America’s Most Wanted: A Federal Strategy to Improve Society’s Mental Health

By Robert J. Horne, Jim Bialick, John Burnam, Saverio V. Feudo, and Dr. Liz Jacoby, PT, DPT, RYT-200

PART 3: New Dimensions in Mental Health Series - Published May 23rd, 2023

Key Takeaways

• Sens. Michael Bennet (D-CO) and John Cornyn (R-TX) are building a modern federal funding strategy to reimagine mental health policy and reverse society’s negative mental health trends.

• The strategy: redesign the federal government’s relationship with communities, reimagine mental and behavioral health services, and continuously improve the system.

• The vision put forward by Sens. Bennet and Cornyn represents real promise that America can end the crisis.

Introduction

American society does little to teach children the secrets to pursuing well-being or support their search for a purpose in life necessary for happiness once retirement diminishes opportunities for social engagement. These and other snapshots of life in America are fueling record numbers of people reporting poor mental health and loneliness and contributing to a national mental health crisis. Current federal approaches do not seem capable of reversing these trends, so new strategies are required. 

This article, third in the New Dimensions in Mental Health series, was written to highlight the need for a federal funding strategy capable of reducing the incidence of poor mental health in American society. The article explores why reimagining the current federal strategy is the only way to achieve this goal. A new strategy to address gaps in access to mental health products and services, knowing the U.S. does not have the financial resources to expand and sustain enough licensed medical professionals. The means of doing more to prevent poor mental health before it manifests as a medical illness. All made politically possible in a tough economic climate through smarter spending policy principles policymakers can use to increase the return on investment of every federal dollar spent now or in the future. 

The U.S. Mental Health Strategy Lacks…. Strategy

“Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.”- Sun Tzu, The Art of War.

In May 2022, President Biden released a comprehensive national strategy to address “… a U.S. mental health crisis,” and used his State of the Union Address to call for “a major transformation in how mental health is understood, accessed, treated, and integrated – in and out of health care settings.” There is a lot to like in the document. As covered in this series’ first and second articles, a reimagined approach to how the federal government funds mental and behavioral health services in local communities is a good and necessary thing. The President’s strategy frames the current problems well and accurately notes the importance of prevention, mental health, and substance use treatments. Further, the strategy proposes funding and new policy ideas worthy of consideration, such as using non-medical workforces and medical workforce alternatives to help fill current gaps in care access. 

The Administration’s strategy, however, suffers from an identity crisis; it is not a strategy because it fails to capture how new investments in mental and behavioral health will reverse society’s poor mental health trends. Instead, it represents a collection of objectives with a more limited goal of improving access to care opportunities for those with diagnosable mental health conditions. Moreover, it also neglects to outline a vision for allocating funds during a challenging economic climate making it difficult to envision the approach's feasibility on its own.

Strategy and tactics are inseparable, and attempting one without the other is failing to pursue a goal because each is a necessary ingredient for success. Therefore, the absence of a concrete federal strategy for allocating the roughly $380 billion spent annually on mental and behavioral health is troubling, given the current crisis. Thankfully a bipartisan group of lawmakers is developing a modern U.S. strategy and objectives that warrant consideration. 

A Bold New Strategy for Mental Health in America

“The highest form of generalship is to conquer the enemy by strategy.”  – Sun Tzu

In September 2021, Senators Michael Bennet (D-CO) and John Cornyn (R-TX) released A Bold Vision for America’s Wellbeing: It’s Time to Redesign the U.S. Mental & Behavioral Health System. 

In it, the Senators lay out a vision and purpose for reimaging mental health policy: 

1. The federal government lacks a strategy sufficient to reverse the current mental health crisis.

A unified strategy is not apparent for how these federal programs, agencies, and departments are to expend funds nor is there a clear goal of how they collectively advance our nation’s mental health.

2. Needed is a fundamental reimagining of the current federal approach:

Importantly, we need a multipronged strategy for advancing mental health that includes a new approach to support a workforce, both licensed and unlicensed, improving and establishing funding mechanisms that support innovative models of care delivery, and encourage community programs that address other unmet mental health needs we have today.

3. Better collaboration can improve returns on current and new investments:

We need a fundamental reframe of America’s relationship with mental and behavioral health by redesigning local systems in communities all across this nation to empower them to have a greater and stronger response to the needs they are facing in the moment. Our local communities should bring forward their most promising solutions and have the federal government support and learn from their efforts with the end goal of sharing and spreading collective mental health improvement.

The paper notes that “the vast amount of federal funds, and the rules governing how they are given to states or spent, is the foundation for much of what we think of as mental & behavioral health today.” As such, efforts by the federal government to reprogram and otherwise rethink how federal funds can be made available to local communities are critical for mission success. The paper also notes that this reimagined funding relationship between the federal government and local communities can be a foundation and catalyst for additional reforms.

The Senators go on to describe three core components of their legislative approach. They are:

1. Relationship Adjustment.

Congress should use the legislative process to reimagine the relationship between how the federal government funds and engages with local communities… The many different programs and authorities that the federal government uses to fund services act as individual silos lacking ability to cooperate effectively because each fail to coordinate effectively with the others. Congress should begin to redefine its relationship with communities and local health systems to create or otherwise improve access to medical and non-medical mental and behavioral health services for those in need. The goal is to promote greater leadership within communities through use of federal financing mechanisms that appropriately balance the national interests of the federal government with those of local leaders and citizens. Much of the foundation needed to support modern systems are already in place. Therefore, reforms should focus on reprogramming and redevelopment activities where possible throughout federal agencies, like better connecting public health and mental health systems, to minimize disruption.

2. Redesign the System.

Congress will establish a strategy for redesigning mental and behavioral health services in America, including improved funding mechanisms. In doing so, Congress should also help the Administration develop a modern national strategy for:

• how annual federal funds and other resources can be better spent.

• better integrating and implementing whole health systems approaches to mental and physical health and breaking down existing care silos.

• modernize and better equip local workforces to meet growing service demands while ensuring the quality of those services does not suffer.

• Leverage common access points within a given community where Americans can improve their mental health journey regardless of circumstance.

3. Reevaluate Continuously.

Congress can use an annual update process to drive meaningful reform incrementally and improve the feedback loop between the American people’s experience and the federal government’s response.

There is a lot to like in the white paper that warrants consideration by those in Congress. Smarter approaches to spending federal funds can allow communities to address unmet demands for care while also creating higher returns for the federal government from current investments. The authors view it as a viable means to address the current crisis and plan to incorporate some design features into additional articles and policy recommendations. 

Conclusion

Poor mental health is not only a solvable problem but also preventable, yet the U.S. lacks a real strategy for how to solve or prevent poor mental health. Some problems require medical solutions no matter what the federal government undertakes, but many others could have been prevented with the right approach. The bold vision laid out by Senators Bennet and Cornyn holds real promise for meaningful improvements in the mental health of American society.

Future articles in this series will explore additional policy recommendations and strategies capable of improving society's poor mental health trends. You can access the complete New Dimensions in Mental Health series or other Kairos articles by signing up here before they are made available to the public.