Proposed Federal Rule Could Exacerbate U.S. Mental Health Crisis

America at a crossroads in an ongoing mental health crisis, with at least 1 in 5 Americans – both adults and children – living with a mental health condition while too many find it difficult to obtain affordable mental health care or substance use treatment. Quite simply, there are not enough qualified, licensed mental health clinicians to meet the rising demand, and too few of those accept health insurance. There is an obvious need to increase access to affordable mental health care, but in doing so we must ensure mental health professionals continue to be held to a high standard.

Thankfully, the Mental Health Parity and Addiction Equity Act (MHPAEA) was enacted in 2008 to ensure better parity between treating patients with mental and physical health needs which gained bipartisan support.

But now, a new federal rule change to the MHPAEA is being considered. The change would significantly increase the cost and risk for mental health patients, yet it doesn’t address the top issue of the current mental health crisis – the shortage of qualified mental health professionals.

This proposed rule would lower the quality standards for mental health professionals to join an insurance network while also pushing more patients or their caretakers to choose a higher-level mental health professional for even more mild symptoms that could be treated by a primary care physician. Simple supply and demand principles would dictate that this will lead to higher costs and exacerbate an already dangerous shortage of mental health professionals.

While the intent was to help encourage more high-level mental health professionals to join in-network insurance plans, studies show that these providers already have a multiple month waitlist for new patients and don’t want to hassle with having to deal with reimbursements.  Because they don’t have to.

Given how rapidly the mental health crisis is growing, this change could have a devastating impact, particularly to children, substance use disorder patients and low-income Americans who already face more difficulty in finding quality support. These individuals are often the most vulnerable and by lowering care standards, it will become even more difficult to navigate which providers are quality providers.

As a nurse practitioner, I’ve worked with numerous parents over the years who struggle to find the right care for their children. It’s already overwhelming for parents to navigate existing providers, but to inundate the existing field to be filled with less qualified providers, it will become even more difficult. Children will be left bouncing from one provider to the next and their condition is likely to worsen during the search.

Put simply, this rule would actually have the opposite of its intended effect. Instead of taking shortcuts in an attempt to remedy the issue of access to care, the Biden administration should implement real solutions to address the issue.

There are better solutions that are easier to implement and less costly. First, prioritize training and collaboration for primary care physicians to better identify and treat mild symptoms. Second, increase access to telehealth support, which has been a proven way to expand care who are located in areas with limited or no mental health providers. Finally, establish long-term programs to build out the mental health workforce, we can both increase access to and improve mental and behavioral health support.

Primary care physicians are often the first resort when patients are seeking specialized care but are left without the tools needed to help. By improving training for these individuals to identify mental health conditions more easily and accurately, patients will receive more tailored support early on. This would limit the potential for patients to fall into a trial-and-error scenario while seeking care.

Telehealth is also a proven means of improving access to care across the board. While this practice may have been implemented as a response to the COVID-19 pandemic, we should continue to take advantage of the benefits. Instead of imposing impossible care standards, we should support quality providers already in the field and their efforts to care for more patients—even those across state lines. In doing so, access to care for individuals in communities without specialized support will increase significantly.

Finally, the most pressing issue facing our country is a workforce shortage, with roughly 122 million Americans living in a Health Professional Shortage Area (HPSA) for mental health. We are proudly home to some of the best care physicians in the world. Instead of lowering our standards, we should focus on long-term plans to build our mental health workforce. Whether through incentivization programs for medical students to enter the mental health field or other programs, we must address this issue head on.

The answer to addressing the mental health crisis in our country is not to implement a rule that will lower standards of care. We must take meaningful steps to build a qualified workforce and bolster support for qualified physicians already practicing.

Constance “Connie” Garner spent 17 years as Policy Director for the U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) under former Senators Ted Kennedy (D-MA), Chris Dodd (D-CT) and Tom Harken (D-IA) played a pivotal role in drafting The Mental Health Parity Act of 2008. She currently serves as the Senior Policy Director at Foley Hoag, K+LLC and is the executive director of Allies for Independence, a nonprofit focused on addressing long-term support needs in within the disability and aging community.