June 23, 2021
WASHINGTON – Last week, U.S. Senator Roy Blunt (Mo.) spoke on the Senate floor to discuss the Excellence in Mental Health and Addiction Treatment Act of 2021, legislation he introduced with U.S. Senator Debbie Stabenow (Mich.) to expand high-quality mental health and addiction services nationwide. The legislation builds off their 2014 Excellence in Mental Health and Addiction Treatment Act by giving every state the opportunity to fully fund the creation of Certified Community Behavioral Health Clinics (CCBHCs) in their communities.
Blunt and Stabenow’s 2014 law was the biggest step forward in expanding community mental health and addiction services in decades by allowing services to be funded through the health care system instead of just grants. Ten states, including Missouri and Michigan, have been selected for full participation in the Certified Community Behavioral Health Clinic program. In addition, startup grants have expanded the number of clinics to more than 300 communities across 40 states, plus Washington D.C., and that number continues to grow. These clinics serve about 1.5 million people across the country.
CCBHCs are required to provide a comprehensive set of services including 24/7/365 crisis services; outpatient mental health and substance abuse treatment services; immediate screenings, risk assessments, and diagnoses; and care coordination including partnerships with emergency rooms, law enforcement, and veterans groups.
A new report, authored by the National Council for Mental Wellbeing, shows that these community clinics are increasing access to high-quality mental health and addiction treatment that is making a difference in the lives of thousands of people in communities across the country.
Statistics from the Department of Health and Human Services show that people who received services at these clinics:
Had 63.2% fewer emergency department visits;
Spent 60.3% less time in jails; and
Saw a 40.7% decrease in homelessness.
Following Are Blunt’s Remarks:
"Madam President, let me say our time got changed today a little bit, and I was trying to finish another thing to get over here and hear in-person what Senator Stabenow had to say. She has been an incredible leader in this effort, a great partner.
"As she mentioned, we came to the floor the last day of October 2013, which was the 50th anniversary of President Kennedy's signing the Community Mental Health Act. And well-intended, but an awful lot of it just didn't get done. Facilities were closed that maybe were well overdue to be closed but the opportunities weren't put in place to replace them as that act had hoped they would be.
"I think we've been in the process of making big strides toward doing that. That was 2013 and 2014. We were able to get the first pilot project for Excellence in Mental Health put into place, an eight state pilot project where we're looking not only at the impact of those individuals and families that needed just to have their behavioral health issue treated like all other health issues but also frankly looking to see what impact it had on all their other health issues when your behavioral health issue is being treated as it should be.
"You know, one of the great costs in health care is missed appointments. You've got to believe that almost 20% of the population that has a behavioral health issue is more likely to miss an appointment than everybody else. And, of course, that costs the whole system but particularly costs them. You know, if you're going to the doctor when you need to, taking the medicine you're supposed to take for any kind of health issue, eating better, sleeping better, feeling better about yourself, your health issues are dealt with in a different way.
"Nearly one in five Americans, according to NIH, has a behavioral health problem. But only a fraction of those Americans get the care they need. NIH says they have a diagnosable—one out of five Americans, almost one out of five Americans has a diagnosable and almost always treatable behavioral health problem. But certainly one out of five Americans that have that problem don't get the care they need to deal with that problem.
"The COVID pandemic added to many of those challenges, and realistically, it would if you think about it. If you've got a behavioral health issue, that's normally not going to be helped by isolation, by worrying about health care for yourself or somebody you care about, wondering whether you're going to lose your job or someone in your family is going to lose their job, none of those things are going to be helpful.
"The other area that comes into play there is an addiction issue of any kind. And if you don't have a behavioral health issue before you have an opioid dependency or some other addiction issue, you certainly have one after that addiction takes over. And so all of those things were exacerbated by the pandemic. The percentage of Americans with symptoms of anxiety or depression grew by more than 40%. Drug overdose deaths increased by 20% between October of 2019 and 2020. And it was 30%—I think I may have said 20—30%. And that was after three years of having drug overdose deaths headed in a dramatically different direction. But suddenly, 2020 was the highest year ever for drug overdose deaths. So the challenges of that are great.
"We now have 10 states, including both Missouri and Michigan, who went through a competitive process and became part of the original Excellence in Mental Health states. In all of those states, we have certified community behavioral health clinics that have to meet standards. They have to meet standards of who staffs that clinic that has to be available 24 hours a day, seven days a week with crisis management as a possibility. They can do preventative screenings. They can determine appropriate care coordination with other providers like emergency room departments or veteran services.
"All of those things make a dramatic difference, Madam President, in people's lives. People getting help through the clinics often have access to primary care treatment as well. I've visited a lot of those clinics in our state. I've seen what happens with these demonstration projects. They're enabling more people to get the complete health care they need and, again, including mental health care and addictive treatment quicker, closer to home.
"In new data from the National Council on Mental Wellbeing, 84% of those clinics—the CCBHCs they're calling them—84% of them were able to see clients within the first week. I think 100% of them were able to see a client that needed to be seen that day that day. I certainly hope that's the goal. I hope nobody goes to a clinic—the professionals believe you need help right now that doesn't get help right now. But 84% of the people that show up get an appointment within the first week. That definitely was not the case 10 years ago, and it's not the case now in states that haven't become part of this program.
"95% of those clinics are involved with law enforcement activities and nursing and criminal justice centers. In my hometown of Springfield, Missouri, every patrol officer that's been trained in crisis intervention has an iPad with them that they can connect anybody they're talking to with a 24/7 rural community health center, and they do. I've seen that happen. I've traveled with officers that have done that. And, by the way, I'm sure they didn't have me with an officer that wasn't really good. But you could see no matter how good that officer was, the individual when they were talking to somebody at the clinic that was a professional dealing with this all the time, you could see that conversation took on a totally different tone.
"We've seen more and more efforts to try to help with substance abuse. We've been able to fund the federally qualified clinics in new ways because of that. So 10 states totally in this program. 40 states, under an amendment we made a couple of years after we got started, have been able to take county units or other units that they could qualify into the Excellence in Mental Health program. And so, what we're working on now with our colleagues is an effort to once again make this available to the entire country. I think we've had enough proof in the last seven years or so to show it makes a big difference.
"Again, let me say, Madam President, everybody has always known that this is the right thing to do, and they've always known it's the thing that even was financially smart in the long run. I think we're also showing here how, in the immediate health care context, it makes a financially smart investment to help somebody with their behavioral health challenges as you're working with all their other health challenges.
"Behavioral health, mental health needs to be treated like all other health. This Congress, this year, hopefully starting in this Senate has the ability to say ‘okay, we're ready to open the door now to every state that wants to participate in a program that would treat mental health like all other health.' I know Senator Stabenow and I are going to be working hard together, and you're going to be helping us as we work to get this done.
"So thank you for the time today. I look forward to the further debate of these issues. I think we've come a long way within the last eight years. We can see the full opportunity here right on the horizon. And the Congressional Budget Office, every time they look at this, thinks it cost less than they thought the time before because they're seeing the overall impact in ways that we thought these pilots would prove but haven't. So let's get this done this year. I look forward to working hard to do it and look forward to a full debate and vote on this issue on the Senate floor.”