Kilmer, Bacon Introduce Legislation to Improve Mental Health Care in Rural Communities

September 28, 2023

WASHINGTON, D.C. - Today, U.S. Representatives Derek Kilmer (WA-06) and Don Bacon (NE-02) introduced the Mental Health Infrastructure Improvement Act, bipartisan legislation to increase access to mental health and substance use disorder (SUD) care in rural and under-resourced areas and address the emergency department boarding crisis.

"From major cities to remote rural communities, the need for comprehensive mental health care is both urgent and undeniable," said Rep. Kilmer. "The Mental Health Infrastructure Improvement Act is about restoring hope and ensuring that every American has access to the care they need when they need it most."

"At a time when one in every five U.S. adults report experiencing mental illness, we need to be investing in mental health care," said Rep. Bacon. "The Mental Health Infrastructure Improvement Act will expand mental health infrastructure and ensure we have the capability to treat those experiencing a mental health crisis. There is a major shortage in availability of treatment, and it is critical we close this gap."

Across the country, there is a critical shortage of facilities dedicated to mental health and SUD treatments. This deficit spans from inpatient beds to essential step-down services like intensive outpatient programs and partial hospitalization. Consequently, numerous patients are left without appropriate care, often finding themselves in emergency departments as a last resort. A case in point is Seattle Children's Hospital, where a staggering 50% or more of emergency beds are consistently occupied by children awaiting mental health care. Such extended stays not only adversely affect the well-being of these patients but also strain the hospital's capacity to address other emergent situations.

The Mental Health Infrastructure Improvement Act helps to address the shortage in mental health care access and the emergency department boarding crisis by:

• Establishing a new loan and loan guarantee program at the U.S. Department of Health and Human Services to fund the construction or renovation of mental health or SUD treatment facilities that provide inpatient care, partial hospitalization, intensive outpatient, and/or crisis stabilization.
• Setting aside at least 25% of the funding for pediatric-serving facilities
• Providing priority for facilities that are in high need, under-resourced, or rural areas; can provide integrated care for patients with complex needs; and will provide multiple services along the continuum of care.

The Mental Health Infrastructure Improvement Act is endorsed by the American College of Emergency Physicians, American Hospital Association, American Psychological Association Services, American Psychiatric Association, Children's Hospital Association, Clinical Social Worker Association, National Alliance on Mental Illness, National Association for Behavioral Healthcare, National Association of Social Workers, National Rural Health Association, The Trevor Project, and the Washington State Hospital Association.

"The National Rural Health Association (NRHA) thanks Representatives Kilmer and Bacon for introducing the Mental Health Infrastructure Improvement Act," said Alan Morgan, CEO, National Rural Health Association. "This important legislation will create a loan and loan guarantee program at HHS to help to address the pressing mental health boarding crisis in rural hospitals. As rural Americans face challenges in accessing the full continuum of mental health care, NRHA applauds the Representatives' efforts to expand access to much-needed mental health facilities and step-down services."

"As a nation, we desperately need to invest in our mental health and substance use infrastructure," said Hannah Wesolowski, Chief Advocacy Officer, National Alliance on Mental Illness. "NAMI is proud to support Representative Kilmer's Mental Health Infrastructure Improvement Act as an important step to expanding access to needed mental health care."

"Every day, countless individuals, including our friends and family, across our nation struggle with mental health challenges and substance use disorders," said Christopher S. Kang, MD, FACEP, President, American College of Emergency Physicians. "For patients with limited choices for access and longer-term care in their community, the best or only option is often an emergency department that is severely strained by staffing challenges and the ongoing lack of needed resources. The 'Mental Health Infrastructure Improvement Act of 2023' can help ensure patients get the care they need, bolster our community mental health infrastructure, and alleviate some of the pressure on our health care safety net. We thank Representative Kilmer for his awareness of and leadership on this critical issue."

"Now more than ever, communities across the country need robust mental health systems that provide the full spectrum of care," said Saul Levin, M.D., M.P.A., CEO and Medical Director, American Psychiatric Association. "APA supports the vital funding the Mental Health Infrastructure Improvement Act seeks to provide, as it would ensure that the most vulnerable communities can deliver mental health services across the care continuum."

"The National Association of Social Workers is pleased to endorse the Mental Health Infrastructure Improvement Act that seeks to address shortages in mental health and substance use disorder (SUD) treatment facilities," said Jeremy Arp, MSW, ACSW, Executive Director, National Association of Social Workers, Washington Chapter. "Efforts to prioritize resources for high-need and underserved rural mental health and SUD facilities - and set asides for facilities serving children - are much needed in Washington and around the country. We hope that this effort, coupled with strategies to strengthen the workforce and remove barriers, will improve responses to Washingtonians requiring care."

"The Mental Health Infrastructure Improvement Act will go a long way in addressing shortages in mental health and substance use disorder treatment facilities in Nebraska," said Terry Werner, BSW, Executive Director, National Association of Social Workers, Nebraska Chapter. "Representative Bacon has always been a champion for improving mental health care for all Nebraskans and we are thankful to him and Rep. Kilmer for their leadership."

The American Psychological Association applauds Representative Kilmer for reintroducing the Mental Health Infrastructure Improvement Act," said Arthur C. Evans Jr., PhD, CEO, American Psychological Association. "The bill would facilitate the delivery of a wide range of services - from 'upstream services,' including prevention and harm reduction, to treatment and recovery support services - in a broad array of settings. This legislation is a key step in expanding access to mental health services by prioritizing vulnerable populations, including children and adolescents, and those living in underserved areas, such as rural and marginalized communities."

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