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Once upon a time, I was a behavioral medicine director at a family medicine clinic in North Carolina. Part of my job was to monitor the patient waiting list. We had normal delays like confirmation of benefits and no appointment slots.
My goal was to schedule new patient appointments within 1-2 weeks of a referral. Often a member of my team could see a patient on the same day as the referral, albeit for a brief visit.
This family medicine clinic offered something unique: integrated behavioral health services. That means shared patients, shared vision of healthcare, shared operational system, and shared workspace. Comprehensive care in one location. Integrated, team-based care is the future.
My behavioral health team worked alongside medical clinicians and nurses to provide timely services to patients with various needs (e.g., mental health, lifestyle change, chronic disease management, addiction). Our waiting list was much shorter than that of the community mental health center across town.
Today, a mental health crisis spans the globe and is the result of years of underfunding combined with pandemic-related disruptions, stresses, and overwhelming demand. Waiting lists for mental health services are soaring. In England, demand is at an all-time high, with 1.2 million people waiting.
Strikes by mental health workers are popping up in California and Hawaii. Workers complain of understaffing, long wait times, and low wages.
A new California law that took effect in July 2022 requires health insurers to provide return mental health appointments within 10 business days unless a clinician determines a longer wait would not be detrimental to the patient.
In Massachusetts, a new law was recently passed to address long wait times for pediatric mental health services in emergency departments, a problem known as “ED boarding”.
This deepening crisis unfolds as the new three-digit number for the National Suicide Prevention Lifeline (988) continues its rollout. 988 is step one of a crisis continuum where individuals in need can receive care over the phone or from a mobile crisis team, be transported to a crisis facility, and then receive post-crisis wraparound services.
The current problem with 988, though, is lack of state infrastructure. Only four states (Nevada, Virginia, Colorado and Washington) passed legislation to ensure state funding for 988. Many states have limited crisis response resources and post-crisis wraparound. My own state of Arizona has expanded their mobile crisis teams and facilities, but lack post-crisis wraparound services.
Excessive waiting times for mental healthcare yield consequences. In the past, law enforcement was the de facto response to mental health crises, sometimes leading to deadly results. In Illinois and Missouri, detainees with mental health needs are languishing in jail because they have been found unfit to stand trial but can’t be transferred to a psychiatric hospital for evaluation and treatment because there are no beds available.
Fortunately, the failing and fragmented mental health system is receiving attention from the federal government and popular television programs. We need elected officials to enforce mental health parity laws and expand state budgets for mental healthcare.
We also need payors and policymakers to push for more integrated primary care. Three out of four Americans have an identified primary care physician. The primary care system is bigger and better funded than the mental health system. Patients can receive comprehensive healthcare in one location from a team of primary care professionals. Integration is a common-sense solution to this crisis.
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