On Thursday, February 17th, the House Subcommittee on Oversight and Investigations of the Committee on Energy and Commerce held an investigative hearing on ‘Americans in Need: Responding to the National Mental Health Crisis.’ The Energy and Commerce Committee has jurisdiction over Medicaid, making it a key committee in any significant effort to enact behavioral health reform. Many of the themes heard in other committee hearings were repeated.
In her opening statement, Subcommittee Chairwoman Diana DeGette (D-CO) emphasized the need to understand the drivers of the current mental health crisis to better inform action, a sentiment echoed by the Chairman of the Full Committee, Frank Pallone (D-NJ). Ranking member Morgan Griffith (R-VA) focused on the impact school lockdowns had on children, a focus that was shared by Full Committee Ranking Member Cathy M Rodgers (R-WA).
The topic of parity proved to be a major theme of the Q&A portion of the hearing. Full Committee Chair Frank Pallone asked what additional steps Congress could take to enforce it. Lisa Fortuna (M.D., M.P.H.), the Vice-Chair of Psychiatry at the University of California San Francisco, answered that Congress needed to support states in their efforts to evaluate and investigate insurance companies and their reimbursement rates. She additionally recommended that parity extend to apply to Medicare, as many vulnerable populations receive coverage through Medicare.
The impact of social media was also a reoccurring theme. Representative Lisa Rochester (D-DE) mentioned her bill, the DETOUR Act (H.R. 8975), which aims to regulate programming used to manipulate children to use social media compulsively. Rep. Rochester asked Jacqueline Nesi (Ph.D.), the Assistant Professor of Psychiatry and Human Behavior at Brown University, why we should be concerned by children using social media compulsively. Nesi explained that, while social media has benefits, such as offering community and a means of disseminating information regarding mental health resources, it can also expose youth to harmful content that can worsen mental health conditions and promote suicide ideation.
Expanding telehealth services was also explored. When asked by Representative Dr. John Joyce (R-PA) what factors are unique to rural areas that impact mental healthcare services, Hon. Elinore McCance-Katz (Ph.D., M.D.), the Former Assistant Secretary for Mental Health and Substance Abuse, replied that distance played the largest role and that telehealth was critical. Dr. McCance-Katz explained that millions of Americans do not have access to broadband in rural areas, and that audio-only care is critical for expanding access. The role of telehealth was explored in suicide prevention as well. When asked about how to decrease suicides by Rep. Scott Peters (D-CA), Amit Paley (M.B.A.), the CEO and Executive Director of the Trevor Project, responded that the 988-lifeline needed to be fully funded and that a separate line be established for LGBTQ callers to address their unique needs and alleviate pressure from the main lifeline.
When it came to potential reforms, the need to reform the Medicaid Institutions for Mental Disease (IMD) exclusion was brought up by Representative Michael Burgess (R-TX). In response to his question, Dr. McCance-Katz noted the patients she served with severe mental
illness were not given the time and in-patient care needed. She said lifting the IMD exclusion would allow patients to stay in care longer and would avoid future hospitalizations.
Workforce reform was also highlighted. Rep. Raul Ruiz (D-CA) asked Dr. Fortuna about what steps Congress should take in dealing with the gap in the demand for services and the lack of providers. Dr. Fortuna mentioned the COPE Program, which allows healthcare staff to access a line to screen their mental health needs and mental health services. To address the issue of burnout, Dr. Fortuna argued that Congress needed to support resources for immediate connection to mental health services for healthcare providers nationwide.
Representative Scott Peters (D-CA) promoted the STANDUP Act (H.R. 586), which would require educational agencies receiving grant money for mental health needs to implement evidence-based suicide prevention training policies. When asked about the role the STANDUP Act would have in a school environment, Christopher Thomas, the Co-Founder of the Defensive Line, claimed that evidence-programming that is mandated and funded would help students, particularly students of color who face more barriers to care.
In her closing remarks Subcommittee Chairwoman DeGette expressed her interest in holding additional hearings on the impact of the mental health crisis on LGBTQ and racially diverse communities.