Mental Health: Potential Bipartisan Oasis in a Partisan Congress

David Hathcox

How will the stars align for mental health policy nationally over the next two years? Good question, since much work remains after Congress took some important steps last year and the Biden administration announced the COVID-19 Public Health Emergency (PHE) will expire on May 11 (COVID-19 Public Health Emergency to End in May). It is apparent to all that greater access to quality mental health care is necessary, with too few psychiatrists, social workers, psychologists, and other clinicians, as well as a multitude of other needs.

Psychiatry made notable progress in the 117th Congress, which concluded on January 3—an unprecedented 100 new Medicare residency slots specific to psychiatry, enactment of new grants that APA proposed to boost access to care through the Collaborative Care Model, new grants and resources to enforce mental health parity, a guaranteed two additional years of Medicare telehealth flexibilities, $500 million to implement the 988 Suicide and Crisis Lifeline, and more. The APA members whose advocacy contributed to these achievements can be proud of those results.

Congress responded to APA and our allies, in part, because the pandemic’s massive negative impact on Americans’ mental health is undeniable. But much was also left on the table. The need for additional action is significant, with increasing numbers of Americans rating their mental health as only fair or poor, drug overdose rates continuing to increase, and suicide the second leading cause of death for people aged 10 to 34. Unlike days past, when lawmakers often sought to change the subject when asked about mental health, today it’s hard to find a lawmaker who doesn’t hear regularly from constituents about it. In fact, 4 in 5 Americans agree on the need for greater access to mental health care. Mental illness affects legislators and voters regardless of their politics.

So, will partisanship and divided government in Washington, D.C., allow for further progress? Despite the dramatic start to the 118th Congress in January and widespread expectations for gridlock, incremental progress again seems possible on mental health issues. Although the scope of such potential action is far from clear, these issues continue to be seen as bipartisan on Capitol Hill and beyond.

That said, the likely approach, interest, and timing of potential action on different issues vary. For example, the newly enacted continuation of telehealth flexibilities has proven to be quite important, now that the PHE designation is about to expire. When the PHE expires, millions also risk losing the Medicaid access they have had during the pandemic. It is far from clear whether Congress will respond to the end of the PHE by making telehealth flexibilities permanent or addressing other access challenges like Medicaid. Telehealth has engendered clear bipartisan interest; access issues like Medicaid less so. These items all have significant costs, and all proposals with fiscal implications will be affected by broader debates over federal spending, including those related to raising the statutory debt limit.

We can expect the debt limit debate to consume much D.C. oxygen before this summer. And the debate over annual appropriations bills that fund public mental health programs will be fever pitched, with many betting that the political parties will be unable to reach agreement, resulting in such spending being put on autopilot for the year. Meanwhile, authorizing committees will be holding hearings and will begin marking up bills.

Two early data points give reason to hope for some progress on mental health, including substance use. First, legislators appear poised to focus on reauthorizing the SUPPORT Act beginning later this year. That important opioid-related legislation was bipartisan when enacted a few years ago, and there is reason to hope Congress will again find the bipartisan will to act.

The second is the bipartisan work on mental health begun last year by the Senate Finance Committee, which played a major role in adding the 100 new residency slots for psychiatry in Medicare. All indications are that the committee plans to continue that work, which could produce further progress on integrated care, including boosting implementation of the Collaborative Care Model in primary care practice, and a series of other items focused on workforce measures, crisis care, and children.

As was the case with the last Congress, the expertise and advocacy of our members are vital contributors to our success with these and the many other important debates to come, not only on the federal level but also on the state level (It’s 10 O’clock: Do You Know Where Your State Legislature Is?). ■

Craig Obey is chief of APA’s Division of Government Relations.