Key Tools Can Help Address Our Behavioral Healthcare Crisis

Ever since the beginning of 2022, many of us have been expressing growing concern about the severe crisis being faced by the behavioral healthcare field. The stress test of the COVID-19 pandemic has made the key outlines of this crisis quite apparent. Essentially, we are not able to deliver accessible, appropriate, and acceptable care to the vast majority of those who currently require behavioral healthcare services. A common ingredient in this crisis is our ever-growing workforce shortage.

In recent commentaries, I have described steps that need to be taken to address this workforce shortage. The first of these steps is for President Joe Biden to declare a national behavioral healthcare emergency. This would make federal resources available on a rapid basis so that immediate steps could be taken in the field to hire and increase salaries for behavioral healthcare providers, and to extend behavioral healthcare capacity into communities via peers and community health workers.

Here, I would like to describe several other actions that we could take at the same time to mitigate our current behavioral healthcare crisis. These include community development, population health management, and care integration. Each could reduce the disparities we currently are experiencing between those who receive care and those who do not, so that we can continue to promote better care equity across income, racial/ethnic, and gender/sexual orientation lines.

Community Development. The model of community development continues to evolve from external management to internal empowerment. The goal is to develop self-empowering and empowered communities that actually begin to function like communities. Several principles need to be followed:

• Listen to community members
• Include historically excluded groups, such as racial/ethnic minorities
• Foster celebratory opportunities for community interaction
• Promote indigenous leaders

Self-empowered communities do evolve groups, places, and events where local persons with behavioral health conditions can gather and offer mutual support and friendship. Over time, such gatherings also can evolve tasks and projects that support the behavioral wellbeing of the entire community. Such foundational social processes can help mitigate the behavioral health emergencies that would occur in the community.

Population Health Management. Population health management gradually is becoming a feature of the behavioral healthcare landscape. Typically known as a tool to modulate service utilization, it also can be deployed to address the social and physical determinants of health that engender behavioral health issues and crises. Population health management can sub-aggregate populations into smaller groups that are exposed to different health determinants. Subsequently, specifically designed interventions can be implemented with each of these smaller groups to forestall the development of behavioral health issues and crises.

Behavioral healthcare providers long have known that issues with relatives, friends, medications, money, housing, support, and social isolation, among others, can trigger a behavioral healthcare episode. Population health management can identify which persons are most likely to be affected by which of these health determinants. Once identified, pre-care outreach can be deployed on a periodic basis to assure that potentially problematical health determinants remain in check.

Care Integration. Behavioral and primary care integration can foster a much broader range of access points for those experiencing behavioral health conditions. It also can improve the detection of behavioral health conditions at an earlier stage. Many people with early-stage behavioral health conditions are more likely to discuss behavioral symptoms with their primary care physicians, rather than to seek care from a behavioral healthcare program. Early detection will be more likely when such physicians are part of an integrated care arrangement that includes behavioral healthcare.

Integration of behavioral and primary care also permits effective whole person care. Many persons with behavioral health conditions have both mental health and substance use conditions, as well as chronic physical conditions. Integrated care can improve both the quality and outcome of care received by persons with these co-morbid conditions.

Each of these tools can be implemented today. I encourage you to deploy them in your own community. Even if a national behavioral healthcare emergency were to be declared immediately, our workforce shortages will remain for some time.

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.