicide was responsible for nearly 46,000 deaths in 2020, many more people attempt or have serious thoughts of suicide – critical risk factors for future suicide. (Centers for Disease Control and Prevention (CDC)).

Crisis services are an integral component of addressing behavioral health challenges in communities across the nation.  A fully developed crisis response system – PDF is responsive any time and any place, providing a person in a mental health or substance use crisis with someone to talk to, someone to respond, and a safe place to go for evaluation, stabilization and follow up. Like a physical health crisis, a mental health or substance use crisis can be devastating for individuals, families, caregivers, and communities.

What We’ve Accomplished
American Rescue Plan

  • Established a new state option for Medicaid coverage of qualifying community-based mobile crisis intervention services for individuals experiencing a behavioral health crisis. The Centers for Medicare & Medicaid Services has distributed $15 million in planning grants for states to develop such programs.
    • As of April 1, 2022, states implementing a qualified mobile crisis intervention option are eligible – PDF for a temporarily enhanced matching rate.
  • Awarded Garrett Lee Smith Campus Suicide Prevention grants in June 2021, which included over $700,000 in ARP funds to expand the program’s reach to an additional eight campuses. Also announced funding for the Garrett Lee Smith State/Tribal Suicide Prevention and Early Intervention grants.
  • In preparation for the July 2022 launch of 988, the new three digit code for the National Suicide Prevention Lifeline, SAMHSA awarded $180 million from the ARP which included $75 million to strengthen and expand existing Lifeline operations, infrastructure, and the centralized response and backup center capacity; and $105 million to increase local, regional, and state crisis call center capacity and to build the workforce necessary to enhance local text and chat response.

Expanding and Strengthening Crisis Care Services and Suicide Prevention

  • In March 2022, the President signed the Lorna Breen Health Care Provider Protection Act into law, which will invest $135 million over 3 years towards improving mental health among health care providers, including suicide prevention efforts.
  • Bright Futures, led by HRSA and the American Academy of Pediatrics, updated its national guidelines in 2022, which included recommending universal screening for suicide risk for individuals ages 12 to 21.
  • CDC announced new Comprehensive Suicide Prevention Program funding to support implementation and evaluation of a comprehensive public health approach to suicide prevention with attention to disproportionately affected populations (e.g. veterans, rural communities, tribal, LGBTQ, and youth).
  • Congress provided FY 2022 resources to bolster the nation’s system of crisis care including $5 million for a new 988 coordination office to streamline implementation, and $10 million for a Mental Health Crisis Response Partnership Pilot Program to help communities create mobile crisis response teams.
  • The Community Mental Health Services Block Grant includes a 5 percent set-aside to support state crisis care systems including mobile crisis units, short-term residential crisis stabilization beds, evidence-based protocols for delivering services to individuals with suicide risk, and state/regional crisis call centers.

Mental Health Parity

Health plans and health insurance issuers that offer mental health and substance use disorder (SUD) benefits must provide those benefits comparable to their coverage for general medical and surgical care. However, parity is only achieved if it is implemented well, consumers and providers understand how it works, and there is appropriate oversight. HHS is committed to working with our federal partners to achieve parity and hold health plans and issuers accountable for delivering care that does not have arbitrary or discriminatory limits on coverage for mental health and substance use conditions.

The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) generally requires that the financial requirements and treatment limitations – such as copayments and prior authorization requirements – imposed by a group health plan or health insurance issuer on mental health or SUD benefits cannot be more restrictive than the predominant financial requirements and treatment limitations that apply to medical and surgical benefits.

Expanding and Strengthening Parity

  • The Affordable Care Act extended parity protections to individual and small group health insurance policies, and the Centers for Medicare & Medicaid Services (CMS) has also taken action to implement parity requirements for Medicaid managed care programs, Medicaid alternative benefit plans, and the Children’s Health Insurance Program, as required by federal law.
  • In January 2022, HHS and the Departments of Labor and the Treasury (Tri-Departments) jointly issued – PDF a Report to Congress with recommendations for improving MHPAEA that would improve enforcement and facilitate greater access to mental health and SUD benefits. The report also suggests that permanently expanding access to telehealth and remote care services could improve implementation of the parity law.
  • Under the Biden-Harris Administration, CMS has increased – PDF its MHPAEA enforcement activities in the individual and fully insured group markets in states where it has enforcement authority, and over non-Federal governmental plans in all states.
  • The HHS FY 2022 Regulatory Agenda includes a planned proposed rule – PDF on parity, which would clarify group health plans and health insurance issuers’ obligations under the MHPAEA and promote compliance.
  • The Substance Abuse and Mental Health Services Administration (SAMHSA), with its partners at CMS and the Tri-Departments, has released new resources to provide patients, families, and state regulators a better understanding of federal parity protections and how those laws benefit and apply to them:

Behavioral and Primary Health Care Integration

Behavioral health and primary care integration strategies have the potential to improve overall health and quality of care. The medical community now widely considers integrating behavioral health care with primary care an effective strategy for improving outcomes for millions of Americans with behavioral health conditions. HHS supports programs and practices that train providers and teams to integrate care, promote the use of telehealth, and remove payment and delivery barriers.

