We Need a Mental Health Infrastructure Bill

In her February 11, 2021 press briefing, White House Press Secretary Jen Psaki stated “The President, Vice President, Secretary, and senators established the mutual understanding that America needs to build new infrastructure across urban and rural areas, and create millions of good-paying jobs in the process of supporting the country’s economic recovery in the months and years ahead.”

What we need by the end of 2021 is a mental health infrastructure bill.

If we think of our current mental health treatment model as our nation’s transportation system, we are anticipating unprecedented traffic on aging, inadequate roadways. This country is significantly understaffed with trained mental health providers. For example, studies have highlighted that an alarming 55% of counties in the continental U.S. have no psychiatrists, and 77% of U.S. counties have “severe shortages” of psychiatrists and other behavioral health providers.

There is no singular solution for this complex problem, and we must approach it with federally supported, organized strategies. Behavioral health treatment should be extended by increasing consultation and co-location of psychiatrists in primary care practices. Telepsychiatry, which has increased significantly during the pandemic, should be reimbursed at the same rate as face-to-face care, allowing its broad application in underserved rural and urban areas. Federal and state loan forgiveness funding could also be expanded to telepsychiatry, which would incentivize providers to work in these communities. Additionally, reimbursement rates for behavioral health treatment must be increased to match the cost of care provision, and prevent the brain drain of providers to cash-based private practices.

Rates of depression, anxiety, and substance abuse were rising before COVID-19, but the pace has quickened at a disturbing rate in the past year. A recent study noted a more than 3-fold increase in depression prevalence during the pandemic, with greater risk associated with lower income and higher number of stressors. Additionally, emergency room visits in 2020 increased for life-threatening events such as suicide attempts and drug overdoses.

Many will point out strategies already in place to mitigate this provider shortage, and they are not incorrect. Innovative models of care are increasingly being utilized. While on faculty at a major academic center, I’ve played a role in various care delivery models: the embedded psychiatrist in a comprehensive cancer center, a consulting psychiatrist and behavioral health lecturer in the family medicine department, and the medical director of the outpatient psychiatry clinic. Additionally, acceptance of telepsychiatry has grown exponentially, and multiple states have signed on to the Interstate Medical Licensure Compact, which provides a licensed telepsychiatry provider eligibility for an expedited medical license in another state.

In our current system, dedicated individuals labor each day to optimize accessible, high-quality mental health care. But just as a state-by-state approach has complicated our country’s response to COVID-19, we need an organized, federally supported mental health infrastructure update to create sustainable growth.

Indeed, in addition to the future mental health of our population, our economic recovery depends on a robust response to the mental health crisis. For example, the cost of mental health problems in the European Union Member States, primarily due to lost productivity, is estimated at 3-4% of the EU’s total GDP. Additionally, as our future workforce increasingly shifts from manufacturing to knowledge-based careers, our productivity will be closely tied to our ability to think and apply complex skills. In this environment, interference due to symptoms of anxiety, depression, or PTSD will be even more detrimental to innovation and impede competition with other nations.

As we slowly emerge from the physical withdrawal required during the pandemic, the emotional toll of this past year will become increasingly apparent. Complicated problems demand organized, financially-supported solutions. We need a mental health infrastructure bill now, and we need to start rebuilding.