In his State of the Union address, President Biden announced an ambitious plan to address the country's mental health needs, presenting it as an issue with bipartisan support.

"Let's get all Americans the mental health services they need — more people they can turn to for help and full parity between physical and mental health care if we treat it that way in our insurance."

On Tuesday, the White House also released a fact sheet that lays out details of the administration's strategy. It seeks to address a mental health crisis that has been years in the making but was only worsened by the COVID-19 pandemic.

The plan focuses on ways to strengthen system capacity and connect people who need help to a continuum of care. It includes measures to expand the mental health care workforce, efforts to establish a crisis-care response system to support the launch of the 988 crisis line in July, a focus on children's mental health and proposals to push insurance companies to improve their coverage of behavioral health care.

"We're really thrilled about this focus," says Schroeder Stribling, president and CEO of the advocacy group Mental Health America. "We have needed a bold national strategy for a long time, and we're just pleased to see that the administration is taking this opportunity. This has been long in coming."

This is the first time since the Carter administration that the federal government has taken such significant leadership in addressing mental health, says Dr. Thomas Insel, a psychiatrist and the former director of the National Institute of Mental Health.

"I think this is an important moment," he says. "For the most part, the federal government has ceded mental health policy [and] services to the states. Essentially, the federal government has been missing in action for 41 years, and Biden's comments and this fact sheet bring it back into the center of the action for mental health."

Insel's and other advocates' excitement also extends to the specifics of initiatives spelled out by the White House.

But they say the success of the plan depends on congressional support for the regulations and funding proposals outlined by the administration.

It's particularly important, says Stribling, that lawmakers consider long-term funding. "This cannot be a one-time intervention from the federal level," Stribling says. "This must be a sustained and broad-based response."

The mental health impact of the pandemic, Stribling adds, "is going to have a very long tail. And we need to remember that we had a preexisting mental health crisis before the pandemic. We're talking about addressing decades' worth of declining mental health in our country."

Still, the president's focus on the mental health crisis — and recent signs of bipartisan support for addressing it — are very encouraging, says Insel: "I think for the first time in a very, very long time, we have both White House and congressional interest and momentum for, as the president said, taking on mental health."

Here are five highlights of the plan that advocates find promising.

1. Focus on children's mental health

In his speech Tuesday night, Biden gave special emphasis on addressing the mental health needs of children, "whose lives and education have been turned upside down" during the pandemic.

The plan proposes several efforts to curtail social media's harmful effects on kids, including calling on Congress to ban excessive data collection from children and advertising that targets them. It also proposes to expand early childhood and in-school services to prevent young kids' mental health problems from growing worse.

The focus on children's mental health is historic and necessary, says Dr. Tami Benton, the president-elect of the American Academy of Child and Adolescent Psychiatry. "Prevention is the most effective and most cost-effective way to prevent the onset of mental illness," says Benton.

2. Build up the mental health workforce

The Biden plan emphasizes the need to build the pipeline of qualified mental health professionals, citing a "severe shortage" of providers. "I think this commitment to the workforce is hugely important, and it is going to take time," says Insel, whose new book, Healing, outlines the failures of the mental health care system and efforts to address them.

But he notes that the plan proposes around $1 billion of new investment in the effort in the next budget, for measures like training, scholarships and loan forgiveness to encourage people to enter the field.

Benton was impressed with a proposal to train and support paraprofessionals to be better able to help with mental health — "people who are already interfacing with vulnerable individuals such as social services employees, child welfare workers" — as well as creating certifications for peer specialists. This would be "a very different way of perceiving who's responsible for the mental health of our nation."

"It's a way to engage our communities. It's a way to destigmatize mental health, and it's a way to really expand the workforce in ways that we haven't talked about before," she says.

3. Make funding for community behavioral health centers permanent

For several years, the federal government has offered grants for funding community mental health clinics — places where people can get 24/7 care in their local community for mental health and substance use issues. Now the administration wants to put permanent funding for these in the next budget.

"That's a long-term investment to create a federally funded community mental health network. We haven't had that since really the 1970s and 1980s," says Insel. "That's a huge, huge change."

4. Support crisis care

This summer will see the launch of the new mental health crisis hotline, reached by dialing 988. The Biden administration has already provided $180 million for staffing crisis call centers and supporting local crisis response. Now it's proposing more funding to staff local crisis centers and a "crisis care continuum: someone to call, someone to respond, and somewhere for every American in crisis to go."