What We’ve Accomplished
American Rescue Plan

  • Distributed nearly $11 million in August 2021 to expand Pediatric Mental Health Care Access by supporting telehealth service integration. These teams provide tele-consultation, training, technical assistance, and care coordination for pediatric primary care and other providers to diagnose, treat, and refer children and youth with mental health conditions and substance use disorders (SUD).
  • Established for the first time a state plan option for states to extend postpartum coverage for 12 months after pregnancy, which could substantially improve access to mental health services. As of April 1, the Centers for Medicare & Medicaid Services (CMS) has approved postpartum coverage extensions in several states and is working with another eleven states and D.C.

Promoting Primary Care Integration

  • Congress provided significant resources through FY 2022 Appropriations for programs that seek to integrate behavioral and primary health care, and also provided a 151 day extension of certain telehealth policies under Medicare, including flexibilities on delivering telehealth services across state lines and authorization prescribing of controlled substances via telehealth without the need for an in-person medical evaluation.
  • Bright Futures, a HRSA partnership with the American Academy of Pediatrics, made 2022 updates to its national guidelines for pediatric care, including adding universal screening for suicide risk to the current guidance for individuals ages 12 to 21, and new guidance for behavioral, social and emotional screening.
  • As part of its Behavioral Health Strategy, CMS will test payment models that support the delivery of whole-person care through behavioral health integration and will propose to authorize Medicaid reimbursement of inter-professional consultations so that primary care providers can consult with a specialist and provide needed care for patients.
  • Across several cohorts, the SAMHSA Primary and Behavioral Health Care Integration program has supported the coordination and integration of primary care services and publicly funded community behavioral health services for individuals served by the public mental health system.

Substance Use Disorder and Overdose Prevention

The crisis of opioid misuse, addiction, and overdose in the United States is a rapidly evolving and urgent public health emergency. Overdose deaths were rising prior to the COVID-19 pandemic, but in 2020 there was a 30% increase in overdose deaths, with nearly 92,000 overdose deaths. Provisional data from the Centers for Disease Control and Prevention (CDC) indicate that overdose have continued to increase, with more than 105,000 overdose deaths predicted in the 12 months ending November 2021.

The burden of overdose expands to other consequences of substance use disorders (SUD), including nonfatal overdose, and the human cost of this crisis also takes a heavy toll on families, caregivers, and communities. The HHS Overdose Prevention Strategy prioritizes four key target areas—primary prevention, harm reduction, evidence-based treatment, and recovery support. The HHS Overdose Prevention Strategy prioritizes four key target areas—primary prevention, harm reduction, evidence-based treatment, and recovery support.

What We’ve Accomplished
American Rescue Plan

  • Distributed $3 billion to states and territories through Substance Abuse and Mental Health Services Administration (SAMHSA) block grants, including $1.5 billion each for the Substance Use Prevention, Treatment and Recovery Block Grant and the Community Mental Health Services Block Grant.
  • Announced a $30 million grant award opportunity for the first-ever dedicated SAMHSA Harm Reduction grant program to increase access to a range of community harm reduction services and support providers to help prevent overdose deaths, reduce health risks often associated with drug use, and link individuals to health and human services.
  • Invested $77 million from the ARP to help expand the Certified Community Behavioral Health Clinic program in both breadth and depth, allowing the program to establish services in new facilities and make services more robust at existing facilities.
  • Established a state plan option for states to extend postpartum coverage from 60 days to 12 months after the end of the pregnancy. Women affected by substance use are at the highest risk for relapse in the postpartum period. The Centers for Medicare & Medicaid Services (CMS) has approved extensions of postpartum coverage in several states, and as of April 1 is working with another eleven states and D.C.

Recent Actions to Expand Overdose Prevention and Access to Treatment

  • CDC proposed an updated Clinical Practice Guideline for Prescribing Opioids for Chronic Pain based on the latest science, and input from the lived experiences of patients, providers, and caregivers, and external experts. CDC is targeting late 2022 for release of the updated final clinical practice guideline.
  • CDC awarded approximately $300 million to states, localities, and tribes to continue strengthening surveillance and scale up overdose prevention programming under its Overdose Data to Action program.
  • CMS finalized a 2022 rule to continue to allow for audio-only counseling and therapy for people with Medicare utilizing Opioid Treatment Programs when audio/video communication technology is not available to the beneficiary, after the COVID-19 public health emergency ends.
  • HHS intends to propose – PDF two rules to extend telehealth flexibilities that were granted during the COVID-19 public health emergency for opioid use disorder treatment using medications for opioid use disorders.
  • Congress provided over $4 billion in FY 2022 appropriations across HHS to address substance use disorders and overdose prevention, an increase of approximately $300 million over FY 2021 levels.

Behavioral Health Telehealth Services

Telehealth use increased dramatically during the COVID-19 pandemic. Recent research from ASPE – PDF suggests that access to telehealth was not equitable across different population subgroups. Behavioral health conditions exit disclaimer icon can be significantly improved with telehealth for conditions such as post-traumatic stress exit disclaimer icon disorder and depression, with improvements in somatic symptoms, functioning, and medication adherence. In addition, studies have examined audio-only telehealth for several exit disclaimer icon mental health conditions exit disclaimer icon and found the effectiveness to be comparable to in-person care.

