2019 State Health Policy Progress: Addressing Mental Health and Substance Use Disorders

Mental health challenges can affect nearly everyone — whether as a family member, caregiver or patient. Yet our policies on mental health and substance use disorders across the country often do not meet the vast needs of those experiencing them. Our health care system currently treats mental health and substance misuse treatment as a separate specialty service — creating challenges for timely access. This fragmentation leaves many unable to receive necessary care. 

In 2017, more than 150,000 Americans lost their lives to drugs, alcohol, or suicide. If this trend continues, 1.6 million more people could die from the preventable causes of drugs, alcohol, and suicide by 2025. Access to equitable, affordable, and quality mental health and substance misuse treatment is paramount to addressing this crisis.

This year, state leaders are taking important action to address the lack of access to needed behavioral health care.  A recent United States of Care report identifies the progress states are making to address mental health and substance use disorders by enacting legislation focused on enforcing coverage parity,  respond to the opioid crisis, and expand access to services. 

In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). The law requires mental and behavioral health coverage to be equal to physical health coverage. Reports prove parity for mental health and substance use disorders has not yet been achieved, despite the milestone implementation of this law and subsequent laws reinforcing its mission. In fact, 32 states entered 2019 with failing grades on mental health parity enforcement. In this legislative session, many states have taken much-needed steps to enforce the implementation of the 2008 parity law.

• New Jersey and Colorado passed legislation to enhance enforcement and oversight of mental health and substance use disorder parity laws, reduce coverage gaps coverage for individuals with behavioral health disorders, and increase insurer accountability.
• Minnesota passed legislation creating accountability requirements for mental health parity, helping to ensure that coverage of mental health care is similar to primary care and care for other chronic or severe illnesses.
• Connecticut passed comprehensive legislation requiring health insurers to submit an annual report on behavioral health coverage parity and ensuring treatment limitations for mental health and substance use disorder benefits are equal to medical and surgical benefits under certain health insurance policies.

Drug overdose death rates have increased significantly in the past decade, making it a major epidemic, affecting every state. Despite this major public health issue, only about 1 in 10 people with substance use disorders receive recommended treatment. This legislative session proved that state leaders are on the front lines of the opioid crisis, with major steps being taken to address the opioid epidemic.

• Connecticut passed legislation prohibiting mandatory step therapy and prior authorization for prescription drugs prescribed for the treatment of substance use disorders. By eliminating these barriers to quality treatment, medication-assisted treatment options for substance use disorders, which have been shown to increase treatment retention and reduce morbidity, mortality, and risk behaviors, are more readily accessible. Connecticut also passed a bill requiring health insurance coverage for substance use services and prescription drug treatments.
• In Minnesota, legislators came together across party lines to enact a comprehensive state response to the opioid crisis, emphasizing prevention, education, treatment and rehabilitation efforts.
• Colorado passed various bills in response to the opioid crisis, focusing on prevention measures, recovery, and providing access to substance use disorder treatment to high-risk families such as those with pregnant and parenting women.

Innovative approaches by states serve as guides to others, proving that solutions for the opioid crisis can be made on a state level.

Much of the state legislative action taken this year has been focused on expanding access to mental health and substance misuse services.

• Texas made significant progress in passing legislation focused on expanding mental health care services for youth in public schools. The state enacted legislation focused on implementing mental health training, curriculum requirements, and programs for schools. In addition, the bill proposes a plan to allocate resources to focus on mental health and substance misuse in underserved school districts. Texas also passed legislation (SB11 and HB906) to create two task forces, the Texas Child Mental Health Care Consortium and a collaborative task force to assess certain public school mental health services.
• Colorado also made significant progress in expanding access to services. The state passed an innovative bill allowing minors 12 years of age or older to seek and obtain psychotherapy services with or without the consent of the minor’s parent or guardian if the mental health professional deems it clinically necessary and a conscious and voluntary decision by the minor. Colorado also passed bills (HB19-1287, SB19-010, and SB19-222) prioritizing grant funding to create and expand services in underserved or unserved communities, including certain public schools and those at risk of institutionalization.

States are taking action and demonstrating that they can have an important impact on improving access to mental and behavioral health care. We are encouraged by the states’ actions to develop innovative solutions on mental health care, and their efforts to treat behavioral health as a crucial, integrated part of our health care system.