The COVID-19 pandemic has had a significant impact on the nation’s mental health. Americans were more likely to report experiencing stress, anxiety, or great sadness compared to people in other countries; Black and Latino people experienced more mental health concerns than whites. Uncertainty and disruptions in employment, income, housing, and food security have contributed to increases in anxiety and depressive disorders among adults, and children were impacted by school closures and the loss of school-based mental health services. The pandemic highlighted long-standing challenges in providing mental health services and the policies and interventions effective in addressing them.
States have an important role to play through insurance regulation, state-funded programs, and coverage of services under Medicaid. The Commonwealth Fund partnered with the Council of State Governments to create a mental health resource guide based on state priorities, best practices, and insights from leaders in the field of mental health. The work was informed by an advisory group of state legislators, health officials, and experts, and focused on four pressing policy areas:
- Social isolation and loneliness. From increased risk of suicide, moderate to severe depression, and faster cognitive decline to increased risk of cardiovascular disease and higher levels of physical stress, the impact of social isolation is substantial and wide-ranging.
- Maternal mental health. Despite increases in the prevalence of mental health disorders among pregnant and postpartum people, fewer than 30 percent who screen positive for depression or anxiety seek or receive treatment. Untreated mental illness among mothers can have profound consequences for their children and future generations. Policymakers face significant challenges addressing maternal mental health, including barriers to access, a lack of best practices regarding psychiatric medication, and varying approaches across states to postpartum care.
- Social determinants of mental health. Social determinants include income, education, and insecurities surrounding work, food, and housing. There is significant research confirming an association between income inequality and poor health outcomes. Unstable income can lead to poorer mental health, increasing risk and incidence of mental illness, and substance-use disorders.
- Mental health insurance parity. The issue of mental health parity centers around insurance plans treating mental health conditions and substance-use disorders as equivalent to other heath conditions in terms of coverage. The Affordable Care Act includes mental health parity, and many states have adopted parity measures. Despite this, enforcement of mental health parity continues to be an issue.
A severe shortage of mental health providers complicates the outlook across these four areas. The resource guide addresses the issue of workforce shortages, and also highlights ways to stretch existing resources, including, for instance, providing peer support and consultation between primary care and behavioral health providers. Some strategies include expanding telehealth psychiatric services and incorporating mental health screening and interventions into various settings like schools, senior centers, workplaces, primary care offices, and in law enforcement.
The mental health resource guide can help state policymakers address the challenges facing many Americans. Specifically, policymakers can focus on the following:
- Building capacity. States can support efforts to train providers, teachers, and community health workers to address mental health needs.
- Requiring inclusive data collection and program design. State policymakers can incorporate data collection into policies to better understand the effects of mental health challenges on communities, disparities in care, and efficacy of interventions.
- Culturally tailoring initiatives. States can use specific culturally appropriate interventions to reach populations with unique challenges.
- Taking holistic approaches. Policymakers can encourage collaborative care and value-based care models; take a “health in all policies” approach — that is, applying a health lens to all policies under consideration, from education to transportation; continue to enforce mental health parity laws; require accepted standards of care in mental health; and work toward the integration of mental health care with primary care.
- Reconfiguring health infrastructure. Changes to insurance and provider payment policies may be required. Current systems are not equipped to accommodate innovations like mother-and-baby psychiatric units.