Transform Policy, Transform the System, Transform Lives: Advancing Mental Health Policy Now

By Rachel Nuzum, MPH and Reginald D. Williams II

Mental Health Awareness month offers an opportunity not only to bring greater awareness to a worldwide crisis but also to spur greater action in the United States — at the federal, state, and local levels — to craft policy solutions that center people with lived experience.

By now we’ve heard the statistics, but they bear repeating. Nearly one in five U.S. adults has a mental health condition. Fewer than half have had their mental health needs met, with barriers to treatment greater for young people and individuals from marginalized groups. These inequities drive poor outcomes, and they have a substantial economic impact as well.

This growing crisis, in which needs far outpace treatment options, has led to bipartisan interest in building a more effective and equitable behavioral health infrastructure across the care continuum — from upstream prevention to crisis response.

At the Commonwealth Fund, our behavioral health (mental health and substance use) efforts focus on four areas, each with a commitment to racial and ethnic equity at its core:

• Integrating behavioral health and primary care. Behavioral health needs account for over half of all primary care visits, yet physical health and behavioral health are often siloed in care delivery, especially addiction treatment. Many primary care clinicians don’t have the training or tools to treat their patients seeking mental health care. By integrating behavioral health with primary care, providers can work together to ensure patients receive all the care they need.
• Strengthening and diversifying the behavioral health care workforce. Accessing behavioral health services in the U.S. is notoriously difficult, because of shortages of licensed providers, low reimbursement rates, and the persistent stigma associated with seeking this care. This is especially the case for rural and underserved communities. Short-term efforts to supplement licensed behavioral health providers with nonlicensed ones, such as behavioral health support specialists — peer specialists, community health workers, and paraprofessionals — could help meet immediate behavioral health needs. Having more support-service providers that come from the communities they serve could lessen some of the cultural barriers associated with accessing behavioral health treatment.
• Leveraging Medicare and Medicaid to drive change. In the U.S., adults age 65 and older are more likely than those in other countries to be diagnosed with a mental health condition. Despite the substantial coverage provided by Medicare, only half of seniors receive necessary care. This is partly because of the limitations of Medicare Advantage plan coverage — among them, narrow provider networks and limited treatment for serious mental health needs.
• Improving youth mental health. Young people are increasingly living with mental health conditions, but families lack the comprehensive resources to help. Leveraging schools and the Medicaid program are two promising strategies to meet the needs of youth and their families where they are. Expanding care models such as the collaborative care model for youth also could help ensure behavioral health issues are identified early.

In partnership with our grantees and partners, we are relying on three distinct policy levers: 1) identifying solutions that could be advanced under existing authorities via administrative actions, 2) highlighting areas where further authorities, resources, or policies are still needed and requiring legislative action, and 3) working to support states as they undertake behavioral health reforms.

As part of this work, we’ll continue our longstanding activities around measuring health system performance and continue to add behavioral health measures as they become available. We’ll also leverage our institutional expertise in international comparisons and policy solutions as we work together to address this public health crisis.

There is no single solution to the complex web of challenges to our collective behavioral health. But the Commonwealth Fund is committed to leveraging our resources and working with the broader policy community to advance change. Leadership is needed at the federal, state, and local levels, as well as within the private sector, to ensure access to effective, equitable behavioral health services for all.