October 13, 2021

Bridging the Gap: Efforts to Increase Access to Mental Health and SUD Treatment  

Sara Moscato Howe

Sara Moscato Howe

For nearly twenty years, I spent many days at the Illinois statehouse speaking to legislators about the significant need for addiction and mental health care. At the time, I could easily cite numerous studies showing the significant gap between individuals in need versus those who receive care. By the early 2000’s, Illinois’ substance use disorder (SUD) treatment gap had hit a low of 5 percent – one of the worst in the country. Usually, my conversations yielded a similar response: “Yes, we know there is not enough care. We would really like to do more but the funding just isn’t available.” In good years, I would celebrate a rate increase – 3 percent if I was really lucky! The cycle repeated year after year and the gap between those who needed services and those who could receive them continued to widen.

In the years immediately preceding the COVID-19 pandemic, our nation’s mental health and SUD service system was already stretched thin. In 2017, the Secretary of the U.S. Department of Health and Human Services (HHS) declared the opioid crisis a public health emergency. That same year, the Centers for Disease Control and Prevention (CDC) reported that more than 47,000 Americans died as a result of an opioid overdose and deaths from suicide were 33 percent higher in the U.S. than in 1999. In 2018, only 1.4 percent of the 21.2 million people aged 12 or older who needed substance use treatment actually received treatment. Furthermore, among the 47.6 million adults with any mental illness, 20.6 million (43.3 percent) received mental health services.

By 2019, the treatment gap had somewhat improved.  A 2019 National Survey on Drug Use and Health estimated that 45 percent of adults with any mental illness received mental health services and 10 percent of individuals over the age of 12 who had a SUD received substance use treatment. Little did we know that we were on the brink of a global pandemic that would stress our nation’s behavioral health system beyond its already fragile state. By June of 2020, the CDC reported that 40 percent of U.S. adults were struggling with mental health or SUD and the pandemic was wreaking havoc on America’s dwindling behavioral health workforce.

This begs the obvious question – what can possibly be done to close this treatment gap? Last month, a bipartisan group of 144 House lawmakers spearheaded by the Bipartisan Addiction and Mental Health Task Force attempted to answer that question. Their 2021 agenda strives to address what they call the “dual addiction and mental health public health crises that have been exacerbated by the COVID-19 pandemic.” The 48-page bipartisan blueprint outlines 12 policy subcategories that support four major areas:

  • Increasing access to recovery resources;
  • Ending the stigma surrounding addiction and mental health;
  • Building the public health infrastructure needed to address the addiction crisis; and
  • Creating safeguards against the flow of dangerous drugs in our communities.

It is important to note that while many of these recommendations have been suggested previously, we have rarely seen one comprehensive document that addresses all 12 categories under one behavioral health umbrella. If we are to address our nation’s mental health and addiction crises, it is far past time to acknowledge this will not be done on just one playing field – we must use every tool at our disposal to combat these emergencies. I applaud the task force for leading the effort to break down our respective silos and develop long-term solutions that will strengthen the full continuum of care in every community.

At the same time, we must also recognize we did not arrive at this crossroads overnight and we will not dig out of it quickly. Policy makers should take both short and long-term approaches to expand system capacity. Federal funding investments and proposed increases must be sustained for the long term. Initiatives to recruit and retain a diverse workforce should be expanded.  Widespread screening and referral to treatment must be adopted as a best practice.  Efforts to reduce stigma and encourage asking for help are crucial to impacting these crises.  Finally, we cannot do this alone. It is only through the strength of our collective voices, our diverse experiences, and our shared understanding of the cause and solutions that we will finally implement the necessary financing mechanisms and policy solutions needed to reverse the ever-widening mental health and SUD services treatment gap.


Sara is an award-winning, nationally recognized behavioral health leader with 20 years of experience building successful coalitions to take organizations to the next level. As a senior director at Third Horizon Strategies, she manages client relationships and deliverables, conducts research and policy analysis, and provides strategic consulting services. Sara has held leadership positions with the Illinois Primary Health Care Association (IPHCA) and the Illinois Association for Behavioral Health (IABH).