COVID Response Must Include Investing in Mental Health

By Benjamin F. Miller and Jonah C. Cunningham

Winston Churchill is credited with saying “never let a good crisis go to waste.”  While we would not argue that the COVID-19 pandemic has been good, there is an opportunity within this crisis to rebuild our neglected mental health and substance use systems to prioritize prevention and ensure equitable access for all communities in a more integrated and intentional way.  

The current mental health crisis has been well documented from startling increases in overdose deaths, to mental anguish caused by necessary social distancing, and shocking increases in hospitalizations for overdoses, self-harm, suicide ideation and attempts, and abuse.  Children, in particular, have faced a heavy toll with claims for substance use care, self-harm, and anxiety disorder all increasing significantly.

This opportunity within a crisis to overhaul our nation’s mental health system requires sustained federal leadership. Congress recently passed the American Rescue Plan Act of 2021.  This new law includes billions of dollars for substance use treatment, mental health care, behavioral health workforce training, school-based mental health services, and suicide prevention. While these funds are much needed, they are a down payment to make up for decades of chronic underfunding despite desperate need. And further, simply putting more money into a system that wasn’t working does little to change any meaningful outcome. We have to think differently about solutions by pursuing more robust policy and structural reform.    

Sustained Funding and Leadership - The American Rescue Plan includes billions for mental health programs. In particular, it includes $1.5 billion for the Substance Abuse Prevention and Treatment Block Grant, which provides funding and technical assistance to states to treat and prevent substance use, and another $1.5 billion for the Mental Health Block Grant, which funds states to provide community-based mental health services. These are needed investments given the crippling cuts to mental health programs in states that followed the recession of the late 2000s. 

However, we must ensure that funding is being put into the system we want, not just the system we have, and sustained over time to meet current and future needs. Trust for America’s Health publishes an annual report on public health funding and found a drastic mismatch between the need for public health investments and actual funding levels. This dynamic is not exclusively a public health problem. Mental health and substance use funding has languished for decades.

This lack of investment has real consequences. Mental health and substance use care are currently undergoing a number of initiatives that could transform prevention, access, and care-like the transition to the three-digit number 9-8-8 for the National Suicide Prevention Lifeline- but require long-term support and leadership to be successful.

Invest in Equity-The COVID-19 pandemic has exposed disparities that cut across race, age, and income levels.  Similarly, disparities exist in access to mental health and substance use prevention treatment. One key to address health care disparities is to account for who is, and just as importantly, who is not getting services. For example, studies have shown a higher barrier to access buprenorphine, a form of medication assisted treatment for opioid use disorder, in communities of color. The Substance Abuse and Mental Health Services Administration (SAMHSA), which oversees a number of grant programs including the aforementioned block grants, should improve demographic data collection to identify gaps and ensure equitable access to services. 

Simple actions like providing resources in multiple languages can have profound effects on access. SAMHSA should expand resources to ensure culturally aware and linguistically competent services are available. One way to accomplish this is by ensuring that behavioral health workforce, like our country, includes individuals from different backgrounds. Further, we should be thinking more creatively about our workforce – and not just investing resources in the licensed workforce but also invest in strategies that can scale up peer support specialists, community health workers, and even trained barbers!   

Build Up Promising and Novel Approaches - As much as we know about effective prevention and treatment for mental health and substance use, we still have much to learn. Much of what we need to do revolves around bringing services to the places people are - from our schools to primary care practices, there is an opportunity to be more proactive identifying needs and meeting those needs in a timely manner.

There are promising initiatives that could transform the way we prevent substance use and mental distress, but they are still in their nascent stages. Programs like the Centers for Disease Control and Prevention’s Adverse Childhood Experiences (ACEs) program funds research and helps communities implement strategies to prevent ACEs from occurring could have significant downstream effects in preventing suicide and overdose deaths. Further understanding of the role childhood trauma has on adult health outcomes could inform current youth-focused programs and improve long term health outcomes.

An equitable mental health and substance use system will not be built overnight.  It requires sustained investments, oversight, leadership and a commitment to enhancing equity. Now is the time to build the system our country needs. Otherwise, this crisis will be wasted.

Dr. Benjamin Miller is the Chief Strategy Officer at the Well Being Trust. Jonah Cunningham is a Government Relations Manager for Trust for America’s Health.