As Prepared For Delivery:
Good afternoon, everybody. Thank you, Dr. Frank and Dr. Blumenthal, for that welcome. And, thank you to Brookings and to the Commonwealth Fund for co-hosting this event. Even virtually, it is good to be back at Brookings. For six years, this was home. For me and my mother. I cherish the time I spent here, the colleagues whom I continue to consult for guidance—and the good night’s sleep a senior fellowship afforded.
For more than a century, Brookings has prided itself on generating fresh ideas to tackle the myriad challenges facing our society. Which is why it is fitting that we’re here today to discuss how to address an issue of utmost concern and consequence: our nation’s growing mental health crisis.
Last December, the New York Times asked 1,320 therapists across the country what they were hearing from their patients. Certain words jumped out over and over. “Anxious.” “Burned out.” “Lonely.” “Empty.” “Done.” This crisis long predated COVID. But, since the start of the pandemic, rates of depression among American adults have tripled. More than one in ten report thoughts of suicide.
As the U.S. Surgeon General, Dr. Vivek Murthy, warned in a recent public health advisory, mental health challenges are especially acute among young people. In 2019, one in three high schoolers reported persistent feelings of sadness or hopelessness—a 40 increase from a decade earlier. From 2007 to 2018, suicide rates for young people increased 57 percent, with Black children nearly twice as likely as white children to die by suicide. As the Surgeon General observed, “It would be a tragedy if we beat back one public health crisis only to allow another to grow in its place.”
Of course, for so many Americans, this crisis is not defined by statistics. It’s something that afflicts a spouse or parent. A child. A beloved aunt or uncle or cousin. A dear friend. Perhaps it’s a challenge we grapple with ourselves.
As terrifying and excruciating as these afflictions can be for individuals and families, their impact extends beyond their human toll. As President Biden’s Domestic Policy Advisor, I have the privilege of driving the development and implementation of the President’s domestic policy agenda in the White House and across the federal government, from health care and economic mobility, to racial justice and rural policy, to education and veterans’ affairs. For many of those issues—so many of our greatest challenges as a society—mental illness is a force multiplier. Roughly a third of America’s homeless population has a serious untreated mental illness. Adults with serious mental health conditions are at least twice as likely to be out of the labor force as those without mental health challenges. Prisons and jails have become our nation’s largest providers of mental health care. And, untreated trauma and its associated mental health effects may increase the risk of involvement in gun violence. There are also national security implications, as mental health problems like PTSD and depression among our military service members reduce retention and military readiness.
Yet, despite the magnitude of this crisis, mental health has too often been overlooked and under-resourced. At every level, our country faces a severe shortage of mental health providers. The providers we do have are often paid less by insurance plans. As a result, half of our most highly-trained mental health professionals no longer accept insurance, leaving millions of Americans on the hook for even basic mental health care. These barriers are even greater for Black, Hispanic, and Asian patients. Add up these obstacles, and you can see why less than half of the 52.9 million Americans diagnosed with mental illness actually receive treatment, and even fewer receive culturally-competent, high-quality care.
Recognizing this crisis for what it is, the Biden-Harris Administration has moved urgently in our first year to support the mental health needs of all Americans. President Biden’s historic American Rescue Plan invested nearly $5.5 billion to strengthen mental health and substance use services, including the most-ever funding for states and communities to address needs on the ground. We devoted another $122 billion to help schools re-open safely and get students back on track academically and emotionally. We’re making health care more affordable and accessible, while ensuring that there are more mental health providers and that health plans fully cover those services. We’ve taken steps to promote safe storage for firearms, which are used in more than half of all suicides.
Thanks to these efforts, schools are hiring more counselors, nurses, and social workers. More rural and underserved young Americans have access to mental health providers. More dedicated staff are answering the phones at crisis call centers. More mobile crisis response teams are showing up when someone is in crisis. More Certified Community Behavioral Health Clinics are providing 24/7 mental health care to Americans, whether or not they can pay—lowering costs and improving health outcomes.
But, this is just the beginning—and it’s still not nearly enough. Many of you have been doing this a long time, and have seen encouraging shifts. We’ve made progress on research. On deinstitutionalizing care. On reducing stigma. But, this moment calls for more than incremental progress. It demands transformational change.
Part of building a better America is building a healthier America—and mental health is foundational to that goal. That’s why President Biden, as part of the Unity Agenda he unveiled in his State of the Union address, called for a major transformation in how the nation understands, accesses, and treats mental health. Our strategy is built around three fundamental goals. First, building a system with enough capacity to treat everyone. Second, connecting people to the services they need, by tackling high costs and other barriers. Third, supporting all Americans by creating environments that improve their health and wellbeing.
To start, we’re seeking to partner with Congress to build a mental health system that has the capacity and capabilities to work for everyone. Right now, more than one in three Americans live in areas with a shortage of mental health professionals; in 60 percent of counties in rural America, there’s not a single psychiatrist. And, when a mental health provider is available, they too often lack the language skills or other cultural familiarity to adequately serve their patients.
