Health Care

After pandemic, mental health crisis challenges legislatures

States face provider shortages, inadequate infrastructure and a spiraling number of deaths of despair.
The California State Capitol Building in Sacramento (Reid Wilson / Pluribus News)

Faced with provider shortages, inadequate infrastructure and a spiraling number of deaths of despair, state lawmakers across the country are preparing to spend billions of dollars on strategies to address mental health crises that impact virtually every segment of society.

Experts say the nation’s already-growing strain of mental health emergencies has only been exacerbated by the pandemic, which brought lockdowns, school closures and the fear of a deadly pathogen.

But as the number of those suffering from mental health strains rises, there has been no commensurate increase in the workforce of trained mental health professionals.

“Our studies show that [the number of those suffering from mental health problems are] roughly four times what it was prior to the pandemic for anxiety and depression, and for substance abuse,” California Assemblyman Joaquin Arambula (D) said in an interview. “And we don’t have four times the providers that we did prior to the pandemic.”

The breadth of the problem has states exploring different avenues to expand help. Some states have loosened tele-health rules, giving people in more rural areas better access to care. Texas has expanded access to mental health medication through Medicaid. New York and Virginia have adopted curricula to teach students about mental health.

“The states are now trying to figure out: How do you build an infrastructure for the mental health? How much money do you spend? Who’s responsible? Is it local, state, you know, combination?” Virginia Sen. Barbara Favola (D) said.

In the last year, some states have expanded the amount of mental health care covered by insurance. Georgia approved a bill requiring state-regulated private insurance plans to comply with federal mental health parity rules. Connecticut, Delaware and Massachusetts all established private insurance coverage for mental health wellness exams.

Debbie Plotnick, executive vice president for state and federal advocacy at Mental Health America, said most states are working to improve their ability to provide care through 988, the national mental health crisis hotline that took over for the infrequently used suicide prevention lifeline.

“States need to build out their infrastructure to support the increased usage and the new perspective that it’s not just for somebody who’s actively suicidal at that moment. Crisis can mean many things,” Plotnick said.

States such as Colorado, Washington and Virginia have passed legislation adding small fees to phone bills to pay for the 988 service, to cover both its operation and the services that underlie its effectiveness. While most people in crisis can get help over the phone, a small number need access to in-person services.

“When someone is in crisis and calls 988, close to 90% of calls can be handled telephonically. But it’s very important that that telephonic help be in a place where a person is,” Plotnick said. The fees imposed by states are “literally a few dollars per year, but that’s the kind of funding that will make a tremendous difference to make sure calls are answered locally and there are resources on the ground if someone needs to be referred.”

State and local governments are also grappling with the burdens of a system that often puts those suffering from mental health crises on a collision course with police, rather than trained responders.

“We have too many people sitting in our county jails awaiting competency, and they have to get a bed to be able to get” treatment, said Texas Sen. Drew Springer (R).

The federal government has weighed in with billions in spending on mental health treatments. The American Rescue Plan Act allocated almost $4 billion for state and local mental health and substance abuse services, $26 billion for housing assistance, including for those with serious mental illness, and funding through Medicaid for mobile crisis teams.

Springer said the root of the problem comes down to a workforce challenge. A mental hospital in his district, in Wichita Falls, is about 300 employees short of the number it needs to fully staff up — and the pipeline of future mental health professionals who will earn degrees in the coming years is far from full.

“We’re going to find that we’ve graduated about a flat number of people [in the mental health sector] for the last 10 years. But at the same time, we’ve seen an exponential spike” in those who need care, Springer said. “We’ve got to look at how we accelerate that pipeline, bringing those clinicians — from doctors to master’s degree to associate degree certifications — to fill those gaps back in the workforce.”

In California, Arambula is pushing to open a new medical school to train the next generation of mental health professionals. Washington and Oregon have approved rules allowing students to take days off for mental health wellness.

Plotnick said the pandemic exacerbated both the number of those suffering from mental health challenges and the workforce shortage hampering the response.

“Since the pandemic, workforce issues have gotten worse, because people themselves are feeling so burnt out,” she said. “When it comes to children, there’s a really acute shortage of child and adolescent psychiatrists.”