Improve Access to Mental and Behavioral Health and Social Care Services

2021 Blueprint of Federal Social Policy Priorities: Recommendations to the Biden-Harris Administration and Congress

Mental and behavioral health are crucial components of overall health. Social workers play a crucial role in promoting mental and behavioral health and do so in a broad range of settings and communities and with a wide array of populations. This includes providing services to diagnose and treat mental illness and to restore and improve social and psychosocial functioning. But it also includes providing services to those who do not have a mental illness, such as promoting wellness, prevention and identifying and addressing social needs stemming from the social determinants of health.

Millions of Americans are affected by substance use disorders (SUDs) every year. In 2018, approximately 7.8 percent of people aged 12 or over needed substance use treatment (Substance and Mental Health Services Administration,2019). Drug overdose deaths rose from 38,329 in 2010 to 70,237 in 2017, and opioid-involved overdose deaths rose from 21,088 to 47,600 during that same period (National Institute on Drug Abuse, 2020). 5.6 percent of people 18 or older have an alcohol use disorder (U.S. Department of Health and Human Services, 2020).

Indeed, Americans have some of the worst mental health-related outcomes, including the highest suicide rate and second-highest drug-related death rate among high-income countries. The pandemic is intensifying the demand for services and treatment.

Mental health also plays a major role in physical health. Mental illnesses, such as depression and anxiety, affect the ability to participate in health- promoting behaviors. In turn, problems with physical health, such as chronic diseases, can negatively impact mental health and decrease a person’s ability to participate in treatment and recovery.

Transforming our mental health system involves integrating physical, mental and behavioral health care. An estimated $10 to $15 billion could be saved each year for Medicare and Medicaid and $16 to $32 billion for the commercially insured through effective integration of mental health care with other types of medical care (Melek, 2012).

The Affordable Care Act expanded on the Mental Health Parity and Addiction Equity Act of 2008, requiring all health plans in the Health Insurance Marketplace to cover mental health and substance abuse disorders, but coverage for mental health care also varies depending on the state where the patient lives. It is unacceptably difficult for many individuals and families to find mental and behavioral health care that is accessible, affordable, and covered by insurance.

NASW calls on national leaders to:

  • Make permanent the telehealth expansion under COVID-19, including removing site and geographic restrictions, enabling the use of audio-only devices and payment parity with in-person payment rates.
  • Enforce current legal and regulatory requirements around parity and identify and address gaps.
  • Support co-responder initiatives and legislation such as the Community-Based Response Act lead by Senator Chris Van Hollen and social worker Rep. Karen Bass.
  • Invest in the further development of the national 211 call number for community information and referral services.
  • Pass the Behavioral Health Coordination and Communication Act (H.R. 7723 in the 116th Congress) to establish the position of Interagency Coordinator for Behavioral Health to coordinate the programs and activities of the federal government relating to mental health.
  • Pass the Social Determinants Accelerator Act (H.R. 4004 in the 116th Congress), the Improving Social Determinants of Health Act (H.R. 6561 in the 116th Congress).
  • Pass the Health Equity and Accountability Act (S. 4819/H.R. 6637 in the 116th Congress).
  • Continue investments in the infrastructure for substance use disorder prevention and treatment, including adequately funding the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Prevention and Treatment block grant.
  • Fund the National Institute of Mental Health, the National Institute on Drug Abuse, Health Resources and Services Administration and SAMHSA to support research integrated among mental and behavioral health care providers and universities nationwide.
  • Expand the use of Home and Community Based Services waivers and other financing mechanisms to support community-based services that promote independent living for all people with serious mental health conditions.
  • Pass the Comprehensive Addiction Resources Emergency Act (S. 1365/H.R. 2569 in the 116th Congress) which will provide emergency assistance and funding to areas most affected by the opioid crisis.
  • Reform 42 CFR 2 to improve information sharing and healthcare integration.
  • Implement the National Suicide Hotline Designation Act (P.L. 116-172).
  • Fund social workers and other healthcare providers in schools and promote the expansion of mental health programs in K-12 and higher educational settings.
  • Repeal the Medicaid Institutions for Mental Diseases (IMD) exclusion.