By Stacy Collins, Associate Director, Health Systems Transformation, Association of Maternal & Child Health Programs
“First – beat the opioid epidemic. There is so much we can do. Increase funding for prevention, treatment, harm reduction and recovery. Get rid of outdated rules that stop doctors from prescribing treatments. And if you’re suffering from addiction, you know you’re not alone. I believe in recovery, and I celebrate the 23 million Americans in recovery.”
“And let’s get all Americans the mental health services they need. More people they can turn to for help, and full parity between physical and mental health care.”
President Joe Biden, State of the Union Address, March 1, 2022
At his first State of the Union address, President Biden offered a preview of his Administration’s commitment to addressing the nation’s behavioral health crisis, expressing his belief in the value of services across the behavioral health care continuum and demonstrating his compassion for those suffering from substance use and mental health disorders.
The Biden Administration’s newly released National Mental Health Strategy is good news for maternal and child health. Women, including mothers with children under 18, are among the most likely to report that stress and worry related to the COVID-19 pandemic have negatively impacted their mental health. The incidence of mental health disorders, substance use disorders (SUD), and overdose has been rising in recent years, and the pandemic has accelerated this trend. Two out of five adults report symptoms of anxiety or depression, with Black and Brown communities disproportionately undertreated for mental health disorders. Nationally, more than 100,000 lives were lost last year due to overdose, and rates of overdose deaths are disproportionately high for Black women compared to White women. Suicide and overdose are now among the leading causes of death for pregnant and postpartum people.
Key components of the Biden Administration’s National Mental Health Strategy
Promoting Harm Reduction Approaches
During his State of the Union speech, President Biden introduced the concept of harm reduction to millions of Americans unfamiliar with the term. This evidence-based approach reduces the harmful consequences associated with substance use, such as fatal overdose and infectious disease transmission, and engages people who might not be otherwise connected to the health care system, including women needing reproductive and behavioral health care services. Stigma and misconception about harm reduction programs have historically limited the availability of such services. The Administration’s strategy includes federal funding for syringe services programs, including the purchase of fentanyl test strips and sterile syringes, approaches that are proven effective in reducing overdose for people who use drugs.
The Administration also plans to examine ways to increase access and availability of naloxone. Naloxone is a prescription medication that can reverse an opioid overdose and has proven to reduce the rate of overdose deaths. Many state MCH programs and perinatal quality collaboratives endorse the broad distribution of this life-saving medication. Naloxone can be safely administered by both medical professionals and people who witness an overdose, but associated costs and variations in state laws governing access to it prevent naloxone from getting into the hands of those most likely to need it.
Making COVID-19 Opioid Use Disorder (OUD) Treatment Flexibilities Permanent
Flexibilities created during the COVID-19 pandemic over the past two years have allowed clinicians to initiate buprenorphine treatment for patients without an in-person visit and prescribe OUD medication via telehealth. Patients also were allowed to receive extended take-home doses of methadone. These flexibilities have benefited parents, for whom caregiving duties often complicate access to OUD treatment. The Biden Administration has called for these COVID flexibilities to continue as standard practice.
The use of telehealth to address mental health and substance use needs rose dramatically during the height of the pandemic and has remained above pre-pandemic levels even where COVID has waned. Tele-mental health services have proven both safe and effective while reducing barriers to care. The Administration plans to work with Congress to ensure coverage of tele-mental health in all health plans and support appropriate delivery of telehealth across state lines.
Strengthening the Behavioral Health Workforce
Meeting women’s mental health and substance use disorder needs is hampered by the nation’s chronic shortage of behavioral health providers. More than one-third of Americans now live in designated Mental Health Professional Shortage Areas. The Administration will pilot new approaches to expanding the use of paraprofessionals in behavioral health care. This will include the development of a national certification program for peer specialists, which will accelerate universal adoption, recognition, and integration of the peer mental health workforce in the behavioral health care system. Peer support is particularly important for pregnant people with SUD who face a litany of challenges such as access to prenatal care, treatment, and recovery services. Pregnant people with SUD are at higher risk for postpartum mental health issues, mandated reporting, and criminal justice involvement.
Strengthening and Enforcing Mental Health Parity
The 2008 Mental Health Parity and Addiction Equity Act called for mental health care benefits to be covered at the same level as physical health care benefits. The Administration’s plan proposes to strengthen enforcement of the parity law, require that all health plans cover a minimum of three behavioral health visits each year without cost-sharing and demonstrate in-network provider adequacy.
Supporting Behavioral Health Integration
The Biden Administration’s mental health strategy places a strong emphasis on the integration of mental health and substance use treatment in primary care settings. Equipping primary care providers, including OB/GYNs, with the tools to identify, treat, and manage behavioral health conditions is a proven approach for delivering quality mental health and substance use care, particularly for individuals with depression. The Administration has also proposed eliminating burdensome licensing restrictions, allowing more providers to prescribe buprenorphine, the standard of care for pregnant people with OUD.
Embedding and co-locating mental health and substance use providers into community-based settings is an approach to creating new, lower-barrier access points to OUD treatment. The President’s FY23 budget will include $50 million to pilot models that embed and co-locate mental health services into non-traditional settings like libraries, community centers, schools, and homeless shelters. The Administration has also called for universal access by 2025 to three medications to treat OUD—buprenorphine, methadone, and naltrexone – to further expand access to life-saving treatment.
The President’s strategy offers much-needed federal leadership to address the nation’s behavioral health crisis, which has been years in the making but was only worsened by the COVID-19 pandemic. To have a meaningful impact on health outcomes for women and families, however, will require a sustained and broad-based response. Recent demonstrations of bipartisan support for addressing mental health and substance use disorder are a hopeful sign for MCH advocates.