On March 2, the House Ways and Means Committee held a hearing titled, “Substance Use, Suicide Risk, and the American Health System.” The hearing was dedicated to discussing solutions to the nation’s behavioral health challenges.
In his opening statement, committee Chair Richard Neal (D-Mass.) discussed the immense public health impact of the interrelated issues of mental health, substance use, and suicide. He reflected upon the committee’s historical efforts to address these issues, including its role in the passage of the bipartisan Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act (H.R. 6) during the 115th Congress, which expanded access to opioid treatment for Medicare beneficiaries.
Neal further highlighted the administration’s national mental health strategy, which the president unveiled during the preceding evening’s State of the Union address [refer to related story]. He concluded, “Testimony today will help to inform the legislative action that the Committee will take this year to address some of the longstanding problems in the way we deliver and access mental health services in this country.”
Committee Ranking Member Kevin Brady (R-Texas) described the impact of the COVID-19 public health emergency and concomitant social isolation and stress on the mental health of Americans in his opening statement. He emphasized the role of fentanyl, a highly potent synthetic opioid, in fueling the nation’s rise in overdose deaths. Brady urged the committee to further build upon the progress made through the passage of the SUPPORT Act by permanently extending telehealth flexibilities to expand access to mental and behavioral health care.
He concluded by underscoring the relationship between economic opportunity and mental health, highlighting the need to jump-start economic recovery: “On the heels of a raging pandemic and a terrible recession, we know the mental health crisis is real. I believe we have the tools to fight it, and we must take a bipartisan approach to doing so.”
The committee heard from Jonathan Metzl, MD, PhD, professor of psychology and psychiatry and director of the Department of Medicine, Health, and Society at Vanderbilt University. In his summary of his written testimony, Metzl highlighted his interdisciplinary academic background in both medicine and social science and shared how this training has shaped his view of mental illness as “individual pathologies within larger structures and systems.” He emphasized the role of technology in both combatting isolation and connecting people to mental health treatment, endorsing the use of telehealth. Metzl concluded by highlighting the role of social cohesion in shaping mental health, urging the importance of “communal infrastructure for mental and biological well-being.”
In a key exchange with Neal, Metzl was asked to provide recommendations as to how Congress can address the impact of “long-standing inequities in our health care and economic systems” on mental health. In his response, Metzl underscored the need to embed “structural competency,” or an awareness of the interplay between clinical conditions and social systems, in physician training. Metzl noted, “What we advocate for is training health professionals, both to understand individual systems, but also to see the weak points in structures, the upstream factors that might lead to downstream mental health issues and to inequities.”
Following up on the health equity theme, Rep. Linda Sanchez (D-Calif.) asked Metzl about the influence of stigma, discrimination, and racism on individual well-being and mental health. Metzl reflected that socio-economic deprivation can be linked to social stigma and isolation, thereby increasing the risk of suicide. For this reason, he concluded, “There’s a real imperative to address economic inequity in a way that feels like people have their safety net.”
Other witnesses included Edwin Chapman, MD, a physician specializing in addiction medicine, Regina LaBelle, JD, director of the Addiction and Public Policy Initiative at the O’Neill Institute, Marielle Reataza, MD, executive director of the National Asian Pacific American Families Against Substance Abuse, and Jessica Hulsey, founder and CEO of the Addiction Policy Forum.