Addressing mental illness in America is a source of continued debate and a new report outlined areas in need of change.

The study detailed the role of response teams in a mental health episode.

Andy Wade, executive director of the National Alliance on Mental Illness-Illinois, sees a need to strengthen the disconnection between the 988 system and the services and facilities supporting post-crisis recovery services.

"The progress has been positive but we need more," Wade asserted. "The crisis system isn't just the phone call. It's also about having a safe and appropriate mental health response, even if that means someone coming out to the house."

He called the system "a work in progress" and emphasized 988 operators should have the tools they need to make immediate handoffs to the right services. Wade acknowledged while law enforcement does a good job, there is often an overdependence on police officers who are not always the best responders. He is encouraged by Illinois legislators' commitment to the crisis system, and wants to continue the forward momentum on funding started by state lawmakers.

The crisis system in Illinois allows people to use it regardless of their ability to pay, which the report highlights as a success.

Angela Kimball, chief advocacy officer for the mental health advocacy organization Inseparable, said state lawmakers are the key to change.

"Lawmakers across the country need to understand, one, what does the system look like? And two, what is their role in helping make this happen?" Kimball outlined. "There is no one entity, no one person, that can make a new crisis response system happen."

She added the challenge for lawmakers is to navigate the complex emergency service regulations in place in order to create effective legislation. Illinois Gov. JB Pritzker signed House Bill 2595 in 2021, requiring insurance companies to cover medically necessary mental health care services.

More than 3 million New Yorkers have a diagnosed mental illness but only around one in three can get the care they need to treat it.

The barriers stem from many factors, like so-called "fail first" policies, which require people to try an insurer-preferred medication first, before covering the original prescription.

Matthew Shapiro, senior director of government and cultural affairs for the New York State Chapter of the National Alliance on Mental Illness, said another issue is what are known as "ghost networks."

"In some cases, up to 75% of providers that the insurance company gives to their client don't actually exist," Shapiro pointed out. "They're no longer practicing in the area. We call that 'ghost coverage,' where they're telling you coverage is there and it's not."

A 2023 New York State Attorney General report found 86% of providers listed on health plan networks are not valid listings. The report recommended state regulators crack down on insurers to maintain consistent and accessible levels of care for all. Another barrier is low mental health care reimbursement rates for providers.

As mental health issues rise nationally, insurance coverage needs to meet the moment. Federal laws like the Mental Health Parity and Addiction Equity Act and the Affordable Care Act ensure behavioral health coverage is on par with other health care.

David Lloyd, chief policy officer for the mental health advocacy organization Inseparable, said loopholes in the laws still have to be closed.

"What mental health advocates across the country and in states are pushing for is to make sure when a doctor is recommending treatment, the health plan has to cover those services when they're consistent with what the standards of care are," Lloyd explained.

The biggest challenge to closing loopholes is lawmakers finding the political will to do so. Lloyd added the overall goal is to align providers' and insurers' standards of care, so patients get the treatment they need.

Advocates said the kids aren't all right and want to tackle the youth mental health crisis head on in schools.

A study of Maryland's youth mental health care found 67,000 children in the state suffered from major depression and nearly half did not receive treatment.

In Maryland schools, the ratio of psychologists to students is nearly five times the recommended ratio. Even worse, the ratio of social workers to students is nearly 10 times the recommended ratio.

Angela Kimball, chief advocacy officer for the mental health advocacy organization Inseparable, said increasing school-based mental health services would overcome barriers some students face when trying to access care.

"They're less stigmatizing," Kimball pointed out. "They normalize mental health care. They're available without cost. They don't require transportation or parents taking time off work. School mental-health services offer this opportunity to reduce barriers and get kids the support they need."

Youths who receive school-based mental-health services are six times more likely to complete a full round of treatment, according to a U.S. Department of Education report.

Other studies have shown teaching students mental health literacy and life skills decreases symptoms of depression and anxiety. Kimball emphasized other states are expanding the ranks of their mental health services and including other students to help their peers.

"That means not just school mental health professionals but also expanding that workforce to take advantage of other caring adults and youths and young adults, who can actually provide support to their peers," Kimball explained.

Kimball argued Maryland should expand its school Medicaid program, which allows more money to flow into schools to better fund mental health services.

While New Jersey has made gains in K-through-12 mental health support, advocates said the state needs to do more.

In recent years New Jersey has passed legislation and seen a mix of state and federal grants awarded to help expand access to school based mental health services. In December, Montclair State University was awarded a federal grant to recruit and train school psychologists. Last fall, Rutgers University announced a similar grant aimed at increasing the number of highly trained school counselors.

Angela Kimball, chief advocacy officer for the mental health advocacy organization Inseparable, said for many people accessing mental health services can seem intimidating.

"When we offer mental health services in schools, it serves to actually normalize the idea of getting support for your mental health," Kimball explained. "That really reduces stigma, and it reduces other barriers to people getting the kind of support they need to thrive. "

The American School Counselor Association recommends a ratio of 250 counselors per student. New Jersey has improved its ratio from 2019 when it was near 350 counselors per student. In 2024, the number was just under 300 to one.

The state is currently in the second year of the New Jersey Statewide Student Support Services network, which offers support to all students in the state through 15 regional hubs. The hubs are staffed by prevention specialists and licensed clinicians, and can deliver services in schools, other community settings and virtually.

The hubs offer three tiers of services ranging from workshops in tier one, to prevention services in tier two for groups of at-risk students and individualized intervention services in tier three. The program was intended to replace existing school-based services in place since the 1980s at 90 schools throughout the state. The school-based programs were preserved after some pushback and Kimball noted research points to benefits for keeping services in schools.

"Research is showing that youth who get school-based services are six times more likely to complete a full course of treatment than with community-based treatment," Kimball reported.

Last year, the New Jersey Department of Education found 13% of 12-17-year-olds in the state reported at least one major depressive episode in the past year, with 8% reporting a severe episode.