Proposed Legislation Designed to Move Us Toward a “Stage 0 System”

As we move out of the COVID-19 pandemic, we also must begin to assess the status of our current behavioral healthcare crisis and the steps that will be necessary to address it. It is noticeably clear that this effort must confront our workforce shortage and also extend parity to all types of health insurance, including Medicare, Medicaid, and private insurance. In the past several months, I have written about the steps that will be necessary in each of these domains.

Through a truly fortunate circumstance, we also have the opportunity to bring important innovations to the solution of our behavioral healthcare crisis. In close collaboration with the public health field, we can introduce community-level programs to address stress and trauma, while also promoting resilience and improved community and personal wellbeing. This can have the effect of reducing some of the burden on our behavioral healthcare providers.

To achieve this goal, the Community Mental Wellness and Resilience Act of 2023 has been introduced in the US House (HR-3073) by Reps. Paul Tonko (D-New York) and Brian Fitzpatrick (R-Pennsylvania) and in the US Senate (S-1452) by Edward Markey (D-Massachusetts). Other cosponsors include Sens. Richard Blumenthal (D-Connecticut) and Sheldon Whitehouse (D-Rhode Island) and Reps. Don Bacon (R-Nebraska), Kathy Castor (D-Florida), and Mary Peltola (D-Alaska). This bill is designed to bring a needed public health approach to address our current behavioral health crisis.

The proposed legislation would establish a $36 million pilot grant program through the Centers for Disease Control and Prevention (CDC) “to provide funding to local community-based mental wellness and resilience programs. These programs would be designed to address the compounding mental health crisis that frontline environmental justice communities face as they bear the brunt of the climate crisis, including extreme weather events, natural disasters, epidemics, and rising temperatures. It also would focus resources on bringing mental health support to rural and underserved people who often cannot afford treatment, experience stigmatization, or face other systemic injustices embedded in the US healthcare system.” 

Of significant importance, the bill would fund local community organizations to undertake initiatives that configure their own unique strategies to build and sustain mental wellness and resilience, particularly for those members most at risk. Recent work undertaken by the Hogg Foundation in Texas, as well as by other entities in Australia, Canada, and New Zealand, shows that a self-empowering approach can be highly effective in promoting Indigenous community leadership, outreach to community members in need, and support for community members in times of stress and trauma.

A Congressional Briefing will be held on September 21, from 12 p.m. to 1:30 p.m. ET. You can read about this briefing and register at: Congressional Briefing of CMWRA (itrcoalition.org). I strongly encourage you to join this briefing to show your support and to learn more details about this groundbreaking legislation.

For far too long, behavioral health has been a “Stage 4 System” in which care is provided only when people are in severe crisis, if at all. This approach frequently harms those who receive such care, and it definitely wastes precious financial resources. Recent work on Phase 1 psychosis has begun to move us toward a “Stage 1 System” that provides care when symptoms first appear. This is an incredibly positive development for those experiencing psychosis. The draft legislation proposes to go even farther, in the direction of a “Stage 0 System” in which community interventions are undertaken in an effort to reduce and prevent trauma and decrease the prevalence of behavioral health conditions.

Such an eventuality would be truly wonderful.

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.