On Feb. 15, the Senate Finance Committee held its second in a series of hearings on youth mental health titled “Protecting Youth Mental Health: Part II - Identifying and Addressing Barriers to Care.” This hearing served as a follow-up to the committee’s Feb. 8 hearing titled “Protecting Youth Mental Health: Part I - An Advisory and Call to Action,” which featured testimony from Surgeon General Vivek Murthy, MD, MBA [refer to Washington Highlights, Feb. 11]. The AAMC previously responded to Chair Ron Wyden (D-Ore.) and Ranking Member Mike Crapo’s (R-Idaho) September 2021 request for input on developing policy proposals and bipartisan legislation to address barriers to mental health care [refer to Washington Highlights, Nov. 19, 2021]. These most recent hearings were specifically focused on addressing the barriers to mental health care encountered by the nation’s youth.
In his opening statement, Wyden reflected upon Murthy’s testimony from the preceding week, which underscored the average 11-year delay between the onset of mental health symptoms and the initiation of treatment. Wyden emphasized the importance of early detection and intervention for mental health conditions, particularly at school and in the community. “The 11-year treatment gap is a sign that young people are struggling,” he stated. “Mental health care simply isn’t starting early enough, and it’s not reaching young people where they are, particularly kids in rural areas.”
Crapo echoed these concerns about delayed and forgone mental health care among young people, particularly those residing in rural areas, in his opening statement. He stressed the importance of telehealth in the provision of mental health care. “Children can—and often do—benefit from services delivered via telehealth,” he stated. “[T]his Committee should also prioritize clarifying and expanding care delivery options for children covered by Medicaid, regardless of geographic location.”
Crapo also highlighted the need for continued investment in the mental health workforce, noting the impact of “health care professional burnout, steep regulatory demands, and other strains” on the long-term retention of providers. In addition, he emphasized the importance of physicians’ perspectives as the committee “look[s] to bridge gaps in care, better integrate physical and behavioral health services, and promote value-based payment models that put patients first.”
The committee heard from Tami Benton, MD, psychiatrist-in-chief, executive director, and chair of the Department of Child and Adolescent Psychiatry and Behavioral Sciences at the Children’s Hospital of Philadelphia. In her testimony, Benton underscored the societal burden of delayed pediatric mental health care on childcare, education, juvenile justice, and medical systems. To expand access to pediatric mental health services, Benton recommended increased investment in the mental health workforce, including psychiatrists, psychologists, mental health therapists, nurse practitioners, case managers, and community mental health workers. In addition, Benton highlighted the role of Certified Community Behavioral Health Clinics (CCBHCs) in expanding access to mental health care among underserved communities and diverting young people from emergency department and in-patient settings.
In a key exchange with Sen. Debbie Stabenow (D-Mich.), Benton was asked about the role of CCBHCs in the provision of mental health care in underserved communities. Benton highlighted the positive impact that CCBHCs have in conjunction with academic medical centers, but also stressed the importance of enhanced reimbursement. “[B]ecause reimbursement isn’t always what it should be, [CCBHCs] tend to run with … a lower number of high-cost providers,” she explained. “Without strong partnerships, we’ll never be able to successfully address the concerns of young people in our country.”
The committee also heard from Sharon Hoover, PhD, professor in the Division of Child and Adolescent Psychiatry at the University of Maryland School of Medicine and co-director of the National Center for School Mental Health. In her testimony, Hoover stressed the role of schools in the provision of mental health care, endorsing “partnerships between the education and behavioral health sectors to support a full continuum of mental health supports and services.” Hoover recommended investment in the school mental health workforce through existing federal programs such as the Behavioral Health Workforce Education and Training Program, the National Health Service Corps, and the Substance Abuse and Mental Health Services Administration Minority Fellowship Program. In addition, Hoover advocated for expanded reimbursement and technical assistance for mental health services administered via telehealth.
Sen. Ben Cardin (D-Md.) also asked Hoover about the challenges of expanding telehealth in school-based settings. Hoover noted that Medicaid and Children’s Health Insurance Program reimbursement parity for mental health services delivered via telehealth is key to supporting important investments in telehealth infrastructure, such as wireless broadband. She explained, “We know that there are continued infrastructure improvements that are necessary to improve tele-mental health services in schools, which would include enhanced broadband systems, up-to-date telehealth delivery equipment, and internet connectivity services, especially in our rural communities.”