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Opinion: We know how to improve mental health, so why aren't we taking action?
The U.S. has experienced several distressing trends over the last decade, including a dramatic rise in suicides and an increase in opioid use, overdose and related deaths. In response, politicians, scientists and community groups call for more research to better understand the “root of these problems” and identify solutions to address them. We are researchers who rely on this funding and agree that understanding a problem is a necessary first step toward developing responses. For many of these issues, however, a strong research base already exists that has simply not been translated into policy or practice. In short, health system leaders, payers and policymakers know what to do, but are not doing it—or at least not enough of it.
Take suicide, for example. Suicide rates have increased by about 30% since the turn of the century. Possibly contributing to this horrifying statistic, the percentage of individuals reporting an unmet need for mental health services has increased every year for the past decade. Billions of research dollars have been spent developing effective suicide prevention interventions and identifying ways to improve mental health screening, referral and treatment. However, we know that the most significant barriers to improving mental health nationwide are the lack of well-trained clinicians, insufficient reimbursement and poor insurance coverage for mental healthcare. Although we have mental health interventions that work, the nation lacks the workforce or infrastructure to deliver them.
New research efforts are certainly important, but we already have evidence-based, systems-level solutions that could be implemented right now to improve Americans’ mental health and many of the conditions that lead to suicide. Health system leaders can lead this charge on several fronts.
First, they can invest in hiring, training and retaining more mental health clinicians at their organizations. Specific strategies include offering sufficient compensation, reducing expectations for increased productivity, working to reduce administrative burdens and providing opportunities for continued professional development.
The percentage of individuals reporting an unmet need for mental health services has increased every year for the past decade."Second, they can invest in infrastructure to support screening and treatment for mental health conditions within more easily accessible primary-care settings. Incorporating mental health treatment into primary care is facilitated by recent changes to Medicare’s billing codes allowing providers to be reimbursed specifically for these services.
Third, they can ensure continued access to telehealth services beyond the COVID-19 pandemic by investing in technical infrastructure for both providers and patients and integrating telehealth into existing clinical workflows.
Additionally, action on the part of payers and policymakers is critical. With regard to payers, state Medicaid programs must significantly raise reimbursement rates for mental healthcare. Medicaid reimbursements are so low for some providers in mental health clinics that many of them have to work second jobs, leading to high staff turnover and significantly limiting access to care. Increasing reimbursement could help pave the way for well-staffed community mental health clinics in every neighborhood.
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Policymakers can enforce requirements for private insurance plans to fully cover mental health services and offer an adequate network of providers, as planned in the Biden administration’s 2023 budget. Taking this step would grant the more than 60% of Americans on private insurance plans true access to mental healthcare. Although the Mental Health Parity and Addiction Equity Act was enacted in 2008, disparities in payment for mental health versus medical care have persisted due to limitations in the law and a lack of enforcement. These disparities have led individuals with mental health conditions, including those at risk for suicide, to have trouble finding providers or to have requests for treatment denied by their insurance plans. Of course, policymakers also have important roles to play in supporting the recruitment and retainment of mental health clinicians, allowing for full reimbursement of services provided via telehealth, and encouraging Medicaid to raise reimbursement rates.
While research funding is important, health system leaders, payers and policymakers need to focus on significantly increasing spending on mental healthcare to widen Americans’ access to services and improve outcomes. Simply calling for more research money is not enough. Support for additional research needs to be paired with making the more challenging, expensive and politically contentious systemic changes needed to put what we already know works into practice. Otherwise, hollow calls for more research can be the equivalent of “forming a committee to study the problem.” We already know a lot about what needs to be done to improve Americans' mental health and well-being. Let’s use that knowledge to make the changes needed to save lives now.
The opinions expressed in this article do not necessarily represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.