The mental health crisis requires real solutions

Across our nation, Americans are facing a mental health crisis that has only been exacerbated by the COVID-19 pandemic. And rural states like North Dakota are at a particular disadvantage because of a severe lack of resources combined with a growing number of people seeking help.

In 2023, 29 percent of North Dakota adults reported symptoms of an anxiety or depressive disorder. And 48 of North Dakota’s 53 counties were classified as “health care worker shortage areas.” One reporter even called western North Dakota a “mental health care desert,” highlighting how desperately our state needs more access to mental health support.

Unfortunately, North Dakota is not alone in this regard. Almost every state in the country faces a shortage when it comes to mental health support, and the number of people seeking help is on the rise. In 2023, 45 percent of adults ages 35-44 reported some type of mental illness, compared to 31 percent in 2019. Adults ages 18-34 reported the highest rate of mental illness at 50 percent.

I was pleased with the Biden administration’s approach to improving access to mental health care through billions in investments ranging from a 9-8-8 hotline to support for school counselors. This is exactly the kind of support our nation needs.

But the departments of Labor, Treasury, and Health and Human Services recently announced a rule change to the Mental Health Parity and Addiction Justice Act of 2008 that could have devastating effects. While the rule is well-intentioned as a means of increasing access, it could have serious unintended consequences, including increased costs and decreased access to quality care.

The proposed rule change would seek to increase the number of providers by lowering quality standards for providers. That would leave patients navigating an already confusing market with little or no help. This influx will likely result in patients playing a game of trial and error as they search for the right provider to meet their needs.

The stigma associated with seeking care, especially for those struggling with a substance use disorder, already discourages people from seeking help. By complicating a patient’s ability to find appropriate care, this process will inevitably discourage patients from seeking care at all, further exacerbating the current crisis.

As the mental health crisis continues to spiral out of control, the answer is not to lower standards of care and complicate the system for patients.

This rule change is intended to fix a problem that doesn’t exist. Our healthcare system is one of the best in the world — we should do nothing to compromise that. Instead, we need to take meaningful steps to address the real problem, which is the shortage of qualified providers.

There are many ways to address the disparity between traditional and mental health care. Increasing support for telehealth services, improving training for primary care physicians and frontline workers, and encouraging people to join the mental health workforce are just the beginning. Unfortunately, this is a long-term problem that cannot be solved overnight.

While the COVID-19 pandemic has exposed the gaps in our mental health system, it has also provided insight into ways we can improve access for patients. Telehealth services, for example, have proven to play a vital role in providing support to those in need – for both mental and physical health.

Just last year, it was reported that 37 percent of mental health care visits were done virtually through telehealth services. Given these data, we must look for ways to expand telehealth services—including allowing patients to seek care from providers across state lines.

Of course, we also need to consider rural broadband coverage and make it a priority to improve access across the country.

In addition to improving telehealth services, we must also make it a priority to train primary care physicians, nurses, school counselors, and others on the front lines of the mental health crisis—especially for the sake of our children.

Often these individuals are the first or only option when a patient seeks help. If they are better equipped to accurately identify symptoms at an early stage, appropriate referrals can be made and patients will be better served.

As it stands, many patients are forced to go undiagnosed or untreated for long periods of time, allowing their symptoms to worsen before they find the help they need. Improved training for our first line of defense can prevent this terrible cycle.

While improved telehealth services and better training for providers are critically important, we also need to implement long-term solutions. The programs can help stimulate medical school students to enter the mental health workforce and retain professionals already in the field.

We have seen how successful incentive programs have been in other areas of health care. For example, studies show that providers who complete their residency in rural areas are significantly more likely to remain in rural areas for the long term. If we can find ways to incentivize mental health care, we can successfully address the problem of provider shortages over time.

Mental health is an issue facing our entire nation right now and we need to take a multi-pronged approach to tackle this growing problem.

I appreciate the Biden administration’s commitment to improving access to care, but we also need to ensure we’re going through the proper channels, working with experts on the ground to ensure the right steps are taken. We cannot afford to govern by rule changes.

Heidi Heitkamp (D) is a former US Senator from North Dakota.