Today, Congresswomen Lizzie Fletcher (TX-07) and Jaime Herrera Beutler (WA-03) introduced bipartisan legislation to help improve mental health care for people across the country.  Through the pandemic, Americans have experienced increased rates of anxiety, depression, and trauma, with an approximately 4 in 10 adults reporting symptoms of anxiety or depressive disorder.  Recent Census data shows, however, that the number of Americans expressing need for mental health assistance but who did not receive it jumped by one-third over the past year.  

In order to meet an increased demand for mental health care services, Congresswomen Fletcher and Herrera Beutler introduced the Collaborate in an Orderly and Cohesive Manner (COCM) Act.  This legislation invests in the Collaborative Care Model, a specific care delivery model that integrates behavioral health care within the primary care setting for the treatment of mental health and substance use disorders that require regular follow-up, like depression, anxiety, and substance abuse.  

“It is time we make serious investments to improve how mental health is treated in our country and to ensure that mental health care is more accessible to those who need it,” said Congresswoman Lizzie Fletcher.  “After such a challenging time for all Americans – a year marked by isolation, trauma, and survival – it is clear that our mental health is as vital to our well-being as our physical health.  I am glad to introduce the bipartisan Collaborative in an Orderly and Cohesive Manner Act with Congresswoman Herrera Beutler to allow primary care providers to better identify and treat mental health and substance use disorders using the Collaborative Care Model.  This will help provide relief both to patients experiencing challenging times and in need of support and to the nation’s mental health system that is working to meet increased demand in services.” 

“The COVID pandemic has been tough for communities across Southwest Washington, and especially for folks who were already struggling with anxiety, depression, or substance use disorder,” said Congresswoman Jaime Herrera Beutler.  “And as the pandemic demonstrated, increasing access to mental health care is paramount. That’s why I teamed up with Congresswoman Fletcher in introducing the Collaborate in an Orderly and Cohesive Manner Act, to expand access to the innovative and cost-effective Collaborative Care Model that has been proven to help people experiencing mental health conditions like depression or a substance use disorder. As policy makers, we should be addressing the mental health crisis in this country by promoting tools like this one that reduce barriers to effective treatment for individuals facing mental health challenges.”

“During the pandemic, psychiatrists have seen increased rates of anxiety, depression, and trauma. It is past time to meet the increasing demand for early identification and treatment of these disorders,” said American Psychiatric Association CEO and Medical Director Saul Levin, M.D., M.P.A. “The APA applauds Reps. Lizzie Fletcher and Jaime Herrera Beutler for introducing legislation to advance the Collaborative Care Model and increase access to evidence-based integrated mental health and substance use disorder services to patients in the primary care setting.”

“Expanding access to the Collaborative Care Model nationally is one of the single most important things we can do to improve and save countless lives for people struggling with depression, addiction, and other mental health concerns,” said Andy Keller, President and CEO of the Meadows Mental Health Policy Institute. “Most mental health conditions are fully treatable when detected early, and the Collaborative Care Model improves the ability to detect and treat mental illness as soon as symptoms begin. This is especially important for youth and young adults, as most mental health conditions emerge then.”

“A strained primary care workforce and an underfunded mental health care system exacerbates the unmet need for mental health care, said Ada Stewart, MD, FAAFP, president, American Academy of Family Physicians. “This legislation, which helps to better integrate primary care and mental health services, is timely and important given the ongoing impact of the COVID-19 pandemic, where we expect to see an increase in patients seeking treatment. Family physicians, who often have strong relationships with patients before the onset of mental illness and a deep understanding of social context and community factors, will be critical in treating unmet mental health needs—now—and for years to come.”

"Many physicians have not participated in promising innovations in care delivery such as the Collaborative Care Model because they lack the financial reserves to make the up-front investments needed for practice transformation,” said AMA President Gerald E. Harmon, M.D.  “This legislation provides an important bridge to help medical practices, especially small and medium practices, make investments in accessible and equitable treatment for their patients’ behavioral, mental, and physical health needs."

While primary care physicians are often the first line of contact with a patient who may have a mental health condition, there are many challenges to them providing the care that patient needs whether it be training or resources.  Because of this the primary care physician will often refer the patient to a specialist and many times, these referrals go uncompleted by the patient.  The Collaborative Care Model addresses this by creating a team made up of a primary care physician, a psychiatric consultant, and care manager all working together in a coordinated fashion to address the patient’s mental health needs. 

The Collaborative Care Model has been studied in more than 90 published trials, showing in many different settings and circumstances that the model improves patient outcomes, lowers total costs of care, and reduces stigma related to mental health.  It offers one of the most rigorously studied approaches to integrate mental health and substance use disorder services to patients within the primary care setting.  This model has been implemented in many large health systems and individual practices, providing early identification and treatment in primary care before a patient’s depression or substance use disorder becomes a crisis.  There is also strong evidence that CoCM can improve health equity.  The model has improved depression outcomes for African American and Latino communities and for older adults in minority communities who are at particular risk for COVID-19 and COVID-related social isolation. 

Specifically, the COCM Act would do the following: 

• Create a new grant program for primary care practices to implement the CoCM: Many primary care practices operate on thin financial margins with limited support staff, making implementing a new delivery model difficult.  Implementing the CoCM in a private practice often requires up front expenses and financial risk that can alienate smaller, rural, and independent practices.  The COCM Act authorizes a $30 million per year grant program from Fiscal Years 2022 through 2026 to invest in the CoCM or, a combined approach of the collaborative care model and primary care behavioral health integration models. The program would:
  • Provide grants to primary care physicians and practices that can be used to hire necessary staff, formalize relationships with other team members, and purchase or upgrade software and resources needed to implement collaborative care; 
  • Give preference to physicians and practices with the least existing capacity to implement collaborative care; and 
  • Prioritize physicians and practices who serve medically underserved populations. 
• Establish national and regional Collaborative Care Technical Assistance Centers to assist practices with direct implementation of integrated care models: Many primary care physicians are unsure of how to appropriately implement the Collaborative Care Model, but national and regional organizations are well equipped to provide technical assistance to aid in implementation.  This legislation would provide grants to establish national and regional Technical Assistance Centers to help primary care practices implement the model in their practices.  The Technical Assistance centers would help do the following:
  • Develop staffing models for essential staff roles; 
  • Provide information technology expertise to help with patient registries, electronic health records, ongoing monitoring, and other IT purposes; 
  • Provide operational consultation to develop practice workflows; 
  • Develop financial models for program launch and sustainability; 
  • Provide guidance on developing and maintaining relationships with community-based mental health and substance use disorder facilities for referral and treatment of patients that may be best served in those settings; and 
  • Share best practices and lessons learned.  
• Expand research on promising integrated care models: While the Collaborative Care Model has by far the most evidence-based research supporting its use among all integrated care, other models have shown promise and more research is needed to identify the best models.  These integration models represent important efforts to improve the care of behavioral conditions in primary care and have added value by supporting primary care practitioners.