Progress and Promise: Advancing Mental Health Care in America
This Mental Health Awareness Month, we are reflecting on the strides made, and also the long road ahead, in ensuring access to high quality mental health care for all Americans. Over many long years, our nation transitioned away from mass institutionalization to community-based support and destigmatization. More recently, clinics have been moved out of building basements and into welcoming spaces. Pediatricians, like those at the UCSF BLOOM clinic, as well as in private practices, now screen for adverse childhood experiences, identifying and addressing factors that can predispose children to mental health challenges later in life. Efforts like those at Zuckerberg San Francisco General Hospital are integrating behavioral and mental health with primary care, ensuring immediate assessment and intervention. Additionally, school-based wellness programs, such as SWELL, provide holistic support to young people, nurturing and normalizing mental well-being from a young age. These advancements are critical.
Yet the stark reality is that we still have a long way to go. Despite these initiatives, Americans continue to face barriers to accessing mental health services. According to a West Health and Gallup poll, three-quarters of Americans feel that mental health needs are more poorly identified and treated than physical ones, and 89% would give a D or F grade to how well our nation’s health care system deals with mental health. Americans rank affordability and finding a provider as the top two barriers to accessing support. These perceptions are well-founded, and the data backs up Americans’ experiences. A Milliman report concluded that two-thirds of insured Americans with a mental health condition were unable to access treatment in 2021, and only one-third of those who sought hospital treatment during a mental health crisis received follow-up care within a month of being discharged. The lack of support for the uninsured is even more pronounced. The study showed that in addition to lack of affordability or providers, additional barriers exist, including poor reimbursement rates for providers, and poor consumer protection enforcement of insurance companies.
The consequences of these systemic shortcomings are profound, and the well-being of our entire society is at stake. A Morehouse Medical School report on the economic burden of mental health inequity in the United States estimated a cost of $278 billion between 2016-2020 due to 117,000 deaths related to mental health inequities. The report demonstrated that these lives and dollars could have been saved with proper investment in mental healthcare for marginalized and underserved populations. A landmark report from the Meharry School of Global Health projects that mental health inequities in the U.S. could cost an estimated $14 trillion by 2040 if left unaddressed.
The moral reasons to address this situation are obvious. In addition, the staggering economic toll and the way in which our healthcare system is being overwhelmed due to the lack of structural change should make the case for a major overhaul. This crisis CAN be averted.
Thankfully, there are innovative efforts underway to address the bottlenecks and hurdles in our system. In California, The Steinberg Institute is strategically advancing public policy to address the shortcomings in our system. My friend, Sacramento Mayor and Steinberg Institute founder, Darrell Steinberg, has announced they are advancing six legislative bills focused on growing the mental health workforce, holding insurers accountable, and reducing hospitalization as well as homelessness and incarceration cycles for those living with behavioral health conditions. Their focus is clear - ensuring that all Californians, particularly our most vulnerable, receive quality mental health and substance use care.
I am also proud of the tireless work of the California Children's Trust, which has moved mountains to connect children to the mental health services they need, ensured that the highest-quality and science-backed models of intervention are covered by insurance, and that whole-family wellness is the goal. Dozens of technical bottlenecks in our MediCal system’s coverage of behavioral and mental health service provision have been removed due to the work of Alex Briscoe and the CCT team.
Nationally, The Kennedy Forum is leading the charge for reform, focusing on cross-sector, multi-stakeholder partnerships to create parity in how health insurers cover mental and physical health. This is at the heart of it all, and critical to making the systemic change we need. I am grateful to Former Congress Member, Patrick Kennedy, for his visionary work to create lasting change, ensuring that mental health is understood as essential health.
My hope is that next year during Mental Health Awareness Month, we will reflect on the past year and see massive overhauls in our system. The complex policy work, technical solutions to improve access, collaborative problem solving, and championing of parity in our mental health system are desperately needed to ensure affordable, accessible mental health support to all Americans. Together, let us renew our commitment to creating this future and ensuring everyone has an opportunity to thrive.