In rural states such as North Dakota, accessing mental-health care can be extremely difficult. Federal officials say it's even worse when someone's benefits for such care are improperly denied.

They're ramping up enforcement under a law aimed to address the issue.

The Mental Health Parity and Addiction Equity Act, in place since 2008, requires most health plans - offering coverage for behavioral health or substance use disorders - to not make those benefits more restrictive than those for standard medical care.

Lisa Gomez, assistant secretary for the Employee Benefits Security Administration, said their investigations have found that providers are still falling short in providing equal access.

"For example," said Gomez, "there were plans that were excluding coverage for nutritional counseling, if you were seeking that coverage for an eating disorder."

However, the plan in question was not restricting coverage for those seeking that type of counseling for help with a physical health issue such as diabetes.

In fiscal year 2022, Gomez's agency investigated nearly 150 plans and found almost two dozen violations.

An EBSA report suggests correcting these situations is significant because in some cases, hundreds of plan participants were affected by a single provision not in compliance.

Report authors say forcing the provider to make good on the claim can be a life-changer for those struggling with a mental-health issue.

Gomez said for underserved populations, such as rural areas, getting rid of obstacles helps that individual make their situation more manageable.

She added that the last they need is to have to wait for something like a co-pay error to be sorted out.

"We've seen what mental-health conditions and substance-use disorders can do to a person, to a family," said Gomez. "And so, it's really important that we try to use the tools that we have available to us and work together to try to address these issues."

Gomez acknowledged that while there is progress, it isn't moving fast enough to remove these specific coverage hurdles.

Various federal agencies are trying to finalize proposed rules that would strengthen provisions under the law.

Outside of benefits roadblocks, Kaiser Family Foundation data show that in North Dakota, only 19% of mental-health care patients' needs are being met due to provider shortages.




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"Uplift Wisconsin" is just one of the latest casualties from a $210 million cut in federal health funds to the state.

The "warmline" operates seven days a week for 10 hours a day and provides peer-led support through certified professionals with lived experiences.

Martina Gollin Graves, president and CEO of Mental Health America of Wisconsin, which runs the program, said people are able to talk to peers who could empathize with them in a way a therapist or family member might not be able to.

"There is lots of testimony from the callers who actually utilize the warmline," Graves explained. "Talking about if they hadn't called our warmline they wouldn't have reached out for support to anyone else."

She pointed out some people called daily and added the program had been crucial in preventing costly emergency room visits and reducing suicide rates across the state. Last year, more than 24,000 people called into the warmline.

The program was initially funded three years ago through pandemic grants the U.S. Department of Health and Human Services recently axed in an effort to curb what it called taxpayer waste on a crisis it said is over.

Graves countered in these uncertain times, the service has never been more needed.

"It couldn't have come at a worse time when we are seeing increased rates of anxiety and depression," Graves argued. "People are struggling, kids and adolescents are struggling in school settings as well as adults in their workplaces."

The program's annual funds were set to expire in September but the last six months of funding were abruptly canceled due to federal cuts. Graves noted they will have to furlough 20 people in the next week.

"These cuts are impacting real people," Graves emphasized. "I'm really worried about the fallout and what that's going to look like in your community and my community in the upcoming days and weeks."

Continued funding for the program was earmarked in the recent state budget proposal but the funds are not a sure thing and would not be available until the fall. To bridge the gap, Graves added they have launched a campaign to try and save the warmline, but for now, it will stop service on Saturday.


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Tennessee advocates are gathering at the state Capitol Wednesday to urge lawmakers to prioritize mental health funding and policies to strengthen families, communities and youth.

According to state records, 937,000 adults in the state have a mental health condition.

Katrina Gay, executive director of the National Alliance on Mental Illness-Tennessee, said her grassroots group is backing Gov. Bill Lee's budget with more investments in mental health and advocating for PTSD treatment for first responders. She explained the legislation they are opposing.

"We're also going to advocate to make sure that only qualified medical professionals have prescribing privileges for people with mental health conditions," Gay explained. "There's a bill in the House and Senate that would grant medication prescriptive authority to psychologists, and we are strongly opposed to that."

Gay added over the years, they have pushed for key legislation, starting with Tennessee's first mental health parity bill in the late '90s, and continue advocating for funding for services and support of the 988 Suicide and Crisis Lifeline and more.

One in six Tennesseans aged 6 through 17 experiences a mental health disorder each year. Gay noted they advocate year-round with community engagement, which includes the Young Adult Advisory Group and NAMI on Campus clubs, webinars for college students who are emerging advocates. She added an in-person training session for advocates is Wednesday at 9 a.m. at the Cordell Hull Building.

"We have more than 50 leaders coming from across the state in person to meet with members of the General Assembly that are in the districts in which they live," Gay pointed out. "They can educate lawmakers, reinforce their experiences and forge stronger relationships."

Gay stressed there is plenty of legislation on mass violence, and while her group is not addressing specific bills, they urged lawmakers to consider the effect on youth, especially those with disabilities. This summer, they will promote approaches supporting positive youth-adult relationships, better educator training and student empowerment to create safer schools without fear or trauma.


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As Mississippi grapples with a growing mental health crisis, state and local leaders are being urged to prioritize diversion programs and crisis care systems to prevent the unnecessary incarceration of people with mental illness.

It is estimated 2 million people with serious mental illness are booked into jails across the U.S. each year.

Shannon Scully, director of justice policy and initiatives for the National Alliance on Mental Illness, said in Mississippi, where mental health resources are often scarce and the incarceration rate is among the highest in the nation, it means more than 19,000 people in state custody.

"The criminal justice system disproportionately impacts people with mental illness," Scully explained. "They are overrepresented in those spaces, and that's mostly because historically, our communities have underfunded and under-resourced behavioral health."

The Bureau of Justice Statistics reports 44% of people in jails and 43% in state and federal prisons have a mental illness. The Magnolia State has made some progress in recent years, leveraging federal funding to expand mental health services. However, advocates warned proposed budget cuts could jeopardize the gains.

Mississippi's prison system has long been under scrutiny for overcrowding and poor conditions, and a lack of mental health services exacerbates the problem. Scully pointed to "nuisance laws" criminalizing behaviors associated with untreated mental illness, such as public disturbances or sleeping in public, as key drivers of incarceration.

"Instead of implementing policies that may connect these folks to crisis services or to supportive housing, they are charged with a crime or they are ticketed," Scully emphasized. "They become involved with the criminal justice system."

As March marks Criminal Justice Awareness Month, she urged Mississippians to learn more about how mental health intersects with the justice system and to push for reforms. Scully promotes the importance of community engagement, pointing to resources like reimaginecrisis.org, where people can track legislation and advocacy efforts for mental health diversion and crisis care in their state.