Alignment for Progress: 
A National Strategy for Mental Health and Substance Use Disorders

Despite effective MH/SUD treatments being available for a wide range of conditions, many Americans remain untreated or undertreated due to historically siloed MH/SUD and physical health systems.[2] Integrating MH/SUD and physical health services can increase access to MH/SUD care and improve patient outcomes.[2]

In 2017, the Centers for Medicare and Medicaid Services (CMS) began paying physicians and non-physician providers separately for supplying patients with Behavioral Health Integrated Services (BHI).[3] These services involve a closer partnership between primary care and MH/SUD providers providers, which has proven beneficial to patients and has evolved into the Collaborative Care Model (CoCM). This model has been demonstrated effective by more than 90 randomized-controlled trials and can help to more effectively utilize limited MH/SUD provider capacity.[4]

However, critical infrastructure is required to effectively implement BHI services.[4][5] Insufficient compensation for training and technical support has effectively contributed to continued payment silos between behavioral health and primary care.[5] Therefore, as proposed by the Senate Finance Committee in its November 2022 Mental Health Care Integration Discussion Draft, Congress should increase Medicare payment rates for BHI services.[1][6]

First responders are often the first on scene in an emergency, placing them at an increased risk for job-related trauma.[2][3] Thirty percent of first responders are likely to develop a mental health condition, such as depression or Post-Traumatic Stress Disorder (PTSD),[3] which is higher than the general population. Suicide attempts of fire and EMS professional is almost at seven percent, when the general population is at 0.5 percent.[3] With an increased risk for trauma, first responders need resources and support services.

On August 16, 2022, President Joe Biden signed into law the Public Safety Officer Support Act (PSOSA) of 2022, which officially acknowledged PTSD as a work-related injury.[4] While this is welcome progress, many employers, including law enforcement agencies and fire departments, are unable to hire full-time mental health professionals to treat first responders experiencing work-related PTSD or acute stress disorder.[1]

There are 10 ROTA-Rs, each located in one of the ten Health and Human Services Agency regions, whose purpose is to develop and disseminate training and technical assistance addressing opioid use in rural communities. ROTA-Rs identify model programs, and create and update materials related to prevention, treatment, recovery, and harm reduction activities for opioid and stimulant use. The centers have also expanded to include stimulant use disorders, which include methamphetamine use.[1] ROTA-Rs should be expanded to include other substance use and mental health disorders affecting rural communities, including alcohol use disorder, serious mental illnesses, and suicide prevention.

Rates of eating disorders among military members are increasing, and their families also have higher rates of eating disorders than the civilian population.[2] Congress passed the Fiscal Year 2022 National Defense Authorization Act with language from the SERVE Act, which requires expansion of treatment under TRICARE and provide additional coverage for Veterans and their families.[1][4] This coverage expansion was supposed to take effect on October 1, 2022, but the Department of Defense (DoD) has yet to implement these changes.[3] To ensure military personnel, retired military, and their families have access to eating disorder treatment, the DoD should fully implement the SERVE Act without delay.[1][2[][3]

Since its passage, the ACA has dramatically expanded access to affordable health insurance and healthcare services.[2] The ACA also mandated coverage for various preventive services, such as routine screenings for diseases or conditions.[3] These screening services must be provided by most private health plans without copay or coinsurance, regardless of whether a person’s annual deductible has been met.[3] The U.S. Preventive Services Task Force (USPSTF) regularly provides updated guidance on mandated preventive services and currently recommends screening for depression in the adult and adolescent population, particularly for those who are pregnant or elderly. The USPSTF also recommends screening and counseling for adults and adolescent populations for unhealthy alcohol use.[4] In an ongoing court case, Braidwood Management v. Becerra, a group of plaintiffs are challenging the ACA requirement to cover preventive services designated by the USPSTF - arguing the mandate is unconstitutional.[5] Access to preventive services must be preserved, including critical screenings for mental health and substance use disorders. The Department of Justice should vigorously defend this latest attack on the ACA and, should protections afforded by the ACA be undone by the courts, Congress should act quickly to restore these protections.

Eating disorders affect an estimated 9 percent of the population and often co-occur with other mental health conditions [3] and have among the highest mortality rates of all mental health and substance use disorders.[4] Eating disorders affect all age groups, including older adults enrolled in Medicare. Medical nutrition therapy is a nutrition-based treatment that also includes counseling services, and has been shown to have positive outcomes for individuals with an eating disorder.[5][6] Unfortunately, about 70 percent of individuals with an eating disorder are unable to receive treatment due to limited insurance coverage.[7] Currently, Medicare Part B only covers medical nutrition therapy for individuals who have been diagnosed with diabetes or kidney disease.[8] The passage of the Nutrition CARE Act would increase access to medical nutrition therapy for Medicare beneficiaries with an eating disorder. [1][2]