The United States still faces significant challenges in achieving behavioral health equity. Millions of Americans struggle with mental health conditions and substance use disorders, yet mental health access remains inconsistent. Disparities exist across socioeconomic, racial, and geographic lines, and individuals in underserved communities often face barriers such as cost, lack of providers, or limited local resources. Research shows that people with serious mental illness have a shorter life expectancy and poorer overall health outcomes than the general population, highlighting how closely behavioral health is tied to overall health.
Addressing these disparities is not just a moral imperative—it is a public health necessity. Mental health impacts everything from productivity to chronic disease management, and untreated behavioral health conditions can exacerbate physical illnesses. During a panel at The Future of Mental Healthcare East 2022 conference, Dr. Meena Seshamani, director of the Center for Medicare at the U.S. Centers for Medicare & Medicaid Services (CMS), stressed the connection between equity and access. “You cannot achieve equity if you’re not addressing the underlying issues that frame our society, and that includes mental health access,” she said.
Panelists agreed that integrating behavioral health into the broader continuum of care is critical. “If you’re not caring for someone holistically, they end up in the hospital getting very sick,” Seshamani explained. By addressing mental and physical health together, health systems can improve outcomes and reduce costs associated with preventable hospitalizations. Expanding mental health access ensures that care is proactive rather than reactive.
Legislative Efforts to Advance Equity
Legislation plays a crucial role in improving mental health access. CMS has outlined an ambitious agenda to address disparities, with particular focus on mobilizing the behavioral health workforce and improving care delivery. A key initiative is the 2023 Physician Fee Schedule, which encourages clinicians to practice at the top of their license and reduces unnecessary supervision requirements for therapists, counselors, addiction specialists, and certified peer recovery specialists. This flexibility allows clinicians to serve more patients efficiently while maintaining high-quality care.
Additionally, CMS is proposing new reimbursement models that integrate behavioral health professionals into primary care teams. By paying psychologists and social workers to help manage patient care in these settings, the system aims to expand mental health access early and effectively. Mobile units are also being explored to reach underserved communities, particularly for opioid treatment and recovery services. These initiatives reflect a broader goal: making behavioral health care an essential, accessible part of everyday health care rather than an afterthought.
Technology’s Role in Closing the Gap
Beyond legislation, technology is playing an increasingly important role in expanding mental health access. Digital therapeutics, which deliver evidence-based treatments through software, have emerged as a powerful tool for conditions like insomnia, anxiety, depression, ADHD, and opioid use disorder.
Celeste James, vice president of equity and population health at Big Health, highlighted the unique benefits of these digital tools. Unlike traditional therapy, digital therapeutics reduce stigma by offering discreet, judgment-free care. They can be culturally responsive and adapted to the needs of diverse communities. “It’s really an easier way to get the kind of care that people need in the way that they want it,” James said. The flexibility and accessibility of these platforms allow patients to engage with treatment in their homes, cars, or offices, making mental health access more equitable than ever before.
Digital solutions also provide opportunities for rural or underserved populations. Communities with few local providers can now receive virtual therapy, and people with demanding schedules can access care on their own time. By reducing barriers related to geography, cost, and stigma, technology is transforming mental health access for millions.
Ensuring Innovation Benefits Everyone
While these advances are promising, panelists stressed that innovation must reach all patients—not just those who can afford it. Reena Pande, chief medical officer of virtual behavioral health company AbleTo, noted, “Everybody, whether you’re a Medicare member, a commercial member, or uninsured, must have access to innovation.” Ensuring mental health access for underserved populations requires deliberate strategies, including partnerships with public payers, sliding scale pricing, or subsidies for digital therapeutics.
Achieving equitable access requires that high-quality, outcomes-driven care reaches all patients. By focusing on inclusion, both technology and legislation can help make mental health access a reality for everyone, not just a privileged few.
A Collaborative Path Forward
Behavioral health equity is a complex challenge, but it is not insurmountable. Success will require collaboration across public and private sectors, including government agencies, health systems, technology companies, and community organizations. Legislative measures, workforce expansion, integrated care models, and digital therapeutics are all critical to expanding mental health access and improving outcomes nationwide.
Dr. Seshamani summarized the stakes clearly: behavioral health is integral to the health of individuals and communities alike. By addressing disparities and ensuring access to innovative care for everyone, the U.S. can make meaningful progress toward a system where mental health access is available, effective, and equitable. Only through intentional, inclusive strategies will behavioral health equity move from aspiration to reality.
