Essential Next Steps to Address Our National Behavioral Health Crisis

All our current indicators—common sense, community observation, county, state, and national measures—continue to shout loudly that we are experiencing a crisis of behavioral health in the United States. Since the beginning of the pandemic early in 2020, behavioral health problems have doubled in the adult population, opioid overdose deaths have shot up by almost 50% to beyond 100,000 per year, and inpatient behavioral health care of children has increased by nearly half. Further, there is a very pervasive realization that we are experiencing very severe shortages of behavioral health providers numbering in the tens of thousands nationally. The net effect is that our national behavioral health system currently only serves about one quarter of all persons with behavioral health conditions. Untreated behavioral health conditions adversely impact work productivity, lead to family breakup, result in inappropriate incarcerations, and even can lead to suicide.

Despite all these problems, and despite very broad recognition and consensus that the current behavioral health crisis has been exacerbated by the COVID-19 pandemic, the United States has yet to develop and implement a national integrated response. Clearly, we must accord the behavioral health crisis the same seriousness we are directing to COVID-19 itself. Nothing less than “all hands on deck” will suffice.

Here, I would like to suggest several essential steps to address our national behavioral health crisis. Although the specific details of each step clearly will require much further development, it is essential that we begin work on these steps immediately. We need discussion, consensus, and action. The key steps are a national emergency declaration; short-term and long-term actions in the field by deploying emergency response resources; and design and implementation of a longer-term national strategy through federal legislation and policy. 

National Emergency Declaration

President Joe Biden would declare a national behavioral health emergency. This declaration would include the designation of the Executive Office of the President as the facilitating entity to remove barriers and coordinate efforts across all elements of the federal government. Creation of a voluntary advisory group to provide expert guidance on essential actions would be part of the declaration. The National Emergency Act, the Stafford Act, and the Public Health Service Act, including emergency Medicaid and Medicare authorities, would be mobilized for this effort (see the related report from the Congressional Research Service).

Short-Term and Long-Term Steps in the Field

The authorities mobilized via the emergency declaration would both free federal financial resources and simplify federal regulatory requirements to permit a much-enhanced field response to the behavioral health crisis. Key steps would include more rapid service delivery to those most in need, as well as concerted outreach to those in need who have not received any services at all. New tools, such as the evolving 988 system and its response network, mobile crisis intervention teams, digital and virtual interventions, and peer support recovery interventions would be essential parts of this enhanced effort. In addition, providers who have departed from the behavioral health workforce, such as baby boomers and those who have left mid-career, would be encouraged to join in this effort, even if only on a part-time basis. Relaxed regulatory requirements would permit social workers, mental health counselors, and substance use counselors to be reimbursed under Medicare and Medicaid.

Simultaneously, major college and university behavioral health training programs would be challenged to devise ways to increase the number and rapidity of their programs. Short-term behavioral health skills training for community health workers, peers, teachers, care coordinators, nurse assistants, and social welfare workers, among others, would be developed and accelerated. Efforts would be undertaken to streamline and expand curricular programs for key professional groups, such as addiction physicians, psychiatrists, psychologists, social workers, psychiatric and addiction nurses, mental health and addiction counselors, and marriage and family therapists.

Particular attention would be needed in three areas: opioid and other drug use, the rising number of suicides, and youth behavioral health. Some key steps would include broad availability of fentanyl test strips and naloxone, earlier identification and intervention with persons at risk of suicide, and much better and broader behavioral health engagement of children and adolescents in our school systems.

National Behavioral Health Strategy

Now is the time to design and implement a behavioral health system for the 21st century. This would require fundamental transformation of our current system. Representatives from the field would develop a plan for this transformation that incorporates all points of view, from consumers and family members, to providers, to county and state governments, to payers and insurers, to the federal government and the political community. The goals of this effort would be very clear: universal access to good quality prevention, treatment, and rehabilitation services and much improved behavioral health status of the US population.

The leaders of our field would be expected to step forward to organize and implement this far-reaching planning effort. The time frame would be 1 year to develop the plan, then 1 year to build support for the key elements and to present the plan to the White House and to the relevant Congressional committees. Work on this effort would begin immediately.

* * *

What I have outlined here is not a “pie in the sky” dream. Rather, these steps actually are essential, granted the current status of behavioral health in the US population. Just a few moments reflection will convince you that this is true. We will need your strong advocacy and deep support to initiate these key steps.

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.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.