• In The Trenches

    Washington Hears Us on Integrated Behavioral Health Care

    April 14, 2022, 12:24 p.m.— It is objectively true that diagnosing and treating the behavioral health needs of the majority of Americans is among the areas in which primary care physicians have for too long been obliged to do more with less. How much more care you’ve delivered than in the past, with how much less support — and how best to adjust policy while improving patients’ mental health — are relatively subjective matters, but legislation that would move us in the right direction already exists. And last week, with the Academy’s guidance and enthusiastic support, lawmakers turned their attention to some of these bills. 

    doctor talking to her patient at office

    We provided detailed testimony to the House Committee on Energy and Commerce’s Subcommittee on Health for an April 5 hearing titled “Communities in Need: Legislation to Support Mental Health and Well-Being.” Nineteen bills related to that broad topic were on the agenda that day, signaling that lawmakers could begin the markup process ahead of passing much-needed legislation — including some for which the AAFP has steadily lobbied.

    The hearing itself was a strong signal that our recent push to center primary care in behavioral health policy is gaining ground. And other testimony supported our position: Carole Johnson, the recently confirmed administrator of the Health Resources and Services Administration, used her part of the five-hour hearing to tout HRSA programs we support, echoing advocacy we shared with her in a recent letter outlining AAFP priorities and requesting a meeting.

    All of this could hardly be more important. As I told you this past winter, one analysis of 2016 to 2018 Medical Expenditure Panel Survey data showed that nearly 40% of all visits for depression, anxiety or cases defined as “any mental illness” were with primary care physicians, and these physicians were more likely to be the source of physical and mental health care for patients with lower socioeconomic status and those with co-morbidities. Meanwhile, the unmet behavioral health needs of children and adolescents last fall led the AAFP to join the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association in declaring children’s mental health a national emergency.

    Specifically, our latest testimony endorsed

    • the Collaborate in an Orderly and Cohesive Manner Act (H.R. 5218), which would provide grants to primary care practices to implement the Collaborative Care Model and stand up technical assistance centers to enable more primary care practices to adopt this evidence-based model for integrated behavioral health care;
    • the 9-8-8 and Parity Assistance Act (H.R. 7232), which would establish a new Behavioral Health Crisis Coordinating Office, boost funding for the National Suicide Prevention Lifeline, invest in care coordination via a pilot program for communities to create or enhance crisis-response teams that include physicians, and direct HHS to establish standards for a behavioral health crisis continuum of care (also including physicians); and
    • the Supporting Children’s Mental Health Care Access Act (H.R. 7076), reauthorizing for five years HRSA’s Pediatric Mental Health Care Access Program, preserving and enhancing access to integrated mental health care for pediatric patients.

    The Academy also expressed qualified support for other legislation under the subcommittee’s consideration while urging lawmakers to include primary care physicians in their comprehensive agenda. These bills include

    • the Strengthen Kids’ Mental Health Now Act (H.R. 7236), meant to reform and bolster the pediatric mental health workforce by raising Medicaid payment rates for pediatric behavioral health services and funding new training opportunities (although the AAFP is lobbying to correct the bill’s failure to recognize family physicians’ role in providing pediatric mental health services) and
    • the Community Mental Health Services Block Grant Reauthorization Act (H.R. 7241) and the Substance Use Prevention, Treatment, and Recovery Services Block Grant Act (H.R. 7235), which fund programs to improve mental health care by promoting greater coordination (and which should robustly incorporate primary care).

    Add Your Voice

    Existing programs to improve resources for family physicians and better integrate behavioral health into the primary care setting need reauthorization. That’s why the Academy is firmly behind the Supporting Children’s Mental Health Care Access Act, which would renew funding for the HRSA’s Pediatric Mental Health Care Access Program and expand it to all states. That would preserve and expand the ability for primary care clinicians to consult with child mental health teams via telehealth. Please use our Speak Out tool to ask your elected officials to support this important legislation.

    I’m also asking you to join our Speak Out campaign to encourage your members of Congress to support the Collaborate in an Orderly and Cohesive Manner Act (H.R. 5218). The legislation would provide grants to primary care practices to implement the Collaborative Care Model, create technical assistance centers for primary care practices and fund studies on additional integration models. Expanding the use of this evidence-based model will help address workforce shortages, increase access to mental health and substance use disorder treatment, improve outcomes and health equity, and reduce health care costs.

    National Minority Health Month

    Our behavioral health advocacy complements National Minority Health Month, which raises awareness about health disparities affecting racial and ethnic minority populations and encourages action through health education, early detection and control of disease complications. The AAFP observes NMHM while reflecting on how we can contribute to addressing racism and inequalities in patient care and elevating Academy member voices. We’ve worked with the Office of Minority Health for more than 15 years on clinical recommendations and practice ideas that can help family physicians improve care for minority patients and underserved communities. This month we’re supporting Public Health Week (April 4-11), Black Maternal Health Week (April 11-17), National Infant Immunization Weeek (April 24-30) and World Immunization Week (April 24-30). And we continue to lobby lawmakers and regulators to improve health equity for all Americans by strengthening primary care. Black Maternal Health Week, for example, is a good moment to reiterate the Academy’s staunch support for the Black Maternal Health Momnibus package


    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.