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3 Keys for Successful Collaboration to Address the Behavioral Health Crisis
Even as options for mental health support increase, Americans struggle to get the care they need. The challenge is not insurmountable, but it’s an issue that requires multistakeholder collaboration and data-informed interventions to solve.
Before COVID-19 emerged, roughly 20% of the US population—and 29% of Medicaid recipients—faced some sort of behavioral health disorder. During the pandemic, that number doubled—to 4 in 10 adults—and has yet to recede to pre-pandemic levels.
To address this, efforts are being made across the country to improve collective mental health. Today, 73% of employers offer mental health services, and 62% offer more mental health benefits than they did in 2021. At a systemic level, the federal government actively invests in behavioral health solutions, with the American Rescue Plan donating $40 million to the Pediatric Mental Health Care Access program and $420 million in grants to Certified Community Behavioral Health Clinics. And the rollout of the national 988 line is an encouraging step toward addressing suicide.
This is definitely progress, but because these efforts focus primarily on traditional behavioral health providers, they will not be enough.
Overcoming Massive Gaps in Behavioral Health Services
It’s no secret that there is a shortage of behavioral health providers. Studies published by the Kaiser Family Foundation show that the country only has enough qualified individuals to support 28.1% of those with behavioral health disorders, including substance use disorders. As a result, roughly 150 million individuals don’t have needed access to behavioral health services.
The shortage of providers, combined with the aftermath of a 3-year pandemic, has left these behavioral health professionals feeling overworked and burned out. For hospitals—still the front door to behavioral health access for many vulnerable populations—it has become even harder to retain and recruit mental health professionals.
Efforts are being made to address this shortage by including increasing educational opportunities for those interested in pursuing behavioral health. We applaud this, but these efforts alone will not solve the immediate behavioral health crisis at hand. We propose hospitals and healthcare systems leverage other key resources in their communities—including emergency medical services (EMS), law enforcement, and community organizations—to collectively address and support populations with behavioral health needs.
Building a Better Continuum of Care
Given its siloed nature, it’s not surprising individuals from vulnerable populations often feel marginalized or alone in navigating the healthcare system. Their behavioral health issues are often the result of a complex combination of risk factors—including genetics, trauma, substance use disorder, and social determinants of health. Thus, the care needed to address their issues requires a patient-centered treatment plan that considers the individual’s whole-health needs as well as the multiple touchpoints that person has with the healthcare system and the larger community. Managing this response is a big ask of any provider trying to help an at-risk patient, but almost impossible for most overwhelmed—and often burned out—behavioral health professionals.
Technology can play a critical role here by integrating the traditional medical behavioral health response with resources from the broader community. Best practices for creating this collaborative approach include the following:
- Bring the right people—and the right data—to the table. While federal mandates to improve health information exchanges (HIEs) have accelerated information sharing, for many hospitals, data sharing is still limited within existing networks of care. This leaves out other important members of a patient’s care team—including emergency services, post-acute care, or even community behavioral health clinics. When it comes to caring for patients with serious mental illnesses—whose estimated lifetime cost of treatment reaches $1.85 million per individual—working collaboratively holds strong potential to improve care while avoiding unnecessary costs.
Creating a truly unified, collaborative system of care requires first identifying each resource the patient touches, then ensuring technology systems are equipped to easily communicate and share appropriate information with team members at each point in the patient journey. This detailed view enables better patient outcomes. It also results in a more integrated approach to in-person care—especially when a patient arrives in the emergency department (ED)—by ensuring the right care professionals and resources are activated and kept in the loop.
- Safeguarding patient privacy is critical—but it’s not an excuse to do nothing. Regulations around patient confidentiality—such as 42 CFR Part 2 for substance use disorder—are common in the behavioral healthcare space and can complicate information sharing. The technology platform must incorporate these safeguards, ensuring compliance rather than excuses when sharing information that can help address patients’ behavioral health needs.
- Facilitate real-time intervention. When it comes to mitigating and preventing additional behavioral health crises, prompt response is everything. However, many information-sharing platforms rely on clinicians to proactively pull reports of behavioral health admissions and discharges for follow-up. Unfortunately, this often results in too little action, too late. Instead, we recommend systems that deliver real-time notifications to the appropriate care team members at the time of crisis. This can help clinicians meet patients where they are as well as facilitate timely follow-up—ultimately resulting in reduced ED utilization and improved outcomes.
When We Work Together, We All Win
This is not a hypothetical approach. Technology-driven collaborative care for behavioral health needs has been shown to strengthen outcomes and reduce costs. For example, at a state-based program in Virginia, implementing technology to engage with behavioral health patients reduced ED utilization 33%, state psychiatric hospital admissions 94%, and state psychiatric hospital admit days by 84% within 1 year. By reducing unnecessary hospital visits and coordinating care between the right care teams, the organization was able to save over $2 million a year—without compromising quality.
In moments of crisis, collaboration can be critical to mitigate the risk associated with behavioral healthcare. The most successful approach begins with consistency in care wherever a patient’s first step in the helping process begins—whether that’s with staff in the ED, emergency medical services, law enforcement, or otherwise. By incorporating solutions that facilitate more tightly integrated efforts, healthcare leaders can help ensure all the appropriate resources are utilized, closing gaps in behavioral health in their communities.
Enrique Enguidanos, MD, MBA, is an emergency care physician and founder/CEO of Community Based Care Coordination Solutions. Benjamin Zaniello, MD, MPH, is chief medical officer for PointClickCare and an infectious disease physician.
References
The state of burnout for mental health workers in 2021. Wheel. Published online May 3, 2021.
Follow-up after emergency department visit for mental illness (FUM). NCQA.
