NCSL Podcasts

Exploring Policy Solutions to Mental Health Treatment | OAS Episode 186

Episode Summary

Millions of Americans experience mental health problems and frequently experience challenges finding treatment, including in the workplace. That’s the context for national task force— Mental Health Matters: National Task Force on Workforce Mental Health Policy—funded by the U.S. Department of Labor working with NCSL and the Council of State Governments (CSG). The guests on this podcast are Colorado Lt Gov Dianne Primavera (D) and Tennessee Sen. Becky Massey (R). The two are at-large co-chairs of the task force, which also includes 27 other state lawmakers from both parties. The two spoke about what they’d learned in the course of the task force’s work, and about the goals, which include developing improved benefit and employment; access to mental health resources in the workplace; addressing underserved communities; and the shortage of mental health care workers. The task force plans to issue the policy framework this summer that can serve as a resource for policymakers across the country.

Episode Notes

Millions of Americans experience mental health problems and frequently experience challenges finding treatment, including in the workplace.

That’s the context for national task force— Mental Health Matters: National Task Force on Workforce Mental Health Policy—funded by the U.S. Department of Labor working with NCSL and the Council of State Governments (CSG).

The guests on this podcast are Colorado Lt Gov Dianne Primavera (D) and Tennessee Sen. Becky Massey (R). The two are at-large co-chairs of the task force, which also includes 27 other state lawmakers from both parties.

The two spoke about what they’d learned in the course of the task force’s work, and about the goals, which include developing improved benefit and employment; access to mental health resources in the workplace; addressing underserved communities; and the shortage of mental health care workers.

The task force plans to issue the policy framework this summer that can serve as a resource for policymakers across the country.


Episode Transcription

Hi, this is Ed Smith, the host of Our American States. We are rereleasing this podcast on exploring policy solutions to mental health treatment in observation of Mental Health Awareness Month and to note the release of NCSL’s “Mental Health in the Workplace Toolkit.” Thanks for listening.


Ed:       Hello and welcome to “Our American States,” a podcast from the National Conference of State Legislatures.  This podcast is all about legislatures, the people in them, the policies, process, and politics that shape them.  I’m your host Ed Smith. 


DP:      For a lot of reasons, I’ve been passionate about increasing behavioral health resources so more people with disabilities can work and thrive and lead a really happy life.


Ed:       That was Colorado Lt. Governor Diane Primavera, who is one of my guests on the show along with Tennessee Senator Becky Massey.  The two are at large co-chairs of the National Bipartisan Task Force looking at mental health issues and developing a policy framework for the states.  Primavera, a Democrat, and Massey, a Republican, are among a group of 29 state legislators from both parties on the Mental Health Matters: A National Task Force on Workforce Mental Health Policy.  It’s the U.S. Department of Labor initiative and NCSL and the Council of State Governments collaborated to bring the lawmakers together.  I spoke with the lawmakers about what they learned in the course of the taskforce’s work and about the goals, which include developing improved benefit and employment policies, access to mental health resources in the workplace, addressing underserved communities and the shortage of mental healthcare workers.  The task force plans to issue the policy framework this summer and hope that it can serve as a resource for policymakers across the country.  Here is our discussion. 


            Lt. Governor Primavera, Senator Massey, welcome to the podcast.


BM:     It’s great to be with you today.


DP:      Thank you.


Ed:       Well, thanks to both of you for coming on the podcast to talk about mental and behavioral health issues and more specifically you are at large cochairs for a national mental health taskforce that aims to create a policy framework that can help state policymakers, our audience, working on this issue.  And I wonder if to start you could each offer a little background about your involvement in this issue and why it’s so important to you.  Senator Massey, why don’t you go first. 


BM:     Ah thank you Ed.  My background actually for 25 years, I ran an agency that served adults with intellectual disabilities and many of our folks were dually diagnosed. And so, when I was elected to the Tennessee state Senate, it was natural for me to be appointed to the health committee where we kind of dove deeper into a lot of those issues.  On top of that, three days after I was elected, we closed a major mental health hospital a mile from my house.  And so that just kind of ramped up the conversation on it.  And then knowing family members and constituents that have struggled with mental health and behavioral health need you know has just made it more personal for me.  And then just the increasing number of folks that are dealing with these issues makes me want to do what everything I can to help with it. 


Ed:       And lieutenant governor, how about for you?  Why is this issue important to you?