What We’ve Accomplished
American Rescue Plan

  • Awarded nearly $11 million to expand pediatric mental health care access by integrating telehealth services into pediatric care. The Health Resources and Services Administration (HRSA) recently announced an opportunity for an estimated 10 more awards ($4.5 million).
  • Awarded more than $6 billion to Community Health Centers nationwide. Uses of funding included increasing broadband capacity to support virtual care models, and activities to expand/enhance telehealth capacity.
  • Announced the availability of nearly $48 million for community-based organizations to expand public health capacity in rural and tribal communities through health care job development, training, and placement, including the option for a Health IT/Telehealth Technical Support track.

Expanding Equitable Access to Virtual Behavioral Health Care

  • Medicaid. Federal Medicaid – PDF law and policy allows states to cover and pay for Medicaid services delivered via audio-only communications. This flexibility will continue to be available to states.
  • Medicare. During the pandemic, HHS has taken temporary measures to make accessing telehealth easier under Medicare, including waivers and regulatory changes to make it easier for providers to deliver telehealth services to people with Medicare.
    • In 2022, Congress provided a 151-day of certain telehealth flexibilities, including on the delivery of telehealth services across state lines and authorization for providers to prescribe controlled substances via telehealth without the need for an in-person medical evaluation.
    • The final CY 2022 Medicare Physician Fee Schedule rule increases access to tele-behavioral health services, including allowing for certain Medicare behavioral health services via audio-only telephone calls when video is unavailable, and allowing access to telehealth mental health services provided by Rural Health Clinics and FQHCs.
  • HHS intends to propose – PDF two rules to extend telehealth flexibilities that were granted during the COVID-19 public health emergency for opioid use disorder treatment using medications for opioid use disorders.
  • A January 2022 report – PDF to Congress issued by HHS and the Departments of Labor and the Treasury recommended permanently expanding access to telehealth and remote care services to improve implementation of the Mental Health Parity and Addiction Equity Act of 2008.
  • Telehealth.hhs.gov maintains resources for providers and patients on the latest efforts to support and promote virtual health care, including a Telehealth for Behavioral Health Care Best Practice Guide.

Youth Mental Health

Recent national surveys of young people show alarming increases in the prevalence of anxiety, depression, and other behavioral health challenges that have been increasing consistently over the past decade. Last year the Surgeon General issued a new Advisory – PDF to highlight the urgent need to address the nation’s youth mental health crisis, outlining the pandemic’s unprecedented impacts on the mental health of America’s youth and families, as well as the mental health challenges that existed long before the COVID-19 pandemic.

In March 2022, a new HHS study showed significant increases in children diagnosed with mental health conditions from 2016 to 2020, including an increase of nearly 30 percent in the number of children diagnosed with anxiety or depression. Centers for Disease Control and Prevention (CDC) data shows that in 2021, more than a third of high school students reported experiencing poor mental health during the COVID-19 pandemic.

What We’ve Accomplished
American Rescue Plan

  • Distributed nearly $11 million to expand the Pediatric Mental Health Care Access program by supporting telehealth service integration. These teams provide tele-consultation, training, technical assistance, and care coordination for pediatric primary care and other providers to diagnose, treat, and refer children and youth with mental health conditions and substance use disorders.
  • Awarded $62 million, including nearly $1 million in ARP funds, to National Child Traumatic Stress Network recipients in July 2021 to provide and increase access to effective treatment and services systems for children, adolescents, and their families who experience traumatic events.
  • Announced $5.4 million in ARP funds for Project AWARE. Recipients will establish and build on existing work to develop a sustainable infrastructure for school-based mental health programs and services.
  • Awarded over $120 million to home visiting recipients to support children and families affected by the pandemic, including through training to identify and address mental health needs.

Responding to the Youth Mental Health Crisis

  • The Centers for Medicare & Medicaid Services (CMS) is developing guidance reminding states about Medicaid’s Early and Periodic Screening, Diagnostic and Treatment requirements for individuals under age 21, including in the provision of behavioral health services. Expected release is summer 2022.
  • In March, HHS announced a joint effort with the Department of Education to develop and share resources – PDF to ensure that children have access to school-based health services.
  • CMS is conducting listening sessions with school-based services stakeholders to understand key challenges preventing more schools from enrolling as Medicaid providers.
  • CDC has developed emotional wellbeing resources for parents, families, and schools, a Toolkit on the mental health impacts of the pandemic on children, and is expanding funding to improve the health of children, adolescents, and school staff in priority areas of emotional wellbeing and school health services.
  • ACF supports implementation of the Family First Prevention Services Act, through which states, territories, and tribes can submit title IV-E prevention plans to provide trauma-informed, evidence-based behavioral health services and supports to help prevent unnecessary entry into foster care.

Christine Crosby

About the author

Christine is the co-founder and editorial director for GRAND Magazine. She is the grandmother of five and great-grandmom (aka Grandmere) to one. She makes her home in St. Petersburg, Florida.

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