Behavioral health stakeholders are expressing cautious optimism that the Biden administration will deliver on campaign promises to expand mental health and substance use disorder treatment access, with telehealth permanence emerging as a critical policy priority following dramatic virtual care adoption during the pandemic. Industry leaders participating in a recent College for Behavioral Health Leadership webinar identified telehealth expansion, medication-assisted treatment access improvements, National Suicide Prevention Hotline implementation, workforce development, and sustained funding increases as essential components of comprehensive behavioral health policy reform that the new administration must prioritize to address longstanding system inadequacies exacerbated by COVID-19’s devastating impact on population mental health and addiction treatment infrastructure.
The discussion reflected measured enthusiasm tempered by recognition that translating policy proposals into operational reality requires sustained congressional support, adequate appropriations, regulatory reform navigating complex federal and state jurisdictions, and collaborative implementation engaging providers, payers, regulators, and advocacy organizations. While President Biden announced several behavioral health initiatives since his January 20 inauguration including proposals for substantial funding increases and coverage expansions, stakeholders emphasized that meaningful progress depends on maintaining political prioritization beyond initial announcements through budget cycles, legislative processes, and administrative rulemaking that will determine whether ambitious goals generate transformative system improvements or fade into unfulfilled promises.
Telehealth Permanence Represents Critical Policy Priority
Pamela Greenberg, president and CEO of the Association for Behavioral Health and Wellness, emphasized that policymakers cannot forget telehealth or fail to pay attention to virtual care during coming years, warning against allowing pandemic-driven progress to erode as emergency flexibilities expire and regulatory frameworks potentially revert to pre-COVID restrictions that severely limited telehealth utilization. Behavioral health patients’ telehealth use has soared since the pandemic’s onset, validating virtual care’s clinical effectiveness while demonstrating that many longstanding regulatory barriers were unnecessary impediments to access rather than essential patient protections.
The dramatic telehealth expansion attracted substantial investment capital flowing into digital behavioral health platforms, with venture funding and private equity transactions reflecting investor confidence that virtual care represents permanent delivery model transformation rather than temporary pandemic accommodation. However, the regulatory framework supporting widespread telehealth adoption relies substantially on emergency waivers and temporary flexibilities that could expire following public health emergency declarations ending, potentially eliminating reimbursement parity, interstate practice authority, prescription flexibilities, and other provisions enabling current virtual care delivery models.
Greenberg specifically emphasized the need to expand medication-assisted treatment for substance use disorders through telehealth, addressing access barriers that have historically limited MAT utilization despite strong evidence supporting its effectiveness for opioid use disorder treatment. Prior to the COVID-19 emergency, federal regulations required initial in-person visits before MAT services could commence via telehealth, creating substantial obstacles for individuals without reliable transportation, those residing in areas lacking qualified MAT prescribers, or patients experiencing the chaotic life circumstances, mistrust of medical systems, or stigma concerns that often characterize active addiction and deter facility-based treatment engagement.
The Association for Behavioral Health and Wellness supports eliminating the initial in-person visit requirement that Greenberg characterized as very burdensome for people seeking addiction treatment during crisis moments when immediate access proves critical to preventing continued use, overdose, or treatment abandonment. The organization’s advocacy reflects broader industry consensus that MAT access barriers contribute to persistently low treatment utilization rates despite an overdose crisis claiming tens of thousands of lives annually, with regulatory modernization representing essential policy reform that could substantially expand evidence-based addiction treatment reaching underserved populations.
Evidence-Based Approach Balances Expansion with Quality Assurance
While advocating for telehealth expansion and regulatory flexibility, Greenberg emphasized that she does not necessarily endorse eliminating all virtual care rules without evidence supporting wholesale deregulation. Instead, she advocated for research examining telehealth efficacy across different patient populations, clinical conditions, treatment modalities, and practice settings to inform evidence-based policy distinguishing contexts where virtual care proves clinically appropriate from situations where in-person treatment remains necessary or superior.
This measured approach acknowledges that telehealth may not suit all behavioral health treatments, settings, or patient populations, with clinical effectiveness potentially varying based on condition severity, patient characteristics, therapeutic approaches, or provider capabilities. Research should assess quality of care delivered through telehealth compared to in-person services, examining outcomes, patient satisfaction, treatment engagement, safety, and cost-effectiveness across diverse scenarios informing nuanced policies that encourage appropriate telehealth utilization while ensuring that virtual care deployment serves patient interests rather than merely reducing provider costs or improving convenience at the expense of clinical quality.
The Association for Behavioral Health and Wellness will support research in telehealth effectiveness before endorsing permanent policy changes, reflecting responsible advocacy recognizing that enthusiasm for technological innovation and access expansion must be balanced against patient safety imperatives and evidence requirements ensuring that regulatory reforms improve rather than compromise care quality. This stance contrasts with more aggressive telehealth advocacy demanding immediate and comprehensive permanent flexibilities without research validating clinical appropriateness, positioning the organization as promoting pragmatic, evidence-informed policy development rather than ideologically driven deregulation.
National Suicide Prevention Hotline Implementation Requires Adequate Resources
Kana Enomoto, a Washington, D.C.-based senior healthcare expert with McKinsey & Company, expressed hope that the Biden administration will effectively deploy resources to fully implement the National Suicide Prevention Hotline’s new 988 number scheduled to begin operating by July 2022. The three-digit number was created through the National Suicide Hotline Designation Act that Congress passed in September 2020 with then-President Trump signing the legislation shortly thereafter, representing rare bipartisan mental health policy achievement during a politically polarized period.
