The Biden administration’s behavioral health agenda going forward prioritizes expanding the capacity of the American behavioral health care system, providing youth mental health services, and cracking down on international and domestic fentanyl trafficking.
President Joe Biden touted the administration’s progress on several behavioral health initiatives in his State of the Union. The White House also released a sprawling report on its priorities for research in the field of mental health.
“Let’s do more on mental health, especially for our children,” Biden said Tuesday night to the joint session of Congress. “When millions of young people are struggling with bullying, violence, trauma, we owe them greater access to mental health care at school.”
In addition to youth mental health efforts, Biden focused his attention on curbing the opioid epidemic by clamping down on fentanyl trafficking.
“Let’s launch a major surge to stop fentanyl production, sale and trafficking, with more drug detection machines to inspect cargo and stop pills and powder at the border,” Biden said.
An estimated 107,500 people have died from drug overdoses — about 75% from opioid overdoses — in the 12 months ending in August 2022, according to the latest Centers for Disease Control and Prevention (CDC) estimates.
Behavioral health advocates applauded the steps the president and his team are taking.
“Our nation made incredible progress last year to address the crisis surrounding mental health and substance use challenges,” Chuck Ingoglia, CEO and president of the National Council for Mental Wellbeing, said in a statement. “But we aren’t done yet, and President Biden tonight acknowledged the many hurdles that remain in efforts to address the mental health crisis and the overdose epidemic.”
Biden touched lightly on his administration’s next steps on behavioral health reform and presented them as supporting tenants of other, broader policy objectives in his speech. The White House supplemented information about its vision for behavioral health with the research priority report and a public briefing document.
Last year, the administration’s four-point agenda called for beating the opioid epidemic, addressing mental health (especially among youth), supporting American veterans suffering from exposure to burn pits and creating the Advanced Research Projects Agency for Health.
Last night, that Unity Agenda was presented more along the lines of cracking down on fentanyl trafficking and related public health efforts. It also focused on broadly addressing mental health, and expanding veteran services to include more mental health and social services.
State of the Union rundown
Biden announced that the White House will redouble efforts to cut off fentanyl from entering the U.S. by focusing on tighter inspection of international transportation and commerce and domestic shipping.
The White House intends to have the U.S. Customs and Border Protection (CBP) increase inspections at land ports on the southwest border, according to the brief from the White House. CBP would increase passenger vehicle inspection from about 2% to 17% and increase commercial vehicle inspection from 17% to 70%. The White House hopes to add 123 “new large-scale scanners” at these ports by the end of September 2026.
Biden this week also highlighted the elimination of Drug Addiction Treatment Act waivers, commonly referred to as X waivers. Physicians were required to get — and were regulated by this waiver — if they sought to treat patients with opioid use disorder (OUD) medication buprenorphine.
When paired with psychosocial interventions like therapy or peer support, medication-assisted treatment (MAT) is often held up as the gold standard of OUD treatment; some worry that deregulating buprenorphine will lead to doctors prescribing more pills without the needed support to make MAT work.
“The Biden-Harris Administration will further expand access to treatment by working with medical professionals to make prescribing proven treatments, including buprenorphine for opioid use disorder, part of routine health care delivery and ensure that manufacturers, wholesalers, and pharmacies are making medications available to everyone with a prescription,” the brief states.
The Biden administration also said it would commit to ensuring all 122 federal prisons would have in-house MAT programs, while expanding grants for communities to get access to the opioid overdose reversal drug naloxone. It will also provide guidance for state Medicaid programs to provide behavioral health assistance — including addiction treatment — to people being released from incarceration.
Other previously announced behavioral health initiatives will continue and, in some cases, expand.
The Bipartisan Safer Communities Act, passed in June 2022, and the 2023 omnibus funding bill, passed in December 2022, both touted in the State of the Union, set aside billions of dollars for youth and school-based mental health initiatives.
Mental health research priorities
In the shadow of the State of the Union, the Biden administration laid out its vision for research to advance mental health in the U.S. in a new report.
The report, from the Office of Science and Technology Policy and Domestic Policy Council, says the administration will push research focused on the following:
— Increasing equity in mental health treatment and awareness
— Digital interventions
— Expanding the mental health workforce
— Increasing mental health care access in the health, education and justice systems
— Integrating mental health and addiction treatment
— Developing new and improving existing serious mental illness (SMI treatment)
— Preventing fatal and non-fatal suicide outcomes
— Youth-specific care
“Research and innovation are key to this challenge. We know that some tools work in some settings, but we need to figure out how to make them work everywhere and for all Americans,” the report states. “There are also some problems we don’t have the answers to. We need to improve how we prevent, diagnose, treat, and destigmatize mental health conditions – and research is key to doing so.”
The report states its intent is to coordinate research and funding efforts across the federal government to reduce duplication and maximize coordination. The specific priorities listed above came out of a process that emphasized mental health issues made worse by the coronavirus pandemic, tied to social stigma and/or made worse by racism or discrimination.
Parity a possibility
While not addressed in detail in either the brief or the actual State of the Union address, the White House is teasing additional efforts on the mental health parity front.
“This spring, the Administration will propose new rules to ensure that insurance plans are not imposing inequitable barriers to care and mental health providers are being paid by health plans on par with other health care professionals,” the brief states.
These new administrative rules will likely make it easier to enforce parity standards and provide a structure for payers to better track and demonstrate compliance, Christen Linke Young, deputy assistant to the president for health and veterans affairs, said, according to a transcript of a conference call between Biden officials and national media outlets.
“This is a critical protection, but we know that too many insurance companies don’t comply with the rules, and they place barriers in front of patient access that shouldn’t be there,” Linke Young said. “And we need to change that.”
Parity is a long-fought-for but elusive policy objective for behavioral health advocates. While not tied to federal parity laws, the 9th U.S. Circuit Court of Appeals recently undid a ruling district court ruling that found that certain health plans can’t deny claims if that cover services that are in keeping with generally accepted standards of care. One behavioral health advocate called the reversal “heartbreaking.”
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