Legislation signed into law this month by Gov. Charlie Baker is expected to bring updates long overdue to mental-health services in Massachusetts.

The Mental Health Addressing Barriers to Care or ABC Act mandates insurance coverage for an annual mental-wellness exam and enforcing mental-health parity laws. It comes at a time when the need for mental-health services has been heightened by the pandemic.

The law also creates an online portal for Emergency Department visits or ED Boarding. Dr. Grace Chang, president of the Massachusetts Psychiatric Society, explained how this can be beneficial for acute mental-health needs.

"ED Boarding occurs when people present for acute care. They're assessed to require it, but then when there is a bed search made for the patient, there's no bed available," she said. "One of the important things is that we need real-time data, and maybe this real-time data can be used to inform admissions."

Chang said she thinks the provisions in the new law can't come soon enough. According to a recent Blue Cross/Blue Shield Foundation study, 35% of adults in the state reported needing behavioral-health care, but 57% said they either had difficulty getting appointments or did not get the care they needed because of other issues.

While Chang said she sees the bill as a step in the right direction, she cited more work to be done. Although this bill removes plenty of barriers to accessing behavioral-health services, she said she feels a different problem must be addressed - a shortage of professionals to provide those services.

"We've got to have more people who can work at all levels in the mental-health care treatment system. So, that's a major factor," she said. "I think that a number of proposals and initiatives are being discussed, and will be offered and implemented, such as loan forgiveness programs for training."

One reason for the shortage is what Chang described as a "pipeline issue" - training to become a mental-health professional takes almost a decade. However, she remains hopeful that the potential incentives will attract more people to the field.

A new report spotlights some of the challenges to accessing behavioral health care for the one in seven Americans who live in rural areas.

Kendall Strong, senior policy analyst at the Bipartisan Policy Center, said integrating behavioral health into primary care can help improve health outcomes, and get patients the mental health and substance-use treatment they need. She noted just like physical health issues, if you do not tackle behavioral problems that arise, it can develop into something much more serious.

"If you are having issues with substance use, or depression, anxiety, and you let it fester, we know it gets worse," Strong pointed out. "When that happens, you often need more acute care later on. More acute care, as we know, is often more expensive."

One of the report's recommendations is to boost training and other resources for Wyoming's 25 federally qualified health centers, which have pioneered a team-based approach to care. When patients go in for their annual medical checkup, they can also meet with mental health, dental and even vision care professionals during the same visit.

The lack of mental health professionals is one of the biggest barriers to accessing care in rural America. The report recommended strengthening workforce development programs, including the Teaching Health Center Graduate Medical Education Program.

Strong emphasized providers are more likely to work in places where they get their training, and most medical schools and residencies are in cities and suburbs.

"If you don't practice in a rural area, if you're not from a rural area, if you don't live in one already, you're less likely to train there and stay there," Strong explained. "We think that allowing the program to be expanded, continued and built upon, will allow more providers to train in rural areas."

Strong added stigma continues to be a barrier to accessing mental health care. Many patients in small towns are uncomfortable if their car is parked outside a psychologist's office. Strong stressed it is important to continue pandemic-era flexibilities for telehealth services, especially in rural areas.

"A lot of those flexibilities are going to expire at the end of 2024," Strong noted. "But in rural areas, we've seen that the use of audio only is really important for folks who can't afford or don't have access to broadband."

The magnitude of climate change can feel overwhelming, creating a sense of so-called "climate grief" for some, but young climate activists say they are turning the sense of loss into motivation.

Studies show eight out of 10 young people are concerned about the climate, and half report feelings of anxiety, anger and helplessness about it.

Megan Birnbaum, youth engagement and policy fellow at The Climate Initiative, said it is important for young people to acknowledge their sadness about the environment, and to connect with other like-minded people who want to fix it.

"Grief can unfold and then, within that space, I think we can find more brain space or creativity, and especially community, in which to take climate action," Birnbaum explained.

Researchers found climate grief is partly caused by the feeling governments are not doing enough to avoid a climate catastrophe. Birnbaum pointed out young people in Maine have used the grief to help pass bills to improve environmental education and green spaces in underprivileged areas.

Leading climate campaigner Greta Thunberg has said she too has experienced a sense of "climate anxiety," and to get rid of it, it is important to "take action against it."

Birnbaum noted a recent gathering of young climate activists in Washington, D.C., revealed a palpable sense of loss but a stronger sense of hope.

"We were all really fired up to be together," Birnbaum recounted. "And felt so much solidarity that all the issues we are facing in our respective communities are connected by climate change."

Birnbaum pointed out activists in Maine are connecting to others in California, Florida and other places, sharing motivation and advice. She added young people deserve a world in which they do not have to fight for their future.

Nevada mental health professionals want to remind everyone it is OK to not be OK.

According to Mental Health America, in 2022 Nevada ranked last in the country for its overall prevalence of mental illness and for having the lowest rates of access to care.

Tennille Pereira, director of the Vegas Strong Resiliency Center, said following the recent mass shootings around the country, traumatic events can be triggering on various levels for people, especially for survivors.

She noted while May is Mental Health Awareness Month, mental health is something we need to take "more seriously year-round."

"We are seeing an unprecedented amount of mass violence, and there is a lot of discussion surrounding mental health and these incidents," Pereira pointed out. "Wherever you are on the spectrum of thought, in regards to that, these events do impact us."

Pereira argued after the Route 91 shooting massacre in Las Vegas in October 2017, killing 58 people and injuring more than 850, the state of Nevada did not have enough "properly trained and vetted providers to handle the need." She added while improvements have been made since then, things still need to improve.

Pereira observed survivors of mass violence often lose their sense of safety, when the "world can no longer feel or appear to them as safe." She emphasized therapy and mental health support are effective ways to work through trauma.

Pereira acknowledged when violent events continue to happen, it can really hamper a survivor's ability to bounce back.

"What it does is, it reinforces that thought distortion that the world isn't safe," Pereira explained. "It is really challenging for survivors to navigate a world where it keeps happening."

Pereira stressed one of the greatest barriers to getting help is the stigma often is associated with using mental health resources. She said the Vegas Strong Resiliency Center is working to "normalize" getting assistance and encourages everyone to check in with themselves, and added the center has expanded to provide services to all victims of violent crimes.


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