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On Capitol Hill Senators Focus on Community Health Centers & Mental Health during COVID

Contact: Amy Simmons Farber 202 309 0338

Jonathan Muther, PhD, Vice President of Medical Services-Behavioral Health at Salud Family Health Centers, CO

The devastation of COVID-19 on mental health was the focus on Capitol Hill today.  A behavioral health specialist from a Colorado Community Health Center told a Senate panel that even before the pandemic struck, the U.S. was experiencing a mental health crisis. Now with COVID,  “the system is cracking at the seams,” said Jonathan Muther, PhD, Vice President of Medical Services-Behavioral Health at Salud Family Health Centers. Salud serves eight counties throughout north and northeast Colorado and is one of 1,400 health centers across the country that serve a total of 30 million people. Muther was among the experts testifying before the Senate Health Education Labor and Pensions (HELP) Committee hearing taking a closer look at how to address mental health and substance use disorders in pandemic times.

Muther told lawmakers that services to address mental health and substance use disorders are outpaced by demand.  “Even prior to the COVID-19 pandemic, there was a mental health crisis in the country related to unmet need, in which the demand for services far exceeded our capacity to adequately address the rates of distress,” said Muther.  “Over half of American youth and adults living with a mental illness or substance use disorder report receiving no treatment. Pre-COVID, rates of adult mental illness of any type were about 19% on average (ranging from 16-25%). Over 20 million Americans aged 12 or older in this country experience addiction and substance dependence. Of these adult individuals who report a mental illness, as many as 57% report receiving no treatment.”

Muther described the workings of Salud, where he oversees a team of about 40 behavioral health clinicians who ensure that patients have several points of entry to getting a mental health assessment.  Whether the visit is for a COVID vaccination, to get a physical or their medications filled, a health center patient can receive a mental health check in the same medical setting.  This should be incorporated into all clinical settings, Muther says, because most people who need mental health interventions show up first at the doctors’ office.

“There is no health without mental health,” said Muther. “We know, from clinical experience and decades of research, that wellness promotion, improving mental health, and reducing risk for substance abuse, improves all health outcomes. However, access to behavioral health treatment is, in and of itself, a health disparity. Our current system allows for inadequate attention to be afforded to behavioral health treatment, coverage, and policy, as compared to medical care. This needs to change.”

Muther cited the example of a 38 year-old patient named Marco who came to Salud:

“He was living in a 600-square-foot shipping container repurposed as a rudimentary home in rural Colorado.  He had no running water and a small wood-burning stove for heat. He had previously been employed in the food service industry until he was forced out of work last April. During a screening phone call by a Salud behavioral health provider – a routine outreach effort to assess need and normalize behavioral health as part of care, Marco stated, ‘I’m so surprised and glad to hear from someone, this is exactly what I need right now.’ He then endorsed multiple symptoms of depression, anxiety, alcohol abuse, and thoughts of ending his life. The patient acknowledged, ‘This is the first I’ve spoken to someone in days and I never would have known what to do had you not called.’”

Muther underscored several policy recommendations that could help people like Marco.  First, invest in smart technologies, such as telehealth, to foster innovation and think beyond the traditional therapy session.  Also, build on existing advancements of alternative payment models and reformed billing and payment structures.  Muther argued that outdated payment and regulatory constraints make it difficult for behavioral health providers to proactively reach out to patients in need. He also pressed lawmakers for continued investment in workforce training and recruitment through financial incentives and loan forgiveness.

“The good news is that health centers are a proven model of care and are staffed with dedicated professionals who know how to help,” said Muther. “We know where to be so that we can ask the right questions and offer the right help and make the right recommendations. We have shown that we can improve the health of our communities by making it normal to treat the emotional toll of stress and illness when you go to school or see your primary care doctor. We have the road map,

but now need to ensure we have the resources, so the roads are sturdy and equipped to handle the increase in traffic needed to get to our destination of improved health and wellbeing for us all.”

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