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Major Issues for the Behavioral Healthcare Sector in 2019

Behavioral Health is a care environment facing major challenges, similar to much of the rest of healthcare. For its workforce, the situation is difficult, as they accommodate demographic and other trends that keep increasing the need for their services as a provider shortage becomes more pronounced. Here are some of the issues facing this area of healthcare that will have an impact on its workforce in the immediate future.

  • Growing Need for Services

    More people than ever are in need of some form of behavioral healthcare, at all levels of care. According to Elsevier, “More than 44 million American adults have a diagnosable mental health condition, and rates of severe depression are worsening among young people. Mental health and disability are well-established drivers of substance use, and drug overdose deaths fueