Tearing Down Barriers to Mental Health Treatment

As Mental Health Awareness Month draws to a close, it is time to reflect on our collective progress—and, more important—how we can improve our nation’s approach to mental healthcare.

Each of us has had our mental health tested in some form in the past year. Isolation, illness, financial struggles, job loss, and the stress of balancing childcare, school, and work time have frayed our nerves.

For those who struggle with serious mental illness, the consequences of the Covid-19 pandemic have been especially devastating. We now know that individuals with schizophrenia are nearly three times more likely to die from Covid-19. Compared with the general population, people with severe mental illness are also more likely to be obese and have disease co-morbidities such as cardiovascular disease or Type-2 diabetes, which have been factors in poorer Covid-19-related outcomes.

Meanwhile, Covid-19 restrictions have reduced the availability of mental health treatment options, as community resources limited in-person contacts and inpatient facilities shifted beds to handle pandemic cases. People with serious mental illness are also vastly overrepresented in our jails, prisons and homeless shelters, facilities that have struggled with repeated Covid-19 outbreaks.

Innovations in telemedicine have been a blessing. Physicians now see 50 to 175 times more patients virtually— including patients with behavioral health needs—than they did before the pandemic. Even with these advancements, though, mental healthcare is still too often governed by archaic regulations that prevent us from building a truly responsive full continuum of care, especially for those who need it most.

Many are surprised to learn that Congress last updated Medicaid guidelines for inpatient mental health treatment 50 years ago.[1] In doing so, Medicaid established a cap on the number of beds provided for patients, and the number of days a patient can receive care in a facility. In some instances, Medicaid will only provide coverage for patients receiving care for 15 days— regardless of medical need.

This restriction is a vestige of a different era that sought to end the practice of indefinitely institutionalizing people with mental illness in asylums. Care to treat mental illness has changed enormously since then, and continuing the Institutions for Mental Diseases (IMD) exclusion now actively hinders access to care and harms those in need.

For no other illness do we allow the law to categorically deny coverage, regardless of medical need. But because of the ongoing stigma associated with mental illness, our society allows these outdated restrictions to continue—and doing so has had damaging consequences. Consequently, people with the most serious mental illness are forced to make do with abbreviated inpatient stays or to seek care in less-intensive community programs that are often ill-equipped to meet their needs.

The IMD exclusion’s 15-day cap is particularly harmful when considering that patients are uniquely vulnerable to suicide upon discharge – they are 15 times more likely than other populations to commit suicide.[2]

We must remove this barrier to care. Please visit our Access to Care page to learn more.    

Congressional leaders are working to solve this issue. Recently, Rep. Tom Emmer (R-Minn.) re-introduced the Expanding Access to Inpatient Mental Health Act, which would eliminate the IMD exclusion’s arbitrary cap on mental health services. Specifically, it would eliminate the 15-day cap for Managed Care Organizations (MCOs) and Prepaid Inpatient Health Plan (PIHP) beneficiaries receiving care in an IMD.

A similar effort from Rep. Grace Napolitano (D-Calif.), the Increasing Behavioral Health Treatment Act, would repeal the IMD exclusion and require states to submit a plan to: increase access to outpatient and community-based behavioral health care; increase availability of crisis stabilization services; and improve data sharing and coordination between physical health, mental health, and addiction treatment providers and first responders.

Efforts such as these could ensure Medicaid beneficiaries finally receive the professionally guided care they deserve, and we can ensure that clinicians, not artificial restrictions, govern mental healthcare for all Americans.

It is not enough to end the stigma around mental health treatment; we must make care affordable and accessible for those in need. With May as Mental Health Month, I hope you will join us in breaking the stigma. Seek care when you need it and encourage others to do the same. We are all in this together.

If you or someone you know is in an emergency, call 911 immediately. If you are in crisis or are experiencing suicidal thoughts, call the National Suicide Hotline at 1-800-273 TALK (8255). If you’re uncomfortable talking on the phone, you can also text NAMI to 741-741 to be connected to a free, trained crisis counselor on the Crisis Text Line.

[1] https://fas.org/sgp/crs/misc/IF10222.pdf

[2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5710249/#:~:text=A%20recent%20US%20study%20reported,the%20US%20national%20suicide%20rate.