A Big Break After a Big Week

Expressing gratitude after a monumental moment in my fight against our fragmented mental health system

I have a lot to be grateful for this week.

First and foremost, I’m grateful for you, readers. Some of you have been here from the very start, and some of you are new to Mental, having either stumbled across my recent feature in Substack’s “What to Read” series, or participated in the Writers’ Library shoutout thread.

However you got here, just know that I am so ecstatic that you are. We need each and every person learning about our mental health, elevating its importance, and advocating for it. We all have mental health, we all have a role to play in improving it nationwide, and so I thank you for following along and joining us in this journey. (Please feel free to introduce yourself in the comments section! I’d love to get to know a bit about you and what you’d like to see us discuss here.)

Second, I’m very grateful for the opportunity to have spoken before the U.S. Senate Committee on Finance on Tuesday. In “Mental Health Care in America: Addressing Root Causes and Identifying Policy Solutions,” I was able to provide a five-minute oral testimony, answer senators’ questions, and submit a longer written testimony too. Which brings me to the third thing I’m thankful for: The plethora of people who called, texted, and emailed offering insight and assistance ahead of the hearing.

It was a true honor to be able to talk about what I see as the three key things Congress can do to start mitigating the mental health crisis that Covid-19 has exacerbated: bring mental health care to where people are; reconsider the design and capabilities of our mental health workforce; and modernize and connect our federal programs and systems to collaboratively solve for common mental health problems.

As you might suspect from my previous posts, I have so much more to say about each of these three keys. And trust me, you’ll hear all about them – and probably then some.

But for the time being, I want to zero in on one solution that got a lot of airtime during the hearing: Certified Community Behavioral Health Centers (CCBHCs). CCBHCs, as many members of the committee pointed out, can do wonderful things for people struggling with issues of mental health and addiction. They often provide people with same-day access to mental health care, crisis response services, and also offer outpatient substance use disorder services in places where people may have literally no other option.

Compared to the alternative, CCBHCs are a good option except for this note of caution: When we create separate centers from which people can receive mental health and substance use disorder care, we run the risk of further separating our mental health care system from our broader health care system. We must work to integrate at all levels, including bringing primary care into CCBHCs more and having CCBHCs integrate into the broader health care system.

As I discussed – you can review my full testimony here – we need to make better use of what resources and professionals we already have so that we can most immediately start serving the plethora of parents and kids who are currently struggling. I recommend we start in primary care, the largest platform in care delivery, and embrace flexible funding mechanisms that provide clinicians with the incentives needed to onboard both substance use disorder clinicians and mental health clinicians. There’s much that we can learn from CCBHCs about what does/doesn’t work for helping those in need, but relying on them alone to address our mental health and addiction crisis would, in the long run, move us further away from our goal of having our health care infrastructure reflect that mental health is health. 

Other topics touched on in this week’s hearing include our children’s mental health crisis, teletherapy services, and ways to our health care workforce – the health care workforce as we currently know it, and the one we need to create. I’ll definitely expand on these themes in future posts, but for now, this is where I leave you. Why? Because the fourth and final thing I’m grateful for this week is my family, who, even though we are on vacation, allowed me to steal enough time away to practice my testimony, prep for the question and answer session, and write this post.

It’s been such an awesome, exhausting and rewarding few days. So for now, I’m going to practice what we preach. I’m going to unplug, soak up some Florida sunshine with my kids, and come back next week refreshed, recharged, and ready to resume our shared fight for a mental health system that is an integral part of our health care system, rooted in community and supported by communities.

I’m looking forward to it, and in the meantime, just want you to know how thankful I am for what you do every day to help advance mental health in whatever way you do.