Mental health crisis requires real solutions

Americans across the country are facing a mental health crisis that has been exacerbated by the coronavirus pandemic. And rural states like North Dakota are at a particular disadvantage due to severe resource shortages and an increasing number of individuals 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 are classified as “health care professional shortage areas.” One reporter even called western North Dakota a “mental health care desert,” highlighting how desperately the state needs expanded access to mental health assistance.

Unfortunately, North Dakota is not alone in this regard. Nearly every state in the country faces a shortage of mental health support, and the number of people seeking help is increasing. In 2023, 45 percent of adults ages 35 to 44 reported some form of mental illness, compared to 31 percent in 2019. Adults ages 18 to 34 had the highest rate of mental illness, with 50 It was a percentage.

I'm pleased with the Biden administration's approach to improving access to mental health care through billions of dollars of investments, from 9-8-8 hotlines to support for school counselors. This is exactly the kind of support our country needs.

However, the Departments of Labor, Treasury, and Health and Human Services recently announced rule changes to the Mental Health Parity Act and Addiction Fairness Act of 2008 that could have devastating effects. Although the rule is well-intentioned as a means to increase access, it can have serious unintended consequences, including increased costs and reduced access to quality health care.

The proposed rule changes aim to increase the number of providers by lowering their quality standards. This leaves patients navigating an already confusing market with little or no support. This influx of patients may also lead to a trial-and-error process for patients to find the right healthcare provider to meet their needs.

Particularly for those suffering from substance use disorders, the stigma of seeking care already deters people from seeking help. By complicating patients' ability to find appropriate care, this process will inevitably deter patients from seeking care altogether, further exacerbating the crisis at hand.

As the mental health crisis continues to grow out of control, the solution is not to lower standards of care or complicate the system for patients.

This rule change is intended to solve a problem that doesn't exist. Our health system is one of the best in the world. Nothing should be done to undermine this position. Instead, we need to take meaningful steps to address the real problem: a shortage of qualified providers.

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

The COVID-19 pandemic has exposed gaps in the mental health system, but it has also provided insights into how to improve patient access. For example, telehealth services have proven to play an important role in providing support to those in need, both in mental and physical health care.

Just last year, it was reported that 37% of mental health care visits were conducted virtually through telehealth services. Given this data, we need to explore ways to expand telehealth services, including allowing patients to seek care from health care providers across state lines.

Of course, rural broadband coverage must also be considered, and improving access nationwide must be a priority.

In addition to improving telehealth services, we must prioritize the training of primary care doctors, nurses, school counselors and others who are on the front lines of mental health crises, especially for children.

These individuals are often the first or only choice for patients seeking help. The ability to accurately identify symptoms early on will allow for appropriate referrals and better serve patients.

Currently, many patients are left undiagnosed and untreated for long periods of time, leaving their symptoms to worsen without getting the help they need. Better training of the first line of defense could prevent this terrible cycle.

Improving telehealth services and improving training for healthcare professionals are both critical, but long-term solutions also need to be established. The program encourages medical students to enter the mental health care workforce and helps retain professionals already in the field.

We have seen how successful incentive programs have been in other areas of healthcare. For example, research shows that providers who complete a residency in a rural area are significantly more likely to remain in the rural area long-term. If we can find ways to encourage mental health care, we will be better able to address the problem of health worker shortages over time.

Mental health is an issue currently facing the entire nation, and addressing the growing problem requires a multifaceted approach.

We appreciate the Biden administration's efforts to improve access to care, but we also need to work with experts on the ground to make sure the right steps are taken and make sure we go through the right channels. We cannot afford to govern by changing the rules.

Heidi Heitkamp (Democrat) is a former U.S. senator from North Dakota.