In his first State of the Union address, President Biden outlined a sweeping plan for mental health access, care, and training. Biden shared a bipartisan vision to make mental health a priority in his presidency.
The administration outlines more specific details in the White House Fact Sheet summary. President Biden will allocate over $700 million of his Fiscal Year 2023 budget and upwards of $100 million in his American Rescue Plan to transform how mental health is understood, perceived, accessed, treated, and integrated in the U.S.
Some of the goals include:
- Widening access to mental health professional care
- Greater training for paraprofessionals
- Building a national certification program for peer specialists
- Promoting the mental well-being of our frontline health workforce
- Launching the "988" suicide crisis response line
- Expanding and strengthening mental health parity
- Integrating mental health and substance use treatment into primary care
- Improving veterans' access to same-day mental health care
- Expanding access to telehealth mental health care options
- Doubling the number of school-based mental health professionals
- Increasing and enhancing behavioral health navigation resources
- Investing in research on social media's mental harms
- Expanding early childhood and school-based intervention services
- Expanding mental health care for incarcerated individuals
With over 30 years in practice, I've learned there are no easy fixes to improving mental health care on state and federal levels. Biden's plan is optimistically hopeful and realistically tailored. But, in my opinion, mental health treatment success comes down to one main issue: the dismantling of managed care as a cog in the American healthcare system wheel.
While offering incentives to those interested in pursuing a career in mental health, creating better trained paraprofessionals, enhancing telehealth standards, and the host of other great ideas outlined in the plan are encouraging, what Washington really needs to address is the mangled care of managed care. Efforts toward this goal were noticeably absent from Biden's State of the Union address.
So, what exactly is managed care in terms of mental health care? Managed care describes a health insurance plan or healthcare system that coordinates the provision, quality, and cost of care for its enrolled members. While the sole purpose of managed care is to oversee and control health services, it is purposefully designed to frustrate and overwhelm the consumer. For instance, one of the most reported problems in accessing mental health care is encountering what's known as a "ghost" network, where therapists/psychiatrists are listed in an insurance network but, in truth, do not participate. Managed care companies also limit patient care with numbered sessions -- and lean heavily on short-term treatment practices as if one-size-fits-all for healthcare. Many "case managers" making decisions about patient care are untrained paraprofessionals, and the authorization process can be so lengthy and convoluted that gaps in treatment occur.
And finally, the be-all and end-all is that managed care companies pay abysmal fees to mental health professionals.
The labyrinth of accessing mental health services via managed care companies mercilessly crushes Americans when they're at their weakest and most vulnerable. Decades ago, managed care was widely viewed as the silver bullet that would curb healthcare costs while ensuring convenient and high quality of care. But in reality, managed care is far from that.
As far back as I can remember, I've viewed the practice of managed care as a gate keeping system that devalues highly trained clinicians and interrupts the consistency of care for children and adults. Mental illness treatment requires consistent sessions, and for those struggling with moderate or serious mental health disorders, long-term treatment is necessary for the recovery and remission of symptoms.
I don't participate, and never have, in any managed care organizations. I slide my fee for those who have anemic managed care policies, see patients pro bono, and for those who have good out-of-network benefits, charge my customary fee without hesitation. However, there are many other mental health practitioners who cannot make this decision easily or realistically. It's high time to dismantle this system.
As hopeful as I felt listening to Biden's goals for mental health parity, training, and access, if managed care companies are not held to superior standards of patient care and higher fees for professional reimbursement, the bandages will only stick so long.
Deborah Serani, PsyD, is a psychologist and professor at Adelphi University in Long Island, New York. She is also a member of the MedPage Today editorial board.