A slew of states are taking on mental health with new legislation aimed at expanding access to care.
The federal government has a number of behavioral health-focused bills on the table, including the Restoring Hope for Mental Health and Well-Being Act of 2022 and the Bipartisan Safer Communities Act.
However, state governments are also working on legislation to help expand access to care on the local level. Many of these new regulations touch on three main areas of behavioral health: pediatric mental health, workforce shortages and the response to the new crisis line, “988.”
“I think on a positive note, COVID really brought mental health into focus for a lot of state legislatures over the last couple of years,” Stephanie Pasternak, director of state affairs and government relations, policy and advocacy at the National Alliance on Mental Illness (NAMI), told Behavioral Health Business. “And we’ve seen a lot more investment just in terms of overall funding than we ever have before.”
A focus on youth
Youth mental health needs often go unmet.
In fact, only about 20% of children with behavioral health needs receive care from a specialized mental health care provider, according to data from the American Academy of Child and Adolescent Psychiatry. Additionally, there are only 8,300 practicing child and adolescent psychiatrists in the U.S.
Now, several states are looking to help curb this youth mental health crisis.
A new proposed bill in Massachusetts is heading to the state senate after passing through the House Committee in a 155-0 vote. The legislation covers everything from behavioral health scholarships and mental health parity, to 988 implementation and a mental health portal.
The bill also seeks to implement more school-based behavioral health programs and training programs for educators.
Additionally, the new bill proposes a mental health portal that shows the availability of pediatric mental health care beds across the state. The portal will also include data about the number of children boarding in a variety of sites and the number of youth waiting for residential dispositions.
“I think the big areas of focus that we’re seeing policymakers hone in on is more support for youth, particularly in the school setting where they are more reachable, especially considering all the added stress of a pandemic,” Pasternak said.
Massachusetts isn’t the only state to incorporate pediatric mental health into new legislation.
In April, the state of Connecticut passed three new bills aimed at children’s mental health needs. The bills focus on community resources, school resources and early childhood intervention.
While a number of states are working to improve mental health access and care, Pasternak noted that some legislation could be detrimental to behavioral health.
“Unfortunately, not all of the attention paid to mental health has resulted in positive legislation,” she said. “We’re also seeing some trends that are going to negatively affect folks’ mental health. A lot of that is reflected in … what I would group as ‘anti-trans legislation’ that targets trans-youth access to gender affirming care and other ways that they can participate in sports and their community.”
Engaging the mental health workforce
States are also looking to solve the workforce shortage in mental health departments. Roughly 130 million Americans live in a region with a mental health clinician shortage, according to data from the Kaiser Family Foundation.
The National Conference of State Legislatures spells out a number of initiatives for recruiting and retaining the behavioral health workforce. The recommendations include better understanding the need of the workforce, increasing supply of professionals, expanding the reach of existing professionals, properly distributing the workforce and retaining the workforce.
The new Massachusetts bill includes scholarships programs that encourage a “culturally, ethnically and linguistically diverse” behavioral health workforce.
“There’s been … across the economy workforce shortages, but we were really in a crisis pre-COVID of not having enough behavioral health providers, and then the need for treatment just grew exponentially,” Pasternak said. “And that workforce didn’t get any bigger.”
Some states are dealing with this shortage by dedicating more funding to training and recruitment of mental health workers.
For example, a Pennsylvania lawmaker proposed the HOPE for PA legislation, which would dedicate $100 million to mental health aid. Of that, $30 million would go towards provider and capacity shortages, and an additional $30 million would fund training, education and outreach programs for mental health providers.
New York is taking a different route with a bill that expands the scope of mental health providers who can make a behavioral health diagnosis. This now allows some master’s level mental health providers to make a diagnosis.
States respond to 988
In mid-July, a new emergency services number, 988, will be able to connect all callers in the United States to the National Suicide Prevention Lifeline.
As a result, a number of states have begun to enact 988 legislation that would take the calls one step further and provide in-person support to individuals in need.
This is a “pivotal time” for creating a behavioral health crisis system of care across the country, Pasternak said
“A lot of that is related to the build up for 988, which is a hotline number,” she said. “But a lot of states are taking the opportunity to not just improve the crisis call centers that will be receiving 988 calls and texts, but also thinking about how do they build out a more robust continuum of in-person crisis care, which looks like mobile crisis teams. And crisis stabilization centers that are actually the ultimate behavioral health-focused alternatives to ERs.”
The Substance Abuse and Mental Health Services Administration (SAMSHA) has previously said that the ideal crisis line gives “you someone to call, someone to respond and somewhere to go,” Pasternak explained.
Now some states are looking to implement that network.
According to NAMI data, four states have implemented comprehensive 988 implementation legislation. Another three states have a comprehensive implementation of 988 pending. Nine states have partial 988 legislation enacted, and two states have partial legislation enacted.