DP:      I have an undergraduate degree in psychology, so I’ve always been interested in psychology.  And then I went on to get a master’s in vocational rehabilitation counseling so my very first internship was working with people who comparable to Senator Massey’s situation had just been deinstitutionalized from an institution in Pueblo and put into the community.  One of my first projects was to go around and interview the people who had come from the institution and were in boarding homes basically on our Capitol Hill and I saw at that point in time that there were no supports for them.  They were basically just thrown into the community to sit and rock in their living areas you know all day long.  There weren’t a lot of vocational supports.  The medication they were on you know was really toxic and things like that.  So, my heart just really went out right at the very beginning of my career to people that were struggling with a severe mental illness.  And then later on in life, my brother was diagnosed with bipolar disorder in his later years.  And, you know, he lost his career and, you know, lost a lot of family members as a result of how his behavior was with a bipolar disorder.  So, for a lot of reasons, I’ve been passionate about increasing behavioral health resources so more people with disabilities can work and thrive and you know lead a really happy life so that’s why it has been important to me. 


Ed:       I think it’s true that so many of us have family members and that sort of thing who have experienced these kinds of issues and it’s not something that really spares almost any family.  Let me ask you this and I’ve asked this question many times in the last couple of years on this podcast which is how the pandemic affected this issue.  You’ve been working on this project in the aftermath of the pandemic, or the acute phase of the pandemic may be more accurately, and I wonder how that’s affected people’s awareness of behavioral health issues.  Lieutenant governor why don’t you why don’t you take that one.


DP:      Well, thank you Ed.  Well, you know I think the pandemic there were good things that came from the pandemic and there were not so good things that you know came from the pandemic and I think one of the things that the pandemic did is it brought to light many underlying issues across the board in society.  Housing issues.  Access to the internet.  If people didn’t have access to the internet, they couldn’t get telehealth behavior health sessions scheduled and couldn’t go to school which you know was difficult for kid mental health.  There was also additional stress on our healthcare workers including our behavioral healthcare workers during that.  And so, we’ve seen a lot of people in the healthcare industry leave the workforce because of burnout.  And then I think we saw that there was really access to timely crisis services during the pandemic.  So, it disrupted our routines.  Changed the ways we work.  The way we travel or the way we interact with family and friends.  I think one of the good things that it did was that it brought to light how important telehealth is.  We saw telehealth in Colorado increase by about 600%, I think.  It really did do some good things there.  It also showed us how important remote work is.How we can work remotely and how we can do flexible hours and I think for people with mental illness just that workplace accommodation is important in itself.  So, there were some good things that came from it and of course there were some bad things.  I think that’s what we saw in Colorado. 


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Ed:       And Senator Massey, what do you think? How did the pandemic affect this situation both in terms of what’s really going on and maybe in terms of how the public perceives the importance of dealing with this issue.


BM:     It increased mental health challenges exponentially.  You know the isolation, the not being able to be around folks, your peers you know kids being able to interact even when they went back to school not being able to see faces when the masking was in place.  That was causing issues, but definite studies that have shown that symptoms of anxiety and depression, stress and substance abuse disorder have really increased dramatically especially it was more pronounced among individuals experiencing household job losses, young adults, and women.I know at our Children’s Hospital the emergency rooms that young folks I think more than doubled that were experiencing some mental health issues.  You had increased deaths from drug overdose, alcohol induced deaths.  There was just that significant increase and made ahm and as the Lt. Governor says there was a decrease in the access to services.


            But I do think that just all the publicity around that and I think a lot of people really did see that there were increased needs and there weren’t enough resources to help with that. 


Ed:       I was surprised doing a podcast about social isolation during the pandemic and speaking to an expert at BYU and she said surprisingly to me that the group most affected were young people.  Not, I had assumed it would be more my age group quite frankly, but she said that it was.


BM:     Young people like you Ed.


Ed:       Young people like me.  More the teenager variety. I think maybe we didn’t appreciate as you both pointed out, the pandemic really made us realize where some of the holes were in our social safety network and things that we thought were running OK maybe didn’t run so well once the stress test was applied.Now Senator Massey, I know part of this discussion revolves around access to behavioral and mental health services in the workplace.  And I wonder if you could talk about why that’s important. 


BM:     Well, I think it’s just important for anyone in a workforce to have the supports they need, but when you are experiencing either mental health or behavioral health issues are struggles.  You actually need a little bit more supports or different kinds of supports. It’s not a cookie cutter one size fits all.  And so, I think that’s a challenge.  I know there’s been studies done by the HR professionals and they don’t feel like they have the tools they need to do all the supports they need.Businesses you know really are not providing enough supports and especially our small providers because they just don’t have the staff in place that can do all the different things that need to be done.  And I think a lot of times your especially your small businesses think that accommodations can be more costly than they really are often.  If you don’t offer these supports, there is a bigger chance that those employees will either be fired, or they will quit because they just can’t get the help that they need or the various supports that they need. 


