From the Senate to Substack: 3 Ways to Increase Freedom in Mental Health Care

People with poor mental health and SUDs deserve to have choices. Here’s how we can increase them.

Welcome back, all. I hope you had a safe and fun Fourth of July weekend. Mine was spent with friends and family celebrating – celebrating the Fourth AND the fact that I had real, live people in my house for the first time in what seems like forever!

Compared to years past, this Fourth of July really was especially important. For starters, it was supposed to mark the day that we could call ourselves officially free from the Covid-19 pandemic. And on a similar note, it was also a date around which many employers based their decision to have employees physically return to work – a tricky transition that should be handled delicately.

In thinking about those two things this weekend, I – surprise! – got to thinking about July Fourth as it relates to mental health. I got to thinking about how much we pride ourselves on living in “the land of the free” and celebrating our ability to choose our own destiny, and yet, when it comes to mental health, we are so far away from experiencing that same sort of freedom.

When we talk about mental health at the national level, we often exclude choice from so much of that narrative. People with mental health and addiction problems usually only have one door to enter into, one person to call, and essentially just one federal policy – The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which isn’t even strictly enforced – that covers treatment. (Yes, I know there are other policies, but few are as consequential as this one.) How can anyone really feel like they have a choice when the person responsible for paying for their care – their health insurer, in many respects – is telling them what they can and can’t have?  

Feeling as though one doesn’t have options or choices, particularly when it comes to help with their mental health – or especially when it comes to getting help for their child’s mental health – can quickly turn into feelings of frustration and hopelessness. And if someone is already struggling with their mental health, this feeling of hopelessness would likely only exacerbate that issue. “Hopelessness” is literally the No. 1 sign of depression identified by HealthLine and Mayo Clinic, and the second per the National Institute of Mental Health. You don’t really feel like you have a choice when a person responsible for paying for your care (your health insurer, in many respects), is telling you what you can and can’t have for your care.  

The lack of choices people have when attempting to get help for their mental health is actually something I mentioned in my testimony to the Senate Committee on Finance. I also proposed solutions to that issue, which I will now share here.

THREE KEY PRIORITIES FOR SHORT- & LONG-TERM CHANGE

The first thing we need to do is to give people looking for help with mental health and addiction more choice in how they get help. This begins by expanding the number of places from where they can get help – better integrating mental health into the places they show up. We need to bring mental health care to where people already are, be that in a school, a workplace or even a barbershop. The Biden administration said this week that they would be expanding the number of places where people could get Covid-19 vaccines, and so it should embrace a similar mindset when it comes to mental health. 

“Getting more vaccines to primary care and pediatric care providers” is a particularly interesting idea, as it’s also one of the best ways to provide people with mental health and substance use needs with help more easily. Most of us have a relationship with a primary care practice. The problem is, right now, asking primary care providers to take on the responsibility of training themselves on how to better serve their patients’ mental health and well-being, plus recruit professionals who are capable of helping provide treatment in their practice, is too great a burden to bear without any monetary support. That’s why a key component of this first priority must be to create more global and flexible funding mechanisms that enable the integration of mental health services into places like primary care practices. There’s no need to reinvent the wheel – we can use existing payment structures like those found in Medicaid Managed Care Organizations, Medicare Accountable Care Organizations, and Medicare Advantage Plans to do this.

The second thing we must do is make sure that in the months ahead, we won’t find ourselves even more short-staffed than we are today. That starts with mapping out mental health utilization and gaps to better determine where services are needed and for whom – that way we don’t widen disparities or put money into places or programs people aren’t using – and doing what has already proven successful in other countries: Invest in our community workforce. By every person in America knowing what questions to ask each other and what to do depending on the answers to those questions, we will establish a much-needed frontline for support. It seems common sense, but if we are serious about giving people better choice, we should look at what they currently do when they need help. Many times, the first thing they do is mention that something is amiss to someone they trust.  

Finally, the third thing we must do is coordinate our efforts. Our federal programs and systems are often so narrowly focused on addressing specific needs, that they don’t work in tandem – sometimes, they can actually get in each other’s way when mental health and substance misuse needs to be understood together and implemented together. In fact, it seems that the complexity we experience on the ground is perpetuated in some ways by the complexity at the federal and state level – just as one example, look at the multitude of funding streams for mental health in Colorado – and so a landscape analysis would help us know what we already have established, what those goals are, what those results are, and how we can maximize the full potential of each. Reducing complexity by streamlining strategies is a short-term action that will yield incredible long-term results.

If we do these three things, people with mental health and substance use disorders will have fewer barriers to care. Why shouldn’t it be that way? Why shouldn’t choice be more a part of our vernacular in health care? Why shouldn’t we have our mental health needs met in a more seamless way – wherever we show up? Wherever we present with our concern?

A world in which we don’t have to ask those questions will be a world worth celebrating.