Despite advances, behavioral health legislation still lags behind

The COVID-19 pandemic, which has led to over $16 trillion in increased healthcare, criminal justice, child welfare, education, and labor market costs. has pushed the topic of mental and behavioral health to the forefront for many Americans. In a new study, Penn State researchers examined all federal behavioral health legislation over the last three decades and found that while federal mental and behavioral health policies have increased in number, opportunities for improving behavioral health policy remain.

The study found that from 1989 to 2019, 4,574 mental health bills have been introduced to Congress, and of those mental health bills, 484 directly referenced behavioral health. Of those behavioral health bills, almost half were introduced by the Senate and nearly 80% were sponsored or co-sponsored by Democrats. The greatest number of sponsors or co-sponsors for the bills hailed from California, New York, Illinois, and Texas.

Language matters in behavioral health legislation

The study's principal investigator, Max Crowley, associate professor of human development and family studies and director of the Evidence-to-Impact Collaborative (EIC), suggests that federal behavioral health legislation that directly includes cost-effectiveness, evidence-based terminology, or uses a prevention frame is more likely to be enacted into law than legislation that does not reference these topics.

"Historically, there was a dearth of mental and behavioral legislation, but that has started to shift in the last couple decades," said Crowley.

Crowley notes that the terms of "behavioral health" and "mental health" are often used interchangeably, but the study specifically focused on legislation that directly referenced "behavioral health" or related terms. Behavioral health legislation was further reviewed for content related to specialty service settings (such as mental health clinics or psychiatric hospitals), evidence-based terminology, prevention framing, and consideration of cost-effectiveness.

The results of the study found that of all the behavioral health bills introduced, almost 70% included content related to prevention framing, and 76% had evidence-based terminology. However, only 58% included content related to community or specialty settings, and 58% included cost-effectiveness content.

"Overall, we found that mental health bills have a less than 10% chance of being enacted into law. Going forward, our country will need more structured legislation surrounding mental and behavioral health systems, particularly in specialty and community settings. This need is further punctuated by the deleterious effects that the COVID-19 pandemic has had on mental and behavioral health, writ large," said Crowley.

Connecting researchers to policymakers

Evidence suggests that there is a need to educate policymakers about the opportunities surrounding behavioral health intervention. Penn State's Research-to-Policy Collaboration (RPC), has spent the last several years engaging in outreach efforts to connect with policymakers on these issues. The RPC facilitates engagement between researchers and legislative staff, helping them to translate their research and experience into evidence-based policies through crafting legislative language and providing scientific evidence for congressional testimonies.

Taylor Scott, assistant research professor for the Edna Bennett Pierce Prevention Research Center, co-director of the RPC and another author on the NIH study, says that the RPC's model is one way for researchers and policymakers to work together.

"The RPC works to build trusting relationships between the scientific community and policymakers," Scott said. "Given the pandemic, it's more important than ever for researchers and policymakers to interact to craft evidence-based and prevention-framed legislation that works."