This Biden proposal puts access to mental healthcare at risk

Historically, our nation has found ways to adapt and overcome crises — for the betterment of our society and its people. Yet one such crisis remains and continues to grow, which now directly affects more than 20% of our adult population. 

As a society, we have an obligation to address the mental health and substance use disorder crisis head on. But several problems have hindered our response.

The most pressing problem associated with this crisis is the shortage of qualified providers, which has left the majority of our nation in a Mental Health Professional Shortage Area with limited access to care. This is especially true in my home state of North Dakota, where only seven of our 53 counties have sufficient access to mental healthcare.

President Joe Biden’s administration is taking steps to address this shortage of providers, most notably by investing hundreds of millions in Behavioral Health Funding Opportunities, mental healthcare in schools and the child welfare system, and for substance use disorder. And while some of these efforts are welcomed changes, one specific initiative has the dangerous potential to disrupt our existing mental healthcare framework, putting patients at risk.

In July, the departments of Labor, Health and Human Services, and the Treasury announced a rule change to the Mental Health Parity and Addiction Equity Act aimed at increasing access to care. This new rule, however, would actually drastically reduce the standards used to designate quality providers, flooding the market with providers previously considered “unqualified.”

This immediately would have serious implications for patients. Already, those seeking care are left to navigate a confusing web of providers. If providers previously considered “unqualified” are added to the market, patients would be forced to play a game of trial and error, endlessly seeking the right fit and prolonging the period of time spent undiagnosed and untreated.

For those struggling with mental health challenges or substance use disorders, the stigma associated with seeking care can be overwhelming, oftentimes deterring people from seeking care at all. If the process to find the right provider becomes more complicated, even fewer people will seek care, ultimately leading the crisis to worsen rather than improve.

Another potential repercussion of this rule change lies with employers. Currently, and regardless of the decision made on this proposed rule, many employers offer mental healthcare benefits to their employees voluntarily. The MHPAEA does not require that benefits be offered at all. Should this rule change be finalized, and previously unqualified providers added to the market, the cost to offer employee benefits could skyrocket, potentially causing employers to withdraw any sort of mental health coverage for employees.

There are, however, numerous, proven ways we can address the mental health crisis and prevent it from growing further.

First, we must better equip our front lines with the ability to identify, or in some cases even treat, mental health symptoms accurately. More often than not, school nurses and primary care physicians are the only providers patients interact with. If these professionals are able to assess and make informed referrals, the undiagnosed period for patients will be reduced significantly.

During the pandemic, telehealth services proved to play a critical role in providing care to patients, particularly for mental healthcare. Even now, 37% of mental healthcare visits occur virtually. We should find ways to expand and enhance the use of telehealth, starting by lifting state-line restrictions.

Lastly, the major problem that remains in the mental health crisis is the number of providers, something that cannot (and should not) be resolved overnight. The administration should encourage its agencies, such as the Department of Education and the Department of Health and Human Services, to partner on incentive programs to encourage students to enter the mental health field. We’ve seen how successful similar programs have been, and I am confident this could be a long-term solution to address the provider shortage.

I am encouraged by the Biden administration’s commitment to addressing our nation’s mental health crisis, but I know there are better ways. We must work together, as policymakers, industry experts, healthcare professionals, and advocates, to better serve our society. This crisis can be remedied, but it must be done with a multifaceted approach.


Heidi Heitkamp is a former senator from North Dakota.

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