Why we are cautiously optimistic about Biden's behavioral health proposal

Nearly one month ago, Biden delivered his first State of the Union address. A direct aim at mental health—and the rare opportunity for bipartisan support—struck us as one of the biggest moments from the speech. This budget proposal is a clear follow-up to promises made in the State of the Union.

We’ve heard from behavioral health leaders that this is the most momentum and alignment they’ve seen in decades—this presents a unique window of time for stakeholders across the industry to come together to improve behavioral health care. We are cautiously optimistic, but let's first into the positive details in the proposal.

Why we are applauding Biden’s proposal

There are some truly positive signs in Biden’s plan and budget proposal. Here are a few highlights:

Medicaid accessibility

Biden proposed $35.4 billion specifically to enhance mental health access for Medicaid enrollees. We know that people with Medicaid tend to have higher rates of behavioral health needs, so this targeted funding could help some of our most vulnerable patients. That said, it’s important to remember how difficult it can be to find behavioral health providers who accept Medicaid and are accepting new patients.

Addressing workforce shortages

We are also excited to see Biden’s focus on addressing workforce shortages in behavioral health, for which he is proposing $7.5B. In particular, Biden has indicated a willingness to invest in non-traditional providers, like community health workers and peer specialists, which is crucial to promoting behavioral health equity. We know that behavioral health is not simply about access to traditional clinical services, and these non-traditional providers can support low-income and marginalized individuals’ behavioral health by providing supportive relationships and addressing non-clinical needs that affect behavioral health.

Low-barrier access points

Biden’s strategy also promises to create new low-barrier access points to behavioral health and substance use providers in community-based settings—think schools and homeless shelters. This will be crucial to make sure additional investments aren’t only concentrated in white, wealthy areas.

Why these efforts may not be enough

We’re heartened by this increased and necessary focus on behavioral health. But there’s a real risk that the health care industry will make improvements in behavioral health access and treatment for only some folks—in particular, well-insured, wealthy, white consumers with low-acuity behavioral health needs. This may happen while deepening pre-existing disparities for the marginalized groups that already face the worst outcomes, including Black and Indigenous individuals and other people of color, those who are low-income, facing housing insecurity, and/or people with high-acuity mental health needs, among others.

And that’s because while Biden’s initial fact sheet acknowledged the disproportionate burden of mental illness in Black and Brown communities, the plan and budget are still far from finalized legislation. There are key gaps that deserve attention, such as the need for diverse clinical trials for new treatments. We also need sustainable community partnerships that can enable early interventions to help mitigate the impact of trauma and adverse childhood experiences.

Health care leaders have a critical role to play

Instead of hoping for the best, we believe industry leaders need to take concrete steps now to support a vision of equitable behavioral health. At Advisory Board, we have dedicated an entire team of researchers to focus on the intersection of behavioral health and health equity—exploring what stakeholders across the industry can do now to advance equitable access, treatment, and outcomes in behavioral health. This includes a range of stakeholders, including but not limited to hospitals, health plans, pharmaceutical companies, and non-profit organizations. If you’re interested in speaking with our research team about your efforts to advance behavioral health equity, please email us at zuckermr@advisory.com

Advisory Board’s Darby Sullivan and Andrew Mohama helped contribute to this article

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