Coalition Makes Case for Investing in Mental Health and SUD Care Infrastructure

Just a few days ago, the Coalition for Whole Health (CWH) released a set of recommendations to Congress and the Biden-Harris administration for improving behavioral health care—Building for Health. The report recommends investments in infrastructure to deliver essential mental health and substance use disorder (SUD) care to the more than 60 million people in the United States living with a mental illness, SUD or both.

The CWH is a broad coalition of more than 200 national, state and local organizations representing the mental health and SUD prevention, treatment and recovery communities. The coalition has worked for over 12 years with Congress and presidential administrations to improve coverage for and access to the full range of effective mental health and SUD services, supports and care.

As Congress and the Biden-Harris administration continue to negotiate the scope of an infrastructure bill, CWH urges them to take swift and decisive action in four key areas that will help people, families, communities, and our nation to become healthier and stronger in the wake of the pandemic:

• Strengthen and expand the nation’s mental health and SUD workforce. Add jobs, engage peers, train other disciplines in mental health and SUD care.
• Invest in the digital mental health/SUD infrastructure. Permanently expand the use of telehealth, fund audio only care, improve the use of telehealth for crisis stabilization, improve the definition of “home” for care delivery, extend IT and internet infrastructure, expand the availability and use of electronic health records.
• Build capacity to expand access to comprehensive care. Increase funding for harm-reduction services, build treatment and recovery support capacity, support health (not punishment), support young people, strengthen home and community-based services.
• Expand affordable and stable housing opportunities. Ensure the availability of affordable homes to all in need, improve access for persons with mental health and SUD histories, ensure a full continuum of housing services, enforce the Americans with Disabilities Act.

Clearly, infrastructure not only is concerned with bridges, roads, airports and the power grid, but also with our human capital. Our national infrastructure literally begins with people. As I have discussed many times in this forum, our human infrastructure for mental health and SUD was vulnerable and struggling—some would say in deep crisis— long before the COVID-19 pandemic began. The pandemic simply exposed and exacerbated these problems even further.

This crisis has several features: the rapid retirement of baby-boomers from the field, the small group from the baby-bust generation who entered behavioral health, the difficulty millennials have in establishing a behavioral health career, the inability of the field to engage peers appropriately because of low salaries, and the failure of the universities to train enough new providers.

Pre-COVID-19, the field was able to provide care only to about half of the population with mental health and SUD conditions. Because COVID-19 has more than doubled the number of persons with behavioral health conditions, the proportion served today has declined to about 1 in 4.   

We cannot ameliorate the devastating impacts of the pandemic without also addressing the mental health, drug overdose and suicide crises that existed before COVID-19 and which have worsened dramatically during the pandemic. Both Congress and the administration are aware that these problems must be addressed if our economic and social structures are to recover. Improving our behavioral health infrastructure must be given priority attention. That can be done through the infrastructure bill now being considered by Congress.

Please join the CWH in this urgent call to the Congress and the Biden-Harris administration to improve our behavioral health infrastructure. The need is dire.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.