"The crisis lines and crisis-based services would be such an addition for many of the families who are coming in to seek emergency care," says Benton. Patients in crisis could potentially avoid going to the emergency room, she says, if they have someone to talk to who can help them understand the problem they're facing and access resources or even go to their home to defuse a crisis.

"There's a large evidence base supporting the effectiveness of those interventions," she says. "It's great to see an investment and, again, training people where they are and keeping families together and in their homes."

5. Make sure insurance covers mental health

Since 2008, a federal law has called for health insurers to cover mental health conditions at the same level as they cover other health problems. But enforcement was left up to states, says Insel, and patients can often struggle to get needed mental health care covered. The Biden administration says it wants to require all health plans to cover "robust behavioral health services."

"This is another great example of the federal government stepping up," says Insel. One specific ask from the White House is "that every individual with commercial insurance will get three behavioral health visits per year without a copay. That's a pretty big step forward," Insel adds.

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The mental health crisis is escalating in the U.S. So when President Biden spoke specifically about children's mental health and the need to expand services for all Americans struggling with mental illness in the State of the Union address last night, mental health advocates took notice. Here to talk more about the White House's plan is NPR health correspondent Rhitu Chatterjee. Hey, Rhitu.


SHAPIRO: So what are advocates excited about from what they heard last night?

CHATTERJEE: Well, you know, they're excited, mainly because this is the first time in, really, decades that the White House has prioritized mental health and is taking leadership in addressing the problem. Here's Dr. Tami Benton. She heads the psychiatry department at the Children's Hospital of Philadelphia.

TAMI BENTON: This is the first time that I've ever seen this level of interest and investment on a national level in mental health, specifically children's mental health.

CHATTERJEE: And she said this is timely because the pandemic has really exacerbated the mental health crisis, especially for kids. And it's been brewing for years before.

SHAPIRO: So what are some specifics of the Biden plan?

CHATTERJEE: Well, first of all, it's a multipronged and comprehensive plan. It includes proposals for funding increase, policy changes, regulations. For example, Dr. Benton pointed out that the president talked about addressing the effects of social media on kids.

BENTON: There are many benefits to social media, but one of the things that we know for sure is that for adolescents who are at risk anyway, social media can have significantly damaging effects.

CHATTERJEE: And the White House is asking Congress to ban excessive data collection and targeted online advertising for children and young people. And then Dr. Benton said she was also glad to see a commitment to making sure that kids and families get access to mental health services when and where they need it. So, for example, the CARES Act and the American Rescue Act have already given schools money to hire more mental health professionals so that schools can do more to address students' mental health needs. And the president is proposing another $1 billion in the 2023 budget to help schools hire more providers. And in fact, last night, the president talked about improving access to mental health services for everybody.


PRESIDENT JOE BIDEN: And let's get all Americans the mental health services they need. More people can turn for help and full parity between physical and mental health care if we treat it that way in our insurance.


SHAPIRO: Rhitu, what would full parity between physical and mental health care in insurance really look like?

CHATTERJEE: So, Ari, you know, we have a mental health parity law that requires insurers to have the same sort of services and benefits for both mental and physical health. So, for example, insurance plans aren't allowed to require pre-authorizations for mental health or have fewer number of providers in their networks compared to physical health. But that's not the reality on the ground. The law is poorly enforced, and the president wants to change that. He's proposing that insurance companies be required to cover at least three visits annually without co-pay. I spoke with Dr. Tom Insel - he's the former director of the National Institute of Mental Health - about this.

TOM INSEL: That's a pretty big step forward. We haven't seen anything like that in a previous proposal.

SHAPIRO: As promising as all that sounds, what are the chances that Congress supports it?

CHATTERJEE: So I asked Dr. Insel the same question, and here's what he told me.

INSEL: If you had asked me about Congress five years ago, 10 years ago, I would say there were points of light but no real energy for this topic.

CHATTERJEE: But now, he says, there's a lot of bipartisan interest and congressional support that's been building for a few years, actually, so he's hopeful we will be seeing some real changes.

SHAPIRO: NPR's Rhitu Chatterjee, thank you.

CHATTERJEE: Thank you, Ari. Transcript provided by NPR, Copyright NPR.

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