The simplified 988 number is designed to improve crisis access by providing an easily remembered alternative to the existing National Suicide Prevention Lifeline’s lengthy phone number that many individuals in crisis cannot recall during emergent situations when cognitive functioning is impaired by severe distress, intoxication, or psychiatric symptoms. The three-digit format mirrors 911 emergency services, creating intuitive associations between the numbers while establishing dedicated behavioral health crisis response infrastructure distinct from law enforcement-oriented emergency systems that may not optimally serve individuals experiencing mental health or substance use crises.
Enomoto anticipated that 988 implementation will divert significant call volumes from 911 emergency services, hopefully providing better first contact for people experiencing mental health or substance use crises while reducing burdens on first responders, emergency departments, jails, and law enforcement by routing individuals into care better suited to their needs rather than defaulting to police response and emergency department transport that often prove clinically inappropriate and unnecessarily expensive. This crisis system transformation reflects growing recognition that law enforcement should not serve as primary mental health crisis responders, with tragic outcomes from police encounters with individuals in psychiatric crisis demonstrating the urgent need for specialized behavioral health crisis response infrastructure.
However, successful 988 implementation requires substantial infrastructure investment beyond simply activating the phone number, including adequate call center capacity to handle anticipated volume increases, trained crisis counselors capable of providing evidence-based intervention and safety planning, mobile crisis teams that can respond to callers requiring in-person assessment or intervention, crisis stabilization facilities offering short-term residential alternatives to emergency departments or psychiatric hospitalization, and coordination systems connecting callers with ongoing treatment and support services addressing underlying conditions rather than merely resolving immediate crises.
Without adequate funding and infrastructure supporting 988, the new number risks generating raised expectations without corresponding service capacity, potentially leading to extended hold times, inadequate crisis counseling, or inability to dispatch appropriate follow-up services that could undermine public confidence while failing to deliver the transformative crisis system improvements that the legislation envisions. Enomoto’s emphasis on hoping for effective resource deployment acknowledges that policy success depends on implementation follow-through rather than merely enacting legislation or launching phone numbers.
Stimulus Package Funding Could Address Multiple System Challenges
The $4 billion earmarked for mental health and substance use disorder care in President Biden’s American Rescue Plan stimulus package generated optimism among webinar participants that adequate funding could address common behavioral health system challenges including workforce shortages, insufficient infrastructure, limited treatment capacity, and access barriers preventing millions of Americans from receiving needed services. This proposed appropriation represents one of the largest federal behavioral health investments in recent memory, potentially enabling substantial capacity expansion, workforce development initiatives, technology infrastructure improvements, and quality enhancement programs if funds are appropriately allocated and effectively deployed.
However, translating funding proposals into operational improvements requires congressional approval in a closely divided legislature where partisan disagreements could delay, reduce, or modify proposed appropriations. Even if funding is approved at proposed levels, implementation challenges including identifying optimal allocation strategies, establishing grant programs, selecting recipients, ensuring accountability, and measuring outcomes will determine whether investments generate meaningful system improvements or dissipate through bureaucratic processes, inefficient programs, or misaligned incentives that fail to address root causes of access and quality challenges.
Workforce shortages represent particularly intractable problems requiring long-term strategies addressing pipeline constraints, educational capacity limitations, reimbursement inadequacy, burnout, and professional satisfaction rather than short-term funding infusions that cannot immediately produce additional psychiatrists, psychologists, social workers, or counselors when training programs operate at capacity and graduation-to-workforce timelines span years. Effective workforce initiatives must encompass loan forgiveness programs incentivizing behavioral health careers, training program expansion increasing graduate output, supervision and mentorship supporting new clinicians, practice transformation reducing administrative burden, and reimbursement reform ensuring competitive compensation.
Provider Engagement Essential for Policy Implementation Success
Ron Manderscheid, president and CEO of the National Association of County Behavioral Health and Developmental Disability Directors and the National Association for Rural Mental Health, emphasized that behavioral health providers must explore how they fit into the administration’s policy agenda and determine what they need to do going forward so the field can become part of what he characterized as a new dawn for behavioral health. This framing acknowledges that policy success requires active provider participation in implementation rather than passive reception of federal initiatives, with community-based organizations, county behavioral health systems, rural providers, and other frontline service delivery entities needing to engage proactively with new programs, funding opportunities, and policy frameworks to ensure that reforms translate into operational improvements benefiting the populations they serve.
Provider engagement encompasses multiple dimensions including advocacy communicating field perspectives and implementation challenges to policymakers, participation in stakeholder processes shaping regulatory details and program design, grant applications securing available funding supporting local capacity development, collaboration with other community organizations building integrated service systems, workforce development initiatives training and retaining qualified staff, technology adoption implementing telehealth and other innovations, and quality improvement efforts demonstrating effective treatment delivery and positive outcomes justifying continued investment.
The characterization of a potential new dawn for behavioral health reflects optimism that the convergence of increased political attention, substantial proposed funding, pandemic-driven system transformation, and growing public awareness of mental health importance could generate meaningful progress addressing longstanding inadequacies if stakeholders capitalize on this favorable moment through sustained engagement and effective implementation. However, this optimistic framing also implicitly acknowledges that previous policy moments generating enthusiasm for behavioral health reform have not always translated into transformative change, with implementation challenges, competing priorities, funding limitations, or political shifts undermining ambitious goals.
Behavioral health leaders’ measured optimism regarding the Biden administration’s policy priorities reflects recognition that while favorable political conditions and substantial proposed investments create opportunities for meaningful progress, realizing transformative system improvements requires sustained commitment, adequate resources, effective implementation, and collaborative engagement across government, providers, payers, and advocacy organizations working toward shared goals of expanding access, improving quality, and ensuring that all Americans experiencing mental health or substance use challenges can access evidence-based treatment supporting recovery and wellbeing.
