Maybe one of the only positives of the COVID-19 pandemic has been an increase in attention to the long-standing crisis in behavioral health and the movement to address the systemic barriers which prevent people from getting care. President Biden has announced a national strategy to address the mental health crisis. The Department of Health and Human Services (HHS) is calling integrated care “an essential strategy”.
MIC DROP! Not quite yet, but it is definitely a noteworthy step.
The goal statement and strategies are outlined in the HHS Issue Brief dated 9/14/2022, HHS Roadmap for Behavioral Health Integration, as follows:
“The full spectrum of behavioral health care will be integrated into health care, social service, and early childhood systems to ensure all people have equitable access to evidence-based, culturally appropriate, person-centered care.”
While the blueprint is to support changes which improve access for all, there is a particular emphasis within each pillar to assure the many barriers for underserved and marginalized populations are addressed. HHS envisions the changes under three Pillars:
- Strengthen System Capacity (workforce and infrastructure)
- Connect Americans to Care (leveraging financing)
- Support Americans by Creating Healthy Environments (promotion, prevention, and recovery)
The report suggests an understanding of the larger systemic barriers which aren’t solved by isolated funding of a set of programs but rather a more global look across U.S. government funding and the direction it provides through its various programs and departments. To support Pillar 1’s goals of strengthening system capacity, SAMHSA, CMS, and HRSA funding is focusing on expanding and “building a more diverse workforce prepared to practice in integrated settings.” This includes training individuals to work in underserved and minority communities as well as upskilling those working in less traditional “mental health” settings such as training nursing home staff to better manage behavioral health conditions and providing services in childcare and education settings. Integration through the Certified Community Behavioral Health Clinic model is being expanded nationally. Enhancement to infrastructure includes the federal health information technology office supporting integration activities by standardizing data sets for measurement and interoperability across care locations.
Connecting Americans to Care Pillar will focus on financing of behavioral health services from both supply and demand sides by addressing costs for individuals, as well as low reimbursement rates and limits on provision of care. Within this pillar are strategies to improve engagement by providing accessible, culturally sensitive, evidence-based, targeted care to the population needs such as pediatrics and those with disabilities. CMS is leveraging its control within Medicaid and Medicare funding to provide reimbursement for licensed mental health counselors and marriage and family therapists working in primary health care and providing reimbursement for interprofessional consultation. HRSA has multi-year tele-health funding for pediatric mental health care teams to consult with emergency room, primary care, and schools.
Efforts to deliver the Support Americans by Creating Healthy Environments Pillar are focused on promotion and prevention in community settings. NIH is funding research in understanding evidence-based strategies for behavioral health promotion and prevention in schools and the barriers to widespread implementation as well as challenges to the provision of behavioral health prevention in low-resource settings. SAMHSA awarded close to $14 million to strengthen the behavioral health infrastructure in the education setting by increasing awareness, identifying and treating behavioral health concerns, and advancing wellness and resiliency.
Anyone involved in integrated care knows it is complicated, challenging, and critical to addressing the behavioral health crisis. The Issue Brief outlines additional ways HHS is working to address the mental health crisis and support the President’s strategy. It’s encouraging to see a deeper understanding of the needs and unified approach from HHS, CMS, SAMHSA, and HRSA to address the challenges.
CFHA is glad to be a part of these conversations that help to promote integrated care.
Matthew P. Martin says
Good summary Julie. Mental health parity laws can help this effort. The government is getting better at detecting noncompliance. Many plans are not following the law. I would like to see states and federal government agencies sharpen their teeth and enforce the parity laws. Clinic leaders will feel more confident in building integrated services if the reimbursement supports it.