Relief Bill Offers Opportunity to Foster Behavioral-Public Health Partnership

About 70% of Americans support the American Rescue Plan designed by the Biden-Harris Administration to address the severe problems fostered by the COVID pandemic, according to data last month from the Pew Research Center. Provisions range from stimulus checks for most Americans, to support for mass vaccinations throughout the country, to economic incentives to decrease the number of children in poverty. This $2.2 trillion package was passed by the Congress almost two months ago, then signed into law by President Joe Biden. This act also contains numerous features that will benefit behavioral healthcare, including additional funding for SAMHSA and HRSA, and $69 billion in COVID-19 relief for counties.

One section of this legislation, funding for the public health workforce, has not received as much attention as deserved by the behavioral healthcare community. Section 2501 appropriates $7.66 billion “to carry out activities related to establishing, expanding, and sustaining a public health workforce...” A broad array of positions is included, specifically, “case investigators, contract tracers, social support specialists, community health workers, public health nurses, disease intervention specialists, epidemiologists, program managers laboratory personnel, informaticians, communication and policy experts, and any other positions as may be required to prevent, prepare for, and respond to COVID-19” (emphasis mine). It is estimated that the appropriation can support about 100,000 new positions.

In the following comments, I will develop a strong case for why a subset of these positions must be devoted to behavioral healthcare.

As noted in earlier commentaries, the COVID-19 pandemic has caused a doubling of the prevalence of behavioral health problems from about 20% to 40% of adults, and very recent estimates would further increase the latter number by as much as 10%. At the same time, the capacity of the behavioral health system has not changed. Prior to the COVID-19 pandemic, the system had the capacity to serve about 50% of those needing services. Today, that percentage has declined to about 25%. Further, these services are not distributed uniformly. An estimated 83% of counties have inadequate or no behavioral health services; 63% of counties do not have a psychiatrist; and 40% of counties do not have MAT available.

It also is very clear that economic recovery post-COVID-19 will be contingent in large measure upon addressing behavioral health conditions in the population. COVID-19 has greatly increased depression, anxiety and substance use, each a factor in job and community performance.

To address these issues, I strongly recommend that 36,660 of these new public health positions be devoted to behavioral health, and that they be distributed across the 3,143 counties as follows:

• Small counties (n=1,048), 5 each: 5,240 positions total
• Mid-sized counties (n=1,048), 10 each: 10,480 positions total
• Large counties (n=1,047), 20 each: 20,940 positions total

Placing these new behavioral health positions in local health departments, as required by the legislation, also can produce further benefits. Operational collaboration between behavioral and public health can enhance our capacity to address the negative social and physical determinants of health that engender trauma and behavioral health problems, as well as to deploy more effective upstream prevention strategies.

Thus, I strongly encourage you to support national advocacy efforts to designate these 36,660 positions for behavioral health. Once placed into these positions, behavioral health providers can play an almost inestimable role in improving community and economic well-being as we seek to end the COVID-19 era.

Ron Manderscheid, PhD, is president and CEO of NACBHDD and NARMH.