While much attention has been focused on the country’s mental health epidemic, with U.S. Surgeon General Dr. Vivek Murthy announcing a crisis among young people and highlighting workplace mental health, states continue to struggle with maintaining mental health parity, according to a Georgetown University’s Center on Health Insurance Reforms report.

The report examined how states are — or aren’t — enforcing the Mental Health Parity and Addiction Equity Act. The law specifies that insurers must cover mental health services in the same manner and to the same extent they cover physical health services.

The Georgetown researchers found that, in attempting to enforce mental health parity requirements, states often push up against resource and data challenges. The use of third-party vendors, like behavioral health organizations, can also complicate matters.

Even though the law has existed since 2008, there’s still a lack of awareness about it among providers and patients. The researchers noted that providers and patients aren’t always aware of their rights to receive equal mental health care access. As a result, violations aren’t flagged especially often..

Since the pandemic, the rate of anxiety and depression has increased by 25% globally. A shortage of psychiatrists and other mental health providers has contributed to challenges in meeting the demand for care.

“Mental health parity remains one of the principle policy levers for improving coverage of mental health and substance use disorder services, an integral component of increasing access to care,” the researchers wrote in the report.

The researchers also noted that states will need more federal funding to effectively enforce the law.

“State resource limitations and a lack of awareness are compromising the effectiveness of our federal parity law, and federal funding to states could help increase access at this time of crisis,” said Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, in a statement.

There’s been a recent push in Congress to improve mental health parity, with lawmakers introducing the Mental Health Matters Act. That bill, which passed the House in a 220-205 vote, would penalize insurers that don’t comply with mental health parity requirements.

The bill remains in flux, however, as it faces Republican opposition over those penalties. They argued that the standards are “unclear and vague” and would “threaten access to critical workplace benefits.”