Ed:       Lieutenant governor, what are your thoughts on the importance of access in the workplace?


DP:      You know I think it’s critical. I think you know as Senator Massey mentioned and I’ve mentioned about the burnout ahm of people.  So, you know as I mentioned also, I started my career helping people with mental illness have the opportunity to work.  So, I think more awareness is needed on the protection granted by the Americans with Disabilities Act.  I think employees need to know about the protections.  I think employers need to know about the protections.  Other federal civil rights laws, parity laws and state laws as well as those that apply to people with disability level behavioral health disabilities.  So, the first thing of course is disclosure you know a person has to disclose that they have some issues before they get ADA protections so making sure that people who are seeking to work understand that they have to disclose in order to get the supports they need in the workplace.  Educating employers about incentives to hiring people with mental health conditions I think is important like job coaches for example.  That can increase their willingness and enthusiasm to hire people in the first place who might need these extra supports. 


            I think employers also need to know how get more information on how they can create and cultivate a mental health friendly workplace.Encourage mental health days if they know that there is an employee struggling.  Encourage breaks to relieve stress is important.  You know maybe giving people more time for deadlines and taking some things off their plate if they are struggling at the workplace.  So, and in Colorado we passed legislation in 2021 to require coverage of an annual mental health wellness examination so I think encouraging employees to take advantage of that exam is really important.And you know we need to highlight the importance of supporting employees who provide direct services in our community.In the state, we have the Colorado State Employee Assistance Program.  We need to make sure state employees are aware of that.  We need to make sure that we give people who are providing mental health services they have a livable wage that we need to do some work on student loan forgiveness so that we can get more providers to support people in the workplace.  So, these are all kinds of things that we can do I think to make sure that ah people have the supports that they need. 


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Ed:       Let me follow up on that a little bit.  Were there any particular challenges here in Colorado?  I’m, of course, here in Colorado along with you.And I’m wondering if there were any particular challenges or barriers you thought in terms of mental health and behavioral health access?


DP:      It’s really hard to provide any kind of support or mental health services if you don’t have the workforce to do that.  So, workforce shortages have persisted ahm and that really impacts access to care.  We also have challenges with providers not being located in close proximity to patients especially the rural areas.  And then sometimes we think there are mental health providers in private insurance networks but find out that there really are ghost networks because providers have burned out.  They’ve left.Those kinds of things so in Colorado, we are in the process of reforming how we approach behavioral healthcare as a state and strengthening our safety net.  Doing some things to get more providers into the workforce.  Behavioral health is complex.  And the other thing is one of the things we’ve noticed is that when people need services, we have so many different state agencies that provide a little piece of this, a little piece of that.  You know they provide services for one population, but not the next.And trying to help people get into the right door so that they can get the services that they need at the right time is really important. 


            The other thing that we noticed is that you know oftentimes it’s one thing for a provider to tell you ah what your diagnosis is.  But it’s really important to talk to people who have been through it themselves and so we are really seeing the importance of peer supports and so we are trying to increase how we can get more peer supports and peer counselors and things like that into the mental health workforce.  I think we’ve seen a lot of challenges.Challenges for people in the agricultural community.  A lack of culturally responsive services.  You know I think when we had listening sessions all over the state before we decided it was really time to reform our behavioral health system and one of the most heart wrenching groups that I met with was people who are deaf and how isolated they are, and they really have no way oftentimes to access mental health services so that’s been a problem.  Stigma still remains a challenge especially with agricultural communities and veterans.And then we have judicial challenges you know when you think of 30% of the people in our prisons have a documented diagnosis of mental illness, they shouldn’t be our biggest service provider, so we need mental health courts.  We need judges to understand so there’s lots of challenges and I could on and on, but I know Senator Massey probably has challenges in her own state of Tennessee as well. 


Ed:       Great segue.  Senator Massey, I am curious.  How about in Tennessee? Similar sorts of things or others?


BM:     Well, I mean I can probably echo just about everything the lieutenant governor said.  I’ll try to add a little bit to it. You know about 35% of folks with needs are not receiving treatment.  And so, you kind of have to look at it.  So, you always start with the base of funding.  The funding at the state level because a lot of times we are subsidizing or contracting with local providers to provide services, but not often providing it at a level that they are able to hire the employees that they need.  So that’s one thing that we are doing is a task force that is looking at kind of those frontline staff that are really the hardest to find and to fill all those positions.  So, funding is a big portion. 


