In his first State of the Union, the President will outline a unity agenda consisting of policy where there has historically been support from both Republicans and Democrats, and call on Congress to send bills to his desk to deliver progress for the American people. As part of this unity agenda, he will announce a strategy to address our national mental health crisis.
Our country faces an unprecedented mental health crisis among people of all ages. Two out of five adults report symptoms of anxiety or depression. And, Black and Brown communities are disproportionately undertreated - even as their burden of mental illness has continued to rise. Even before the pandemic, rates of depression and anxiety were inching higher. But the grief, trauma, and physical isolation of the last two years have driven Americans to a breaking point.
Our youth have been particularly impacted as losses from COVID and disruptions in routines and relationships have led to increased social isolation, anxiety, and learning loss. More than half of parents express concern over their children's mental well-being. An early study has found that students are about five months behind in math and four months behind in reading, compared with students prior to the pandemic. In 2019, one in three high school students and half of female students reported persistent feelings of sadness or hopelessness, an overall increase of 40 percent from 2009. Emergency department visits for attempted suicide have risen 51 percent among adolescent girls.
This youth mental health crisis has been accentuated by large social media platforms, which for years have been conducting a national experiment on our children and using their data to keep them clicking-with enormous consequences. While technology platforms have improved our lives in some ways, there is mounting evidence that social media is harmful to many kids' and teens' mental health, well-being, and development. As the Surgeon-General has said, "when not deployed responsibly and safely, these tools can pit us against each other, reinforce negative behaviors like bullying and exclusion, and undermine the safe and supportive environments young people need and deserve." In the State of the Union, the President will call on Congress to strengthen privacy protections, ban targeted advertising to children, and demand technology companies stop collecting personal data on our children.
President Biden is laying out a vision to transform how mental health is understood, perceived, accessed, treated, and integrated - in and out of health care settings. The American Rescue Plan laid the groundwork, providing critical investments to expand access to mental health services. Now, far more is needed to ensure that everyone who needs help can access care when and where they seek it.
The President is announcing a national mental health strategy to strengthen system capacity, connect more Americans to care, and create a continuum of support -transforming our health and social services infrastructure to address mental health holistically and equitably.
Strengthen System Capacity
At the center of our national mental health crisis is a severe shortage of behavioral health providers. More than one-third of Americans live in designated Mental Health Professional Shortage Areas, communities that have fewer mental health providers than the minimum their level of population would need. Even outside of these shortage areas, the fragmentation of the current system makes it hard for mental health providers to meet people where they are. We must dramatically expand the supply, diversity, and cultural competency of our mental health and substance use disorder workforce - from psychiatrists to psychologists, peers to paraprofessionals - and increase both opportunity and incentive for them to practice in areas of highest need. Our crisis response infrastructure must also be strengthened to ensure that those facing acute behavioral health challenges can be seamlessly connected to necessary services. We will:
- Invest in proven programs that bring providers into behavioral health. The President's FY23 budget will invest $700 million in programs - like the National Health Service Corps, Behavioral Health Workforce Education and Training Program, and the Minority Fellowship Program - that provide training, access to scholarships and loan repayment to mental health and substance use disorder clinicians committed to practicing in rural and other underserved communities. These major new investments will both expand the pipeline of behavioral health providers and improve their geographic distribution to target areas with the greatest unmet need.
- Pilot new approaches to train a diverse group of paraprofessionals. Doctors, nurses, and other clinicians cannot do this work alone. In the fall of 2022, HHS expects to award over $225 million in training programs to increase the number of community health workers and other health support workers providing services, including behavioral health support, in underserved communities. The President's FY23 budget will also propose major new multi-year funding to develop provider capacity and support mental health transformation.
- Build a national certification program for peer specialists. The Biden-Harris Administration will convene stakeholders, launch development, and support implementation of a national certified peer specialist certification program, which will accelerate universal adoption, recognition, and integration of the peer mental health workforce across all elements of the health care system.
- Promote the mental well-being of our frontline health workforce. Three-quarters of frontline health care workers report burnout, while more than half say they lack adequate supports to cope. The Administration has already dedicated $103 million in American Rescue Plan funding to address burnout and strengthen resiliency among health care workers. The President will strengthen this commitment by signing the bipartisan Dr. Lorna Breen Health Care Provider Protection Act into law, which will invest $135 million over three years into training health care providers on suicide prevention and behavioral health while launching an awareness campaign to address stigmatization, promote help-seeking and self-care among this workforce. In addition, HHS will continue grant programs to support health systems and provider groups to prevent burnout, relieve workplace stressors, administer stress first aid, and increase access to high-quality mental health care for the frontline health care workforce.
