Across our nation, Americans are facing a mental health crisis, which was only exacerbated by the COVID-19 pandemic. And rural states like North Dakota are at a particular disadvantage, dut to a serious lack of resources paired with a growing number of individuals seeking help.
In 2023, 29 percent of adults in North Dakota reported symptoms of anxiety or depressive disorder. And 48 of North Dakota’s 53 counties were classified as “health professional shortage areas.” One reporter even referred to Western North Dakota as a “mental health care desert,” shedding light on how desperately our state needs increased access to mental health support.
Unfortunately, North Dakota isn’t alone in this regard. Nearly every state in the country is facing shortages when it comes to mental health support, and the number of people seeking help is growing. In 2023, 45 percent of adults ages 35-44 reported some sort of mental illness, compared to 31 percent in 2019. Adults ages 18-34 reported the highest rate of mental illness at 50 percent.
I have been pleased with the Biden administration’s approach to improving access to mental health care, through billions in investments ranging from the 9-8-8 hotline to support for school counselors. This is exactly the kind of support our nation needs.
But the Departments of Labor, Treasury and Health and Human Services recently announced a rule change to the Mental Health Parity and Addiction Equity Act of 2008 that could have devastating effects. Although the rule is well intentioned as a means of increasing access, it could spur severe unintended consequences, including increased costs and reduced access to quality care.
The proposed rule change would seek to increase the number of providers by decreasing the quality standards for providers. This would leave patients to navigate an already-confusing market with little to no assistance. This influx is also likely to result in patients playing a game of trial-and-error as they seek the right provider to address their needs.
The stigma associated with seeking care, especially for those struggling with substance use disorder, already discourages individuals from seeking help. By complicating a patient’s ability to find proper care, this process will inevitably deter patients from seeking care at all, further exacerbating the crisis at hand.
As the mental health crisis continues to grow out of control, the answer is not to lower the standards of care and complicate the system for patients.
This rule change seeks to remedy a problem that doesn’t exist. Our health care system is one of the best in the world — we shouldn’t do anything to compromise this standing. We must instead take meaningful steps to address the real issue, which is a shortage of qualified providers.
There are numerous ways to address the disparity between traditional and mental health care. Increasing support for telehealth services, improving training for primary care physicians and individuals on the front lines as well as incentivizing individuals to join the mental health care workforce are just a start. Unfortunately, this is a long-term problem that cannot be fixed overnight.
While the COVID-19 pandemic exposed the gaps in our mental health care system, it also provided insight to ways we can improve access for patients. Telehealth services, for instance, proved to play a vital role in delivering support to those in need — both for mental and physical health care.
Just last year it was reported that 37 percent of mental health care visits occur virtually through telehealth services. Given this data, we should be seeking ways to expand telehealth services — including allowing patients to seek care from providers across state lines.
Of course, we must also consider rural broadband coverage and make it a priority to improve nationwide access.
In addition to improving telehealth services, we must also make it a priority to train primary care physicians, nurses, school counselors and others on the front lines of the mental health crisis — especially for the sake of our children.
Often, these individuals are the first or only option when a patient is seeking help. If they are better equipped to accurately identify symptoms early on, appropriate referrals could be made, and patients would be better served.
As it stands, many patients are forced to go undiagnosed or untreated for long periods of time, allowing their symptoms to worsen, before finding the help they need. Improved training for our first line of defense could prevent this terrible cycle.
While improved telehealth services and better training for providers are both critically important, we must also institute long-term solutions. Programs can help that incentivize medical school students to enter the mental health care workforce and retain professionals already in the field.
We’ve seen how successful incentive programs have been in other areas of healthcare. For instance, studies have shown providers who complete their residency in rural areas are significantly more likely to continue in rural areas long-term. If we can find ways to incentivize mental health care, we can successfully address the provider shortage issue over time.
Mental health is an issue our entire nation is currently confronting, and we must take a multifaceted approach to address the growing problem.
I appreciate the Biden administration’s commitment to improving access to care, but we must also ensure we’re going through the appropriate channels, working with field experts to ensure that the right steps are being taken. We cannot afford to govern through rule changes.
Heidi Heitkamp (D) is a former U.S. senator from North Dakota.