            Looking at the insurance coverage and making sure that it is adequate, you know.  We talked a little bit on the task force about you know coupling you know mental health and a physical checkup, preventative checkup with a mental health checkup annually and getting the insurance companies to understand that that preventative measure will same them money in the long run. 


            The education piece educating the employers to know what their responsibilities are, but also what the benefits are for them to provide a healthy workplace.  And to educate the employees one the peer employees to support their peers in the workplace.  But also, the employees that are experienced the mental health behavioral health issues to know that you know oftentimes they are afraid to self-identify and because they are either worried that they will lose their job or that they will not be up for promotions and things.  So, a lot of times they keep that to themselves.  One of the things that we did oftentimes as a state government we tell the providers in the state, we tell everybody else what to do.  We don’t always walk the walk, so we pass the state as a model employer to encourage the state to hire more people with disabilities whether it’s mental disabilities or intellectual or it’s our deaf folks as Lt. Governor talked about.And the first step of that was to try to get their employees to self-identify and cause often they don’t.


            And the other thing I think that’s the biggest challenge to access is folks don’t know where to look.  They don’t know what they have available to them, what’s not.  We talked about potential navigators to help the average citizen to ahm understand what was available.  And then the last thing I would say is you got your low-income people and people with disabilities we got always have great services for. You’ve got your wealthy folks that can go out and purchase whatever they need.  But even I mean people even with insurance they may not have good insurance.  They may not know what they can do in it, and I think they fall more in the gap than probably any other segment because they are just kind of in the middle and being able to afford and find what they need and their co-pays in there, I think.  So, there are definite challenges, but we are going to keep working on it. 


Ed:       We will be right back with the rest of our discussion after this short break.


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            Let me switch to a little bit more of a political question.  One of the things we are always interested in on this podcast is bipartisanship.  Senator Massey let me stick with you for a minute.  Is this an area where you have found it easy to get bipartisan support?Are there fault lines there?  Are there ways you’ve found to try and keep that in the bipartisan lane?


BM:     I think it really is pretty easy to keep it in the bipartisan lane.If you go back and are looking at the root cause, I think people realize that the challenges we have now obviously different people have different types of solutions or different amounts of solutions.But as far as trying to make the needs of our constituents in our state and the residents of our state I think that is a bipartisan that it really crosses lines.  Truthfully most of what happens in the state legislature is more bipartisan.I always tell people and it surprises people because of what they see on either social media or on the national news, but I’d say at least 90% of everything we pass passes with good bipartisan support. It may be more than that, but at a minimum 90%. 


Ed:       Lieutenant governor, how about from your perspective not just in Colorado, but as you’ve talked to people around the country are you finding this largely to be a bipartisan issue?


DP:      Yeah, well first I want to take my hat off or my earphones off to NCSL and CSG and the Department of Labor for intentionally making this a bipartisan issue or bipartisan solution.  I was really lucky to get to know Senator Massey and to work with her and some of the other Republican legislators that were in the room.  One of our panelists on our last fireside chat we approach this with a heartful of grace and a soul full of love.  I think he was quoting some part of Martin Luther King.  But our last panel that we had, it was a fireside chat and we had legislators from all over the country both Democrats and Republicans becoming really vulnerable.  You know sharing their mental health struggles that they’d had throughout life whether it was alcoholism or abuse or eating disorders or you know anything like that.  And so, it didn’t matter what their party was.  You know they were just up there showcasing they have struggles as well.And so, some of the best ideas I heard during the committee hearings were proposed by Republican legislators.I think some of the best ideas Senator Massey heard were proposed by Democrat legislators.  So, you know it is something that we need to come together on because this is an important issue that we need to resolve on a national level.And I agree with Senator Massey that I think the most successful policies have fly in from both sides and we are lucky in Colorado that we have a legislature that is willing to work together to embrace some of the ideas from both sides.


Ed:       Lieutenant governor, let me stick with you for a second here.  I know this taskforce convened in person in Charleston I think it was last year and then Chicago in April.  What were the big takeaways for you following those meetings?


DP:      As I mentioned one of the big takeaways was just how passionate people are on both sides of the aisle about this issue.  You know initially I think I was a little skeptical about what our outcomes were going to be because this is a big elephant that we have to turn around, but the more and more we met, the more and more the people from CSG and NCSL understood about what the issues were, the better panels they put together.And we just heard some amazing panels on the final day addressing a lot of the issues about workforce, about accommodations, about you know different things like that.  And so, I’m really excited to see the policies that they propose that have come out of this that have been suggested from all over the country.And the national engagement I think has been really important.  And like I said, the final fireside chat really kind of put it all together for I think all of us I think to see the legislators themselves that struggle with this and how passionate they are about doing something about it so.  I know that things are going to come, and I think now is the time.