- Launch the "988" crisis response line and strengthen community-based crisis response. This summer, HHS will launch the 988 mental health crisis service hotline, which will create a national network of local crisis centers fortified by national back up centers to answer calls and texts. Through the American Rescue Plan, the Administration has provided $180 million to support local capacity to answer crisis calls, and establish more community-based mobile crisis response and crisis stabilizing facilities to minimize unnecessary emergency department visits. The President's FY23 budget will build on this investment with an additional nearly $700 million to staff up and shore up local crisis centers while also building out the broader crisis care continuum: someone to call, someone to respond, and somewhere for every American in crisis to go.
- Expand the availability of evidence-based community mental health services. The American Rescue Plan invested millions of dollars to expand Certified Community Behavioral Health Clinics (CCBHCs), a proven model of care that has been shown to improve health outcomes while lowering costs, by delivering 24/7 mental health and substance use care to millions of Americans, no matter who they are or whether they're able to pay. The President's FY23 budget will build on this down payment, by proposing to make this program permanent while granting states funding to expand CCBHCs for the communities that need them most. The President's budget will also permanently extend funding for Community Mental Health Centers, which provide essential mental health services to vulnerable communities that would otherwise lack access.
- Invest in research on new practice models. New scientific and technological innovation has the opportunity to expand our capacity to meet American's mental health needs, but there is a pressing need for research to validate what works and build a robust evidence base. The President's FY23 budget will call for investing $5 million in research into promising models for treating mental health conditions.
Connect Americans to Care
Less than half of Americans with mental health conditions receive treatment. The average delay from the onset of mental health symptoms to treatment is 11 years. Too often, costs prevent people from accessing care far. At the same time, those with mental illness are often misunderstood, mistreated, mislabeled, and misdirected to services. It is imperative that we promote better pathways to care and make it as easy as possible for all Americans with behavioral health needs - including common and pervasive conditions like anxiety and depression - to access the resources that will improve their well-being. We must fight to ensure that every American can access mental health and substance use disorder care through their insurance coverage, while integrating mental health services and supports into a variety of other settings, online and in the community. The Biden-Harris Administration will:
- Expand and strengthen parity. The 2008 Mental Health Parity and Addiction Equity Act called for mental health care benefits to be covered at the same level as physical health care benefits. The President's fiscal year 2023 (FY23) budget will propose that all health plans cover robust behavioral health services with an adequate network of providers, including three behavioral health visits each year without cost-sharing.
- Integrate mental health and substance use treatment into primary care settings. Equipping primary care providers with the tools to identify, treat, and manage behavioral health conditions is a proven approach for delivering quality mental health and substance use care, particularly for individuals with depression. To facilitate adoption of these models, the President's FY23 budget will double funding for primary and behavioral health integration programs. In addition, using existing authority, the Department of Health and Human Services (HHS) will test payment models that support the delivery of whole-person care through behavioral health integration and authorize Medicaid reimbursement of inter-professional consultations so that primary care providers can consult with a specialist and provide needed care for patients.
- Improve veterans' access to same-day mental health care. Veterans are at higher risk for mental health and substance use challenges than the general population. Increasing their access to quality mental health care is the first step to closing this disparity. The Department of Veterans Affairs (VA) will reduce barriers to mental health access by fully implementing their Primary Care Mental Health Integration and Behavioral Health Interdisciplinary Program, which connect veterans to same-day mental health care and improve the integration of these services into primary care settings.
- Expand access to tele- and virtual mental health care options. The use of telehealth to address mental health and substance use needs rose dramatically during the height of the pandemic and has remained above pre-pandemic levels even where COVID has waned. These tele-mental health services have proven both safe and effective, while reducing barriers to care. To maintain continuity of access, the Administration will work with Congress to ensure coverage of tele-behavioral health across health plans, and support appropriate delivery of telemedicine across state lines. At the same time, the HHS will create a learning collaborative with state insurance departments to identify and address state-based barriers, like telehealth limitations, to behavioral health access. And the United States Office of Personnel Management will facilitate widespread, confidential, and easy access to telehealth services, in part by strongly encouraging Federal Employees Health Benefits Program carriers to sufficiently reimburse providers for telehealth services, and to eliminate or reduce co-payments for consumers seeking tele-mental service.
