The House Energy and Commerce Subcommittee on Oversight and Investigations held a Feb. 17 hearing titled “Americans in Need: Responding to the National Mental Health Crisis.”
In his opening statement, full committee Chair Frank Pallone Jr. (D-N.J.) discussed the impact of the COVID-19 pandemic on Americans’ mental health. Pallone noted that there are myriad barriers to accessing mental health treatment, including stigma, discrimination, an inadequate supply of providers, and concerns over cost. Pallone stressed the need to vigorously enforce the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343), which provides for the equal coverage of treatment for mental and physical health conditions. He emphasized additional funding in the Consolidated Appropriations Act of 2021 (P.L 116-260) that endows the departments of Labor, Treasury, and Health and Human Services with new regulatory mechanisms to enforce parity requirements. Pallone concluded his remarks by highlighting the Build Back Better Act’s (H.R. 5376) $175 million in funding to support mental health workforce and community service initiatives.
Subcommittee Chair Diana DeGette (D-Colo.) noted in her opening statement the enormous impact of the COVID-19 pandemic on historically underserved communities, including communities of color, people with disabilities, and essential workers. DeGette also emphasized the impact of the pandemic on youth and children, citing the subcommittee’s hearings last fall on the impact of the pandemic on the nation’s young people. DeGette underscored the important role that telehealth can play in the provision of mental health services, as well as the need to invest in the mental health care workforce. DeGette concluded, “We must work to ensure that all Americans have access to the mental health services and care they need to support their lifelong health and well-being.”
The committee heard from Lisa Fortuna, MD, MPH, vice chair of the Department of Psychiatry at the University of California, San Francisco and chief of Psychiatry at Zuckerberg San Francisco General Hospital. In her testimony on behalf of the American Psychiatric Association, Fortuna underscored the disproportionate impact of the COVID-19 pandemic on the mental health of people of color, who are disproportionately represented among low-income essential workers. To promote access to culturally competent mental health care among historically underserved communities, Fortuna urged the committee to extend telehealth flexibilities introduced under the COVID-19 public health emergency. In addition, Fortuna recommended that Congress remove the requirement of an in-person evaluation prior to a patient’s first telehealth visit with their provider. She stated, “Though the pandemic has been difficult for a multitude of reasons, the progress we have made in reaching more patients through telehealth and coordinating care with other systems of support has been a silver lining.”
Fortuna also highlighted the importance of increased investment in the mental health care workforce, endorsing the 4,000 additional Medicare-funded graduate medical education (GME) training positions included in the Build Back Better Act (H.R. 5376), 15% of which would be allocated towards psychiatry. AAMC President and CEO David J. Skorton, MD, and Chief Public Policy Officer Karen Fisher, JD, previously issued a statement commending the Build Back Better Act’s important investments in GME, including the creation of new Medicare-funded GME positions and the establishment of the Pathways to Practice Training Program, which would strengthen and diversify the nation’s mental health workforce.
In addition to strengthening the mental health care workforce, Fortuna recommended that the subcommittee pursue additional funding streams to support value-based programs that integrate physical and mental health care. Fortuna stressed the positive impact of the Collaborative Care Model (CoCM), an evidence-based, integrated care model that cultivates collaboration between primary care providers and mental health professionals in the care of patients with behavioral health conditions. Fortuna stated, “The CoCm is population-based, which improves access by facilitating treatment for many more patients in comparison to usual one to one care.” The AAMC endorsed the CoCM in a letter to Senate Finance Committee Chair Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho) responding to their request for input on developing policy proposals and bipartisan legislation to address barriers to mental health care [refer to Washington Highlights, Nov. 19, 2021].