Ed:       And Senator Massey how about for you?  What did you walk away with after those meetings?


BM:     It reinforced that there’s a lot of caring people that are serving in our legislatures that really just want to do well by the citizens in their state.And for us to come together you know on the national level to see what we can make a difference that can spread to other states that weren’t represented at the meetings.  I was I’ve been fortunate to serve on a couple of task force and so it really is amazing what all comes out of it.  I think just as far as some key takeaways though, I think we’ve mentioned I think the education piece is tremendously important to the mental health training, but for employers and employees and to help reduce the stigmas that may be there and to help people understand how to support each other better.  Because I think that at the end of the day, that’s what businesses want.  That’s what just our community wants is to help each other be better.  I think the insurance piece sometimes it’s missing where it really needs to go to prevent the occurrences from where you could give some supports at the beginning level you could weigh lay some significant problems down the road and I think we’ve got to start looking at more preventative type efforts.  The mental health friendly workplaces and just make providing the access that people need and letting them know where that access is.


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Ed:       Now as we wrap up, I wanted to ask you about this policy framework, which, as I understand, will come out this summer and the folks at NCSL tell me they don’t know exactly when, but it should be out by the time NCSL holds its Summit in August in Indianapolis.  And I wonder, Senator, let me stick with you. What do you hope it will achieve and what your message is to other state policymakers.


DM:     Well first that there is hope.  There’s hope if we all work together.  There’s no magic wand.  You are not going to solve everything with just one bill or one program or anything, but if we can start offering tools in the toolbelt so that we can incrementally get better and address these snakes in our state.  As the lieutenant governor talked about that that last panel showed how personal it is and so we are not just talking about a policy; we are talking about people.  How we can make a difference in people’s lives and so I think that’s the goal of this.What’s nice as a legislator is to have policies kind of written down that I can refer to that have worked in other states so I can pattern some legislation after that if we are not doing that in Tennessee.  And I can share policies that folks in other states can call me up and say okay how did you do that model disability employment bill that you just passed, or you know so that sharing, that camaraderie among folks.  But it’s just ah it’s to there is no reason to reinvent the wheel anywhere.I mean because if something has been done probably somewhere and just to kind of put it all in a resource guide for legislators across the country, I think is really important.


Ed:       Well, certainly NCSL is dedicated to that mission of trying to spread and help people share that information.  Lieutenant governor how about for you.  What are your thoughts on the policy framework.  You get the last word here.


DP:      Well, you know as Senator Massey said I have great hope for what we’ve accomplished to know what we are going to accomplish so I’m excited to see the recommendations that come out of this.  But you know there is no substitute for face to face.  And I was really lucky to meet people like Senator Massey and some of the other representatives.  I keep my seed notebook next to me all the time and I know if I have an issue I can refer back to the agendas and find someone that’s an expert on networking adequacy or pick up the phone and call the representative from Georgia and say what are you doing.  And so I think the list of experts that we came away with people that we can contact and pick their brains is ah you know as important almost as the policy that will come out cause there will be new things that are happening and now we have the context across the nation of people that we can call on and rely on and brainstorm with about how we an make mental and behavioral health better in our states.  So, I was just really lucky to have this experience and I just want to thank NCSL, CSG and the Department of Labor for that experience.


BM:     And I too want to thank them too I mean because they always do an amazing job.  They had the vision to pull this group together and to coordinate all these meetings and it’s like sometimes like herding chickens.  I really appreciate the work that all three of those groups do in their field.


Ed:       Well, thank you both so much.  This is such a critical issue and I think that this gives us all a little bit better idea of what we might look forward to in the policy framework.


BM:     Thank you.


DP:      Thank you. 


Ed:       I’ve been talking with Colorado Lt. Governor Diane Primavera and Tennessee Senator Becky Massey about their work as at large cochairs on the national bipartisan mental health taskforce working to develop a policy framework for state policymakers.  Thanks for listening.


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You can check out all the podcasts from the National Conference of State Legislatures by searching for NCSL podcasts wherever you get your podcasts.  Tim Storey, NCSL’s CEO, hosts “Legislatures:  The Inside Storey” where he focuses on leadership and legislatures.The “Our American States” podcast dives into some of the most challenging public policy issues facing legislators.On “Across the Aisle” host Kelley Griffin tells stories of bipartisanship.  Also check out our special series “Building Democracy” on the history of legislatures.