- Expand access to mental health support in schools and colleges and universities. The President has committed to doubling the number of school-based mental health professionals. The Department of Education (ED) will continue to support states, school districts, colleges and universities, in using relief funds - including the more than $160 billion invested by the American Rescue Plan in the Elementary and Secondary School Emergency Relief (ESSER) and Higher Education Emergency Relief Fund (HEERF) - to address the mental health needs of students, including by training, recruiting, and retaining more school- and college and university-based mental health professionals. With the help of ESSER funds, schools have already seen a 65% increase in social workers, and a 17% increase in counselors. To help schools sustain these roles, the Department of Health and Human Services will make it easier for school-based mental health professionals to seek reimbursement from Medicaid, and the President's FY23 budget will propose $1 billion to help schools hire additional counselors and school psychologists and other health professionals.
- Embed and co-locate mental health and substance use providers into community-based settings. Expanding pathways to care also means creating new, low-barrier access points, in settings where Americans already live, work, and play. To that end, the President's FY23 budget will include $50 million to pilot models that embed and co-locate mental health services into non-traditional settings like libraries, community centers, schools, and homeless shelters.
- Increase behavioral health navigation resources. Finding the right care or an available provider can be a frustrating experience. We need to make it easier for Americans both to find help, and to receive it. To meet this need, the Administration will build new easy-to-access, user-friendly online treatment locator tools - starting with a redesigned and refurbished mentalhealth.gov - so Americans can find care when they need it, where they need it, with the click of a button. The Department of Defense will also create a one-stop online resources for service members and their families to access mental health information and locate mental health providers.
Support Americans by Creating Healthy Environments
We cannot transform mental health solely through the health care system. We must also address the determinants of behavioral health, invest in community services, and foster a culture and environment that broadly promotes mental wellness and recovery. This crisis is not a medical one, but a societal one. In December 2021, the Surgeon-General released an Advisory on Protecting Youth Mental Health that outlined a wide range of causes for the national youth mental health crisis and underscored growing concern about the harms of digital technologies, particularly social media, to the mental health and well-being of young people, as well as calling for practical action from technology companies to address these concerns.
We need a whole-of-society effort to address these concerns: to expand prevention programs and actions that improve mental health at every age and across settings; and to enhance programs that support recovery, especially for populations at increased risk during vulnerable transition periods. The Biden-Harris Administration will:
- Strengthen children's privacy and ban targeted advertising for children online.
The online platforms have billions of users worldwide, many of whom use the platforms for hours a day. These companies know everything from where users are physically located at any moment, to how many seconds they spend reading a particular post, to intimate personal data like what medical symptoms they have been researching. Children are also subject to the platforms' intensive and excessive data collection vacuum, which they use to deliver sensational and harmful content and troves of paid advertising to our kids. By one estimate, online advertising firms hold 72 million data points on the average child by the time they reach the age of 13. The President is calling on Congress to ban excessive data collection on and targeted advertising online for children and young people.
- Institute stronger online protections for young people, including prioritizing safety by design standards and practices for online platforms, products, and services. Social media platforms are designed to be addictive, too often deliver age-inappropriate content, promote unhealthy social comparisons, and enable harassment, child sexual exploitation, stalking, and cyber-bullying. Children, adolescents and teens are uniquely vulnerable to harmful and dangerous content online. Other democratic countries have been acting to prevent and reduce the online harms to their children. The President believes not only that we should have far stronger protections for children's data and privacy, but that the platforms and other interactive digital service providers should be required to prioritize and ensure the health, safety and well-being of children and young people above profit and revenue in the design of their products and services.
- Stop discriminatory algorithmic decision-making that limits opportunities for young Americans. When a girl searches for jobs online, platforms will too often push her away from fields like engineering that historically have excluded women. Searches for "Black girls," "Asian girls," or "Latina girls" too often return harmful content, including pornography rather than role models, toys, or activities. Platforms shape how our kids understand what is possible and access opportunities. When young people are treated unfairly, it can have mental health impacts including anxiety and depression. We must ensure that platforms and other algorithmically-enhanced systems do not discriminatorily target our kids.
