4 Areas of Focus for a Likely Contentious 2024

This coming year promises to be a very tumultuous one—an extremely contentious presidential election, major divisions in the House and Senate over the appropriate federal role, and general unrest among citizens, with concern that our society is not moving in a good direction. In this very unpredictable context, what can we expect in 2024 for behavioral healthcare?

Clearly, behavioral healthcare has its own internal issues that require action, and it also must be attentive to the broader political environment to sustain progress we have made in the past several years. Within this nexus, several major foci seem likely in 2024.

Confronting the workforce crisis. Although Congress and the Department of Health and Human Services (HHS) already have taken related steps, it seems clear that behavioral healthcare still has a major workforce crisis: We simply do not have a sufficient supply of professional and paraprofessional providers to meet the obvious need for behavioral healthcare services. For most Americans, finding and getting access to care is extremely difficult, if not almost impossible.

In 2024, we can expect more communities, counties, and states to begin identifying local solutions to this vexing problem. These solutions are likely to include:

• Outreach to re-engage retired and other professional, paraprofessional, and peer providers already in the community who are not currently active;
• Implementation of local paths for recruitment of new providers, new retention incentives; and
• More effective outreach to the primary care community.

Such actions are likely to spark new innovative solutions that can be exported to other communities.

At the national level, we can expect that the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA) not only will continue to collaborate on current programs to increase the number of providers, but also may propose new strategies to reduce the prevalence of acute behavioral health conditions. These are likely to take the form of direct efforts to modify negative life determinants in order to reduce the subsequent traumas that engender behavioral health conditions, as well as efforts to implement population health management strategies to support those subjected to particular determinants. All these efforts may also be associated with new projects already underway to improve local community functioning through self-empowerment strategies.

Developing essential crisis services. Currently, suicide rates are exceptionally high and are cause for concern. At the same time, recent research shows that most Americans are not aware of 988. Among those with serious psychological distress who have used 988, only about one-quarter say that they would use it again. All of this suggests that improving 988 and crisis services will be an extremely high priority in 2024.

Throughout the year, we can expect SAMHSA to continue significant efforts to increase awareness of the availability of 988 and to continue to develop related local crisis services, including mobile crisis response teams. Simultaneously, leadership in the field can be expected to undertake efforts to develop a better understanding of who uses 988, who does not (and why they don’t), and who indicates that they would not use 988 again and why not. Information of this type, developed through participatory action research engaging community members, will be particularly important for the future of 988 and related local crisis response activities.

National efforts to acquire additional financial resources for crisis services can be expected to continue throughout the year. Even with the significant added resources that have been provided in the past several years, many gaps remain in local crisis services, particularly in rural communities. And some of these gaps may not be geographical but rather population based. For example, the extremely high rate of suicide among older Americans suggests that crisis services are not reaching this group.

Protecting and developing important new programs. The behavioral healthcare field has enjoyed considerable success with the growth of the federal Certified Community Behavioral Health Clinics (CCBHC) program. And federal budget projections indicate this growth is anticipated to continue for the next decade. In 2024, the field needs to consolidate these gains, implement new CCBHCs successfully, and provide good, sound evidence that this program is working well.

Each of these steps will be essential in the face of expected federal budget contractions likely to be proposed by Congress throughout the year. The best defense against such proposed cuts will be to demonstrate that CCBHCs are working well and actively addressing behavioral health problems in our communities.

Being good citizens. Finally, and perhaps most importantly, we also can anticipate that 2024 will be a watershed year politically. The best response that we can make to the expected conflicts, obfuscations, and intransigence will be to conduct ourselves as exceptionally good citizens. We need to make a full commitment to vote ourselves and to encourage others from the behavioral healthcare and related fields to do so as well. Voting is the clear antidote to difficult politics.

On balance, 2024 is likely to be a year of many mixed positive and negative events and activities. We can influence this balance in favor of the positive by how we address the priorities of our field and by active participation in the broader community.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.