NCAD West | Out of COVID Crisis Comes Opportunity for Policymakers to Improve Behavioral Health

From the crisis of the COVID-19 pandemic, an opportunity has arisen to improve behavioral healthcare, Andrew Kessler, founder and principal of the behavioral health consulting firm Slingshot Solutions, recently told NCAD West attendees in Denver.

Key indicators around mental health and addiction had begun to trend in the wrong direction prior to the pandemic, said Kessler, who noted that opioid overdose rates were rising again before COVID-19. The pandemic then exacerbated existing challenges. In its latest data, the CDC reported 95,000 drug overdose deaths in the United States for the 12-month period ending in January, a 30% increase year-over-year.

Meanwhile, RTI data shows that treatment initiation by patients in California is now down 28%. Kessler said justice-involved and Medicaid populations have been hit especially hard, and individuals have also expressed reluctance to seek addiction treatment over fears of contracting COVID. Concurrently, providers have struggled to maintain their volume of service because of staff shortages, lack of personal protective equipment, lack of funding for implementing telehealth solutions and hiring temporary staff, and lack of facility capacity to allow for social distancing.

A sizeable amount of relief, however, is coming from Washington, Kessler said. Signed into law in March, the American Rescue Plan has earmarked $1.5 billion for Substance Abuse Prevention and Treatment block grant funding. Combined with funding from the December 2020 stimulus, states are receiving almost triple their standard block grant funding in fiscal year 2021, and they are being given 2 years to spend the funds instead of the standard 1-year window.

“The American Rescue Plan aimed at COVID did a lot for SUD [treatment and prevention],” Kessler said. “The Biden administration and Congress saw where the problems were, and that’s why this was included in the legislation.”

Among the potential key uses for American Rescue Plan grant funds highlighted by Kessler:

• Mental and behavioral health workforce training
• Addressing surge capacity for service needs
• Supporting, enhancing, or expanding mental and behavioral health preventive and crisis intervention services

CARA 3.0 proposed

More help for providers could be on the way, Kessler said. A follow-up to the Comprehensive Addiction and Recovery Act of 2016 has been proposed in the House and Senate. Dubbed “CARA 3.0” (version 2.0 was proposed in 2018, but stalled in Congress), the new bill “takes a bold approach” that would boost the current behavioral healthcare infrastructure and create new systems as well, Kessler said.

Among its provisions, the bill would authorize $55 million for the Health Resources and Services Administration to train and retain substance use disorder treatment professionals. One forecast estimates a need for 20,000 to 30,000 more SUD counselors in the next 5 years—a figure that does not include peers and peer supervisors, Kessler said. The average turnover for SUD counselors is currently 3 years, a churn that has weakened facilities’ institutional knowledge.

CARA 3.0 would also establish a pilot program through SAMHSA to address the SUD prevention workforce, directing SAMHSA to study existing challenges and barriers, and then make recommendations for improvement. Prevention efforts, Kessler added, will need to go beyond messaging to address trauma and adverse childhood experiences.

Among other highlights of the bill, CARA 3.0 would:

• Require SAMHSA, along with national accrediting entities and reputable providers of recovery housing services, to develop guidelines for states to promote availability of high-quality recovery housing that meets National Alliance of Recovery (NAR) standards.
• Authorize $200 million per year to build connections between recovery support services and networks, including treatment programs, mental health providers, treatment systems and other recovery supports.
• Allocate $50 million in grants to peer recovery services to provide continuing care and ongoing community support for individuals in recovery.
• Make law enforcement-assisted deflection and pre-arrest/pre-booking diversion programs explicitly eligible for Byrne-JAG grants, and authorize $30 million over 5 years for the development of best practices for deflection/diversion teams.

Ultimately, Kessler said, it is important to keep in mind that CARA 3.0 is only in the proposal stage, and that the bill has not been passed by either branch of Congress. The 2016 version of CARA was the first standalone bill dealing strictly with SUD since 1973.