Policy Priority: Access to Care and Services

AFSP seeks to address these issues and increase access to mental health and substance use (behavioral health) care and services through policy initiatives such as expanding the workforce, enhancing crisis response, and implementing innovative forms of treatment. AFSP also works to eliminate barriers to care and services such as limited or lack of insurance coverage, available providers, and treatment types or settings. AFSP recognizes that connecting individuals with behavioral health services and resources can help to prevent suicide and works to ensure that those services and resources are accessible to all.

The recent transition to the 3-digit 988 Suicide and Crisis Lifeline number represents a monumental opportunity to transform the way we as a country respond to suicide, mental health, and substance use crises, ensuring that everyone in the U.S. has someone to call, someone to respond, and somewhere to go when in crisis. The Lifeline’s national and local call centers and the community crisis response services that support those centers are already facing increased service demand as the public becomes more informed on 988 and the services and linkages it provides. Sustainable funding and support will be needed to ensure the full vision of 988 is realized.

• Increase diverse and sustainable funding and support for the full continuum of crisis response, including but not limited to Lifeline call centers (someone to call), mobile crisis response services (someone to respond), and crisis respite and stabilization centers (somewhere to go).
• Enhance training for counselors answering 988 calls and strengthen coordination between 988, 911, and all services within the continuum.
• Bridge the gap between 988 and post-crisis supports through evidence-based suicide prevention, intervention, and treatment services, including crisis stabilization, outpatient care, and follow-up services.

Expanding telebehavioral health services can increase the reach of existing healthcare providers, reduce service gaps, and lower treatment costs. Research demonstrates comparable effectiveness of telebehavioral health and in-person services and reveals consistent evidence of its feasibility, acceptance by intended users, cost savings, and improvement in symptomology and quality of life among patients across a broad range of demographic and diagnostic groups. Easing restrictions on and providing coverage for an alternate form of behavioral health treatment will increase access to lifesaving services.

• Minimize barriers to accessing best-practice telebehavioral healthcare and ensure coverage for those services at parity, particularly within rural and other underserved communities.
• Increase access to telehealth training for students entering behavioral health fields and for behavioral health professionals.

The Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurers and health plans to cover behavioral health care no more restrictively than they cover other types of medical and surgical care. Despite the fact that this federal law was enacted over a decade ago, many insurers are still not in compliance with the MHPAEA and many consumers remain unaware of the law’s requirements or how to report insurer violations.

• Uniformly implement and enforce MHPAEA and state parity laws and regulations across plan types.
• Increase oversight and transparency by requiring insurers and state commissioners to submit regular reports on parity compliance.
• Implement consumer and provider education efforts and require the promotion of accessible information on parity requirements and consumer rights under the law.

There is a critical shortage of behavioral health providers in the U.S. When accounting for the entire country, 88% of counties are considered a mental health professional shortage area and a mere .05% of counties are considered to have no provider shortage county-wide. Put another way, over a third of the U.S. population lives in an area with a shortage of behavioral health professionals, and nearly two-thirds of shortage areas are rural.

• Address provider shortages in underserved areas, including in rural communities and incarcerated populations, through loan forgiveness and other financial incentives.
• Expand the behavioral health workforce by promoting access to peer support specialists and properly trained and supervised para-professionals who can provide support for suicide-focused care.
• Coordinate communication between stakeholders to leverage existing federal and state scholarships and related programs.
• Increase access to clinical supervisors, training credentials, and peer support certification programs.
• Expand primary care and behavioral health integration, including through the Collaborative Care Model and the development of learning collaborative partnerships.