According to research from the U.S. Department of Health and Human Services, a strong correlation exists between social determinants of health — the conditions and environments in which people live and work — and health outcomes. Social drivers, such as employment, access to insurance and health care and quality of care can profoundly impact a person’s health and well-being.
Data shows underserved groups have less access to mental health services and are less likely to experience high-quality care due to a lack of culturally competent providers and implicit bias among health care professionals, among other factors. Similarly, rural residents often face greater behavioral health workforce shortages, transportation barriers and social stigma than those in urban areas. The reciprocal relationship between health and employment also means that individuals with unaddressed mental health conditions experience a higher rate of employment instability further exacerbating adverse mental health effects. To reverse these negative outcomes, state policymakers can work in their communities to adopt equitable policies that reduce barriers to employment and increase access to mental health services.
These issues were a focus of the Mental Health Matters: National Task Force on Workforce Mental Health Policy convened by The Council of State Governments and the National Conference of State Legislatures, in collaboration with the State Exchange on Employment & Disability (SEED), funded by the U.S. Department of Labor Office of Disability Employment Policy. The task force engaged state policymakers and subject matter experts from across the country to explore policy options and actions taken by states to address workforce challenges and employment barriers for people with mental health conditions. Four task force subcommittees explored specific issues.
The Underserved Rural, Racial and Ethnic Communities Subcommittee identified strategies to increase access to mental health services and treatment. These include:
- Collecting data to better understand care disparities across populations.
- Engaging underrepresented community members.
- Expanding telehealth and broadband infrastructures.
Understanding quality of care, assessing where health disparities exist and effectively allocating resources requires appropriate data collection. Although most hospitals collect some data, across the U.S. collection methods and data quality related to underserved or underrepresented groups varies widely. According to 2019 information, Medicaid programs face similar data challenges. Most states reported missing, inconsistent or unusable race and ethnicity data for their Medicaid programs. However, some states are beginning to require more stringent and standardized data collection practices in their health systems. For example:
- Maine LD 274 (2021) directed the Maine Health Data Organization to determine the best methods and definitions to use when collecting data to understand and analyze health care disparities.
- Massachusetts Chapter 277 (2020) Section 4513-2020 appropriated funds for the Office of Health Equity to conduct a study assessing the availability of culturally competent behavioral health providers in the state.
- Washington HB 2755 (2020)requires health care data reports to include specific demographic information such as income, language, health status and geography.
Some states are also attempting to mitigate mental health inequities for multiple marginalized populations by including representatives from these communities in state advisory groups. Engaging communities in the decision-making process can help build trust, increase collaboration and hold governments accountable. It can also lead to improved accessibility and quality of services. Members from these communities can leverage their lived experience to provide valuable input on policy and programing. States can use legislation or executive orders to create commissions, task forces, councils, advisory groups and offices that incorporate the voices of underserved populations. For example:
- Kentucky SB 10 (2021) established the Commission on Race and Access to Opportunity to conduct studies and research where disparities may exist across sectors. The goal is to identify opportunities for improvement in providing services, especially to underserved communities.
- Michigan Executive Order 2020-55 (2020) created the Coronavirus Task Force on Racial Disparities to study the causes of disparities and recommend actions to address systemic inequities. The task force is responsible for developing and improving systems that support long-term economic recovery, as well as physical and mental health care, following the COVID-19 pandemic.
- Vermont H 210 (2021) established an office and advisory committee focused on health equity to eliminate health disparities and promote health equity among Vermonters. The committee advises the Department of Health and General Assembly on funding decisions related to improving health care for underserved populations.
Lack of access to care is one of the most substantial barriers to health equity that can be alleviated through the expansion of telehealth and broadband access. Though the behavioral health workforce shortage is not unique to rural areas, the distribution of the workforce is significantly uneven. Rural counties are more likely to lack psychiatrists and psychologists than urban areas. Underserved groups also find it difficult to locate culturally and linguistically appropriate care. Furthermore, underserved groups, including people living in rural areas are less likely to have access to broadband. Several states are taking steps to expand access to broadband and telehealth services. For example:
- Arkansas HB 1176 (2021) ensures that Arkansas Medicaid reimbursements for certain behavioral and mental health telemedicine services continue now that COVID-19 public health emergency has ended.
- Colorado HB 21-1289 (2021)codified the Colorado Broadband Office in the Office of Information Technology and created the digital inclusion, broadband stimulus and interconnectivity grant programs to increase community broadband deployment.
For more information about these findings and others, visit the “Mental Health Matters: Framework on Workforce Mental Health Policy.” This resource outlines policy options to recruit and retain qualified mental health providers; increase access to workplace care and supports; address the unique needs of underserved communities; and enhance mental health parity. Such practices are vital to solve the mental health crisis — and build a stronger, more inclusive workforce and economy.