This analysis was prepared by McDermott+ Consulting, on behalf of AACOM.
PURPOSE
The purpose of this hearing was for the Senate Subcommittee on Primary Health and Retirement Security on the Committee on Health, Education, Labor, and Pensions (HELP) to identify challenges that people face when accessing care for mental health or substance use disorders. The Subcommittee also explored solutions aimed at improving access and increasing continuity of care through community-based solutions. The Subcommittee focused especially on the fentanyl crisis, youth mental health, and issues faced by rural communities when accessing behavioral and mental health care.
MEMBERS PRESENT
Chairman Markey, Ranking Member Marshall, Senators Tuberville, Baldwin, Hickenlooper, and Murkowski
WITNESS
- Dr. Maria Celli, Deputy CEO, Brockton Neighborhood Health Center, Brockton, MA
- Mr. Steven Denny, Deputy Director, Four County Mental Health Center, Independence, KS
- Dr. Stephen Taylor, President Elect, American Society of Addiction Medicine, Birmingham, AL
- Dr. Warren Ng, President, American Academy of Child and Adolescent Psychiatry, New York, NY
KEY TAKEAWAYS
- There was bipartisan consensus about the importance of funding solutions and addressing the current mental health crisis.
- Community based solutions for mental healthcare, including community health centers and certified community behavioral health clinics (CCBHC), play a key role in addressing the mental health crisis, especially in rural areas.
- There was a focus on combatting fentanyl and increasing prevention, education, and the tools available to treat addiction and substance use disorder.
- Integrated care teams and creating a continuum of care were highlighted throughout as important ways to address mental health.
RELEVANT DISCUSSION
Ranking Member Marshall (R-KS) ask Mr. Denny about mobile crisis centers and the issue of violence in the ER. Mr. Denny talked about the importance of diverting crisis, so individuals do not end up in the ER. He also mentioned the importance of partnerships and a continuum of care. Ranking Member Marshall asked Dr. Ng what is currently working and not working in the field. Dr. Ng reiterated the importance of creating a continuum of care through outpatient and community services to provide culturally competent and responsive care. He highlighted the need for sustainable innovation programs to provide wrap around care.
Senator Baldwin (D-WI) described a meeting with mothers who lost children to a fentanyl overdose, or poisoning because they did not know they were taking fentanyl. She highlighted the importance of needing to stop fentanyl from coming into communities and making overdose reversal drugs more widely available. She also mentioned a bill she is cosponsoring with Senator Murkowski, Bruce’s Law, that would provide prevention education about fentanyl. Senator Baldwin asked Dr. Taylor about how the crisis has changed over time and how the current fentanyl phase is providing new challenges. Dr. Taylor described the three phases to the issue: opioid prescriptions, using heroin when prescription drugs became more expensive and harder to get, and now using fentanyl which is cheaper, more potent, and more readily available. He provided several examples from a recent ASAM conference where front-line providers shared strategies about how to help someone addicted to fentanyl because the withdrawal is so severe, reiterating the need to have every tool available.
Senator Murkowski (R-AK) thanked her colleague for her support on Bruce’s Law. She reiterated Dr. Taylor’s points about the intensity of addiction and the importance of educating people about the intensity and lethality of it. Senator Murkowski followed up by noting that the challenge in Alaska, and other rural locations, is a lack of access to providers especially pediatric providers. For example, in Alaska patients will need to leave the state to receive the care they need. She asked what needs to be done to grow the workforce, and what more they can do to help parents and educators be the support in local communities until patients can get to the medical professionals. Dr. Ng thanked her for leadership and support on S. 462 and highlighted the importance of telepsychiatry to bridge gaps and bring in key members of the community and family to partner in care. He stated that there are no quick fixes, but loan repayments, funding behavioral health interventions and telepsychiatry programs are important steps
Senator Hickenlooper (D-CO) Senator Hickenlooper asked Dr. Celli, given the importance of community health centers, what do they need to help address these gaps in the behavioral health care system and what more can be done. Dr. Celli noted that the cornerstone of community health centers is all services are provided in the same team, increasing care coordination. She also noted a program that trains behavioral health providers to work with kids, increasing access.