We’re working to change all that. The budget President Biden unveiled last week proposed investing more than $700 million to increase scholarships, loan repayment, and training programs that will bring more—and more diverse—providers to rural and other underserved communities. And, we’re not just increasing the number of advanced mental health professionals like psychiatrists or psychologists. We’re also proposing a dramatic increase in funding for community health workers, counselors, recovery coaches and others whose support can make all the difference. A few weeks ago, President Biden signed the bipartisan Dr. Lorna Breen Health Care Provider Protection Act, which invests $135 million to reduce health care worker burnout and care for those who care for us. And, in July, we’re launching the 988 crisis response line and investing another $700 million to staff and shore up crisis centers and crisis response, so that people in crisis will have someone to call, someone to respond, and somewhere to go.
But, it’s not enough to build the mental health workforce if Americans can’t access the help they need. That’s why our second imperative is to ensure that cost or stigma or red tape don’t prevent people from getting connected to care.
Since the 2008 mental health parity law, insurance companies are supposed to cover mental health care the same as physical health care. But, too many insurers have skirted those obligations. Accordingly, the President is proposing to require all health plans to cover robust behavioral health services—including three annual behavioral health visits without cost-sharing—while ensuring there are enough in-network behavioral health providers. We’ve requested additional funding to enforce mental health requirements, and to finally apply these vital protections to older adults covered by Medicare.
But, cost and insurance coverage are not the only barriers to patients’ seeking care. We must also continue to make it more comfortable and convenient to access care. That’s why we’re seeking investments to make sure that mental health care is widely integrated into traditional and non-traditional settings—whether that’s a primary care doctor’s office, a college campus, a library, or a homeless shelter—and make it easier to find these resources with the click of a button. We’re also doubling down on telehealth and virtual care. Telehealth expanded dramatically during the pandemic, and it works—especially for Americans without easy access to a provider. We’re going to work with Congress to make telehealth available across health plans and state lines.
Finally, we’re looking beyond health care settings to foster environments that support and promote mental health and wellbeing. We want to reduce the likelihood that someone develops serious mental health challenges in the first place and help people stay healthy after treatment.
Creating healthier environments starts with our youngest brains. That’s why the President’s budget increases our investment in home visiting programs, which give families the skills and support to build safe, healthy homes. We’re also dramatically expanding funding for community schools, which provide essential counseling and other wraparound services to students and their families—and making it easier for school-based mental health professionals to seek reimbursement from Medicaid. We’re increasing funding for youth-focused programs that can help support young people as they transition from school to employment. We’re seeking to increase funding for treatment courts—which help people recover from substance use, rather than get locked up for it—and shore up resources for mental health and substance use disorder in our jails and correctional facilities. To ensure that help is available in all kinds of settings, we’ll also train a range of social and human services professionals in basic mental health skills—from housing counselors to the USDA employees who support farmers and ranchers.
And, when over 80 percent of young Americans say they use social media “daily” or “almost constantly”—and one in three teenage girls report that Instagram makes them feel worse about their bodies—we must be equally focused on promoting healthy environments online. As the President has said, “We must hold social media platforms accountable for the national experiment they’re conducting on our children for profit.” To do that, we’re working to strengthen children’s online privacy and ban ads targeting kids. We are pushing to institute stronger online protections for our young people, and require social media companies to place user safety at the center of their product design. We’ll work to stop the discriminatory algorithms that return hurtful content when a young woman searches a term like “Black girls” or “Latina girls.” And, we’ll invest in research to further understand how social media impacts mental health and how to address it. We owe it to our kids to prevent bullying, shaming, exclusion, and self-harm—online and off.
Back in February, I had the opportunity to participate in a virtual roundtable with some remarkable Black women who’ve been outspoken about mental health. We had Golden Globe-winning actress, Taraji P. Henson. Sloane Stephens, the U.S. Open Champion. WNBA star Nneka Ogwumike. Dr. Miriam Delphin-Rittmon, the Assistant Secretary for Mental Health and Substance Use. These were some of the most accomplished Black women on the planet, but they reminded us that mental health struggles impact each of us. We’re all human. We all feel the good, the bad, and the ugly.
The conversation was moving, inspiring—even healing. These powerful women opened up and made themselves vulnerable. But, as Taraji Henson commented after our discussion, “Vulnerability is strength.” And, what’s true of individuals is true of our institutions and our nation. By acknowledging our vulnerabilities and identifying our shortcomings, we can grow stronger and healthier.
That’s what this is about. That’s what’s at stake. That’s how we usher in a future where mental health is just considered “health.” And, with the leadership of President Biden, the support of Congress, those here from Brookings and the Commonwealth Fund, and everyone who has been touched by this crisis, I’m confident we can transform how we approach mental health in our country and lift the lives of our fellow Americans. Thanks very much.