- Invest in research on social media's mental harms. Ample research has now emerged that social media is associated with negative mental health outcomes, particularly among young people, and that children under 18 are disproportionately vulnerable to the dangerous and harmful content that they might encounter online. More research, however, is needed to understand why and how these harms occur - and how they can be prevented and treated. To meet this need, the President's FY23 budget will dedicate at least $5 million toward advancing research on social media's harms, as well as the clinical and societal interventions we might deploy to address them. Over the next year, the Department of Health and Human Services will also launch a national Center of Excellence on Social Media and Mental Wellness, which will develop and disseminate information, guidance, and training on the full impact of adolescent social media use, especially the risks these services pose to their mental health.
- Expand early childhood and school-based intervention services and supports. Half of all mental disorders begin before the age of 14. And when systems act to promote well-being at early developmental stages, youth reap the mental and emotional benefits for years to come. The American Rescue Plan dedicated millions of dollars to youth mental health. The President's FY23 budget builds on this investment and proposes to make historic investments in youth mental health services, including more than $70 million in infant and early childhood mental health programs. For example, Project LAUNCH works to ensure that the systems that serve young children have the resources and knowledge to foster their social, emotional, cognitive, and behavioral development. The FY23 budget will also continue funding for the Maternal, Infant, and Early Childhood Home Visiting Program of the Department of Health and Human Services, which supports new families by teaching positive parenting skills, conducting developmental and mental health screenings, promoting school readiness, and linking to community resources and supports. Additionally, the President's FY23 budget will propose to dramatically expand funding for community schools by increasing funding for the Full-Service Community School program by over $400 million dollars relative to current levels - a more than ten-fold increase. Community schools provide a range of wraparound supports to students and their families, including mental health services and other integrated student supports.
- Set students up for success. When students struggle in school, it impacts their well-being. A comprehensive strategy to support student wellness must also include efforts to address the impact of the pandemic on student learning, particularly on students most impacted by the pandemic, and create supportive learning environments. ED will continue to help states and school districts use the $122 billion in ARP ESSER funds for this purpose. Specifically, the Department will help states and districts use the funds to provide more individual and small group instruction, hire instructional and other critical staff, launch high-impact tutoring programs, provide high-quality afterschool and summer learning and enrichment programs, and invest in other evidence-based strategies that will help our students recover from the pandemic. Districts nationwide are already using ARP ESSER funds to invest in these strategies. To support this work, we need more caring adults taking on roles supporting students. The President is calling on Americans nationwide to take on roles as tutors and mentors to help our students recover. Those looking to return to the workforce, who are just out of school, or changing careers, should consider the rich, rewarding job opportunities in our schools and with our young people. The investments the President will propose in his FY23 budget will support and sustain efforts that set up students for success. This includes more than doubling funding for Title I, a ten-fold increase for the Full-Service Community School program, and an historic $3.3 billion increase for Individuals with Disabilities Education Act grants that support PK-12 children with disabilities and $450 million for IDEA PART C, which supports early intervention services for infants and toddlers.
- Increase mental health resources for justice-involved populations. In too many communities, jails and other correctional facilities have become the largest provider of mental health care. Approximately 40 percent of incarcerated individuals have a mental illness, yet merely one-third receive treatment. The President believes that we have both a moral and a public health obligation to increase access to comprehensive mental health care for the justice-involved. To this end, the Department of Justice will expand funding and technical assistance to local communities and corrections systems to provide behavioral health care, case management services, family services, and other transitional programming for adults returning from incarceration into the community.
- Train social and human services professionals in basic mental health skills. It's not enough to train health care providers to deliver mental health care; social and human services providers must also be equipped to identify, understand, and respond to signs of mental illness and addiction among those they serve. To this end, the Department of Housing and Urban Development will launch a national effort to train housing counselors, housing-based services coordinators, and Fair Housing grantee staff to recognize the signs of emotional distress and to connect residents with mental health resources. The U.S. Department of Agriculture will provide training on mental health resources and communication strategies to Farm Production and Conservation Mission Area field employees, who serve farmers and ranchers, as well as incorporate updated mental health information into its online resource center for State, local and clinic staff administering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). ED will continue to highlight the effectiveness of Mental Health First Aid training for educators, so that they can better support their students and one another. And the Department of Health & Human Services will provide additional training support to Head Start, Early Head Start, and home visiting grantees to spot and address mental health challenges among children.
