On Wednesday, February 2nd, the House Ways and Means Committee held a hearing on “America’s Mental Health Crisis.”  The full 42-member Committee heard testimony from:

Dr. Wizdom Powell (Director of the Health Disparities Institute and Associate Professor of Psychiatry) focused on four main points, youth as a target population in the mental health crisis, the inadequacy of the workforce, the need for updated systems in mental health (focus on the overall person), and the racial and ethnic disparities that will continue to grow if needs are unmet.

Dr. Peggy Johnson (Chief of Psychiatry, The Commonwealth Care Alliance) spoke about integrated care plans that coincide with primary physical care and the needs of systemic change outside of the mental health system.

Deborah Steinberg (Health Policy Attorney, The Legal Action Center) focused her testimony on reforming Medicaid/Medicare for substance misuse treatments to lessen the discrepancies in coverage for behavioral health care.

Angela Sausser (Executive Director, The Public Children Services Association of Ohio-PCSAO) focused her testimony on grant programs for students seeking mental health education, an expansion to Title IV-E funding, and child welfare caseworkers who are suffering secondary trauma, stating, “failure to care for the mental health of workers exacerbates mental health needs and crisis in children;” and

Deepa Avula (Director of the North Carolina Division on Mental Health) spoke on community interventions with strategies focused on school services and increased preventative strategies.

Angela Sausser, also spoke on behalf of the National Association of Counties (NACO) and she focused much of her testimony on child welfare and what has taken pace during the pandemic stating,

“Even though state and federal laws governing children services aim to protect children from abuse and neglect, nationwide, there has been an increase of children, especially adolescents, in foster care whose needs are primarily related to mental illness, developmental/intellectual disability, or juvenile delinquency. Children requiring higher levels of care to address their complex multi-system needs are placed in a treatment foster home, a group home, or a residential treatment facility. However, county children services agencies struggle to find appropriate and available treatment placements to address the unique, intense, and challenging needs of these children.

Chairman Richard Neal’s (D-MA) opening remarks discussed how stigma is a significant barrier to accessing care, with four in ten Americans facing symptoms of anxiety and depressive disorders at a post-pandemic level, and that COVID-19 pandemic is exacerbating the mental health crisis. Chairman Neal was first to question witnesses on how to ensure access is culturally competent and encompassing to everyone. Dr. Powell stated it begins within systems outside of mental health as people are “entering and exiting the system broken,” a point that was repeated many times by Dr. Johnson.

Ranking Member Kevin Brady (R-TX) and Representative Jason Smith (R-MO) focused on the pandemic’s impact on youth development and education. Deepa Avula discussed how telehealth mental services can provide some necessities to combating mental health issues and crises that arise in students but are not as impactful as in-person services. She also mentioned the need to incorporate kids and youth in mental health care services, extend mental health block grants, and enhance existing mental health crisis services.

Youth and mental health became a critical focus for Representatives Vern Buchanan (R-FL), John Larson (D-CT), and Gwen Moore (D-WI), specifically for youth experiencing childhood poverty, the ability to access treatment and youth aging out of foster care. Multiple witnesses answered their questions, reiterating that systemic changes need to happen to see differences; however, increasing funding and resources to providers such as cross-training counselors and creating an incentive program for students enrolled in advanced mental health degree programs are needed.

Representative Jackie Walorski (R-IN) referenced her bipartisan bill that increases caseworker support and protects youth’s continuation of care services as a possible solution. Another bill mentioned by Representatives Judy Chu (D-CA) and Adrian Smith (R-NE) is the bi-partisan PEERS Act (HR2767), an expansion on Medicare coverage to encompass peer support specialists under physician care (read more here). Representative Trent Kelly (R-PA) also quoted his bill as a way to reduce high-cost care and prior authorization barriers, the main issues he discussed Wednesday, as a way to decrease individual wait times for care (read more here).

Returning to Sausser’s testimony, she highlighted recent research in Ohio that becomes an important point against the recent backdrop and debate over the placement of adolescents and youth within the child welfare system.  PCSAO surveyed Ohio members to learn about the lack of placements for youth with high acuity needs, many of whom have behavioral health needs.

In Ohio, they found that the stress placed on the workforce is compounded by the diversion of youth previously involved in other systems of care who have been increasingly referred to the child welfare system. The counties reported that 24 percent of youth who came into care last year entered primarily due to their behavioral health needs, developmental/intellectual disabilities, or as a diversion from juvenile justice. Notably, of the youth who were diverted from juvenile justice, 26 percent of them entered being accused or convicted of a felony. The key issues driving this current crisis are the lack of community alternatives, viable treatment homes, and placement options due to staff shortages, particularly at residential facilities. The survey showed that six percent of the youth had to spend at least one night at our county agencies in 2021, and “41 percent of our workers are calling 51-100 providers before finding an available foster home or residential placement.”

 She also said, that last year, “A national study of a representative subset of Ohio counties revealed that 53 percent of our caseworkers demonstrated levels of secondary traumatic stress that met the threshold for Post-Traumatic Stress Disorder (PTSD).”

View full hearing and testimony here.