On February 1, 2022, the Senate Health, Education, Labor, and Pensions (HELP) Committee held a hearing, Mental Health and Substance Use Disorders: Responding to the Growing Crisis, to discuss ways in which Congress can respond to the increase in mental health and substance use disorders (SUD) in the United States. Throughout the hearing, bipartisan discussion ensued over providing early mental health interventions and various supports to school-age children and different ways to ease medical provider shortages we are seeing throughout the country.
Present at the hearing were the following witnesses: Mitch Prinstein, PhD, ABPP, Chief Science Officer at the American Psychological Association; Michelle P. Durham, MD, MPH, FAPA, DFAACAP, Vice Chair of Education, Department of Psychiatry and Clinical Associate Professor of Psychiatry & Pediatrics at the Boston Medical Center and Boston University School of Medicine; Sara Goldsby, MSW, MPH, Director of South Carolina Department of Alcohol and Other Drug Abuse Services; Jennifer D. Lockman, PhD, CEO of Centerstone Research Institute; and Claire Rhyneer, a Mental Health Youth Advocate.
Opening Statements
Committee Chair Patty Murray opened the hearing by discussing the high rates of mental health and SUD issues in the United States, especially following the COVID-19 pandemic. She specifically called out fentanyl and methamphetamine as the main driving force behind overdose deaths and lamented the rising rates of suicide among teenagers.
Senator Lisa Murkowski agreed with Senator Murray that mental health and SUD are at “crisis levels” and that the COVID-19 has only exacerbated the problems. She spoke about the limitations in communities, including a lack of provider networks to support patients, and also discussed the rising suicide rates among younger individuals.
Witness Testimony
Dr. Prinstein opined on what he believes are some potential solutions to the mental health and SUD issues, including: having a diverse and robust workforce; additional school and community-based services; reauthorizing and expanding graduate psychology education and minority fellowship programs; and expanding scientific investment into psychological research.
Dr. Durham discussed low barrier housing and integrated care as suggested ways to help those who have both mental health and SUD issues. She also covered the disparate impact mental health and SUD issues have on Black and Latinx populations.
Ms. Goldsby made some specific recommendations as well, including allowing the Substance Abuse and Mental Health Services Administration (SAMHSA) to coordinate all federal mental health and SUD programming and congressional support for the Substance Abuse Prevention and Treatment (SAPT) block grant. She also discussed the impact workforce challenges have on mental health and SUD.
Dr. Lockman discussed the SAMHSA grants her company received to address suicide and the suicide screening process, but noted that without those grants, keeping providers up to date on training is costly. She also discussed the importance of the Behavioral Health Crisis Services Expansion Act currently in the Senate and the Certified Community Behavioral Health Clinic (CCBHC) Medicaid Demonstration, the CCBHC grant program, and the Comprehensive Opioid Recovery Centers grant.
Ms. Rhyneer gave powerful testimony about how those who are most in need of mental health services are the ones who are least likely to have access to those services and support. She also stated that she believes supporting school counselors and integrating mental health classes into the health curriculum at schools are critical to addressing youth mental illness.
Workforce Limitations
One of the major topics throughout the hearing was covering limitations in the provider workforce. Dr. Durham noted that patients who have both mental health and SUD needs often fall through the cracks of health care, as one provider cannot typically help with both as they are trained in just one specialty.
Senator Bob Casey discussed integrating mental and behavioral health with primary care. Dr. Prinstein, while supportive of the idea, noted that there are barriers to putting such a plan in place, including funding, cross-disciplinary training, record sharing, and billing codes.
SUD
Dr. Durham noted during a discussion with Senator Murray that she believes some of the inequities in SUD treatment are a result of SUD being treated as a crime instead of a medical condition.
Senator Casey also discussed developing Plans of Safe Care (POSC) for families that deal with SUD and the need for “non-punitive services,” including reporting mechanisms for infants who need a plan of safe care. Ms. Goldsby discussed the importance of the SAPT block grant and the Child Abuse Prevention and Treatment Act.
Senator Mike Braun raised discussion points about the impact of Southern Border crossings on overdoses. Ms. Goldsby noted that trends in overdoses related to fentanyl do coincide with the border trends and that naloxone and fentanyl test strips have been integral to treatment approaches.
Youth Mental Health
As one might expect, youth mental health was a huge topic and Ms. Ryneer and Dr. Prinstein both acknowledged that the youth are experiencing decompensating mental health as a result of the COVID-19 pandemic. Dr. Prinstein also pointed out the importance of in-school interventions in identifying students with trauma who need mental health support.
Senator Bill Cassidy raised the limitation of federally funded programs for children with severe emotional disturbances, in that they are regulated to only cover children who have received a mental health diagnosis. He and Dr. Prinstein agreed that those federal regulations should include preventative services and children waiting on a diagnosis in their coverage determination.
Senator Tina Smith brought up several bills that have been introduced this Congress that attempt to address mental health care access in schools and noted that policies to remedy these issues must be included in a broader mental health legislative package. She specifically pointed to her own bill, Mental Health Services for Students Act.