Although the Biden-Harris administration is coming to an end, some of its work will continue. The administration has invested tens of billions of dollars to expand federal and state mental health and substance use services through the Safer Communities Act, the American Rescue Plan, and other legislation. In the fall, they significantly extended these efforts by finalizing rules to extend mental health parity laws.
This amounts to one of the most significant federal government investments in the behavioral health sector in history. For those of us who have toiled in the mental health sector for years (in my case decades), these developments are exciting. Behavioral health care has always been massively underfunded relative to the burden that these disorders have on people, families, and communities. To have the federal government leaning into these challenges with serious policy and funding initiatives can only be described as laudable. It’s about time.
But there is a potential problem. There is significant evidence that increasing access to behavioral health treatments does not, in and of itself, reduce the burden of mental disorders in the community. In August, Time magazine reported data showing that although more Americans are receiving mental health care, the number of those reporting excellent mental health has fallen. This conundrum, known as the “treatment-prevalence paradox,” is well known to researchers. For example, a study that examined access to mental health care across the U.S., U.K., Canada, and Australia concluded, “All four countries have had increases in rates of treatment. … Despite these changes, none of the four countries had any evidence for a reduction in the prevalence of disorders or symptoms over the period. If anything, there were indications of changes in the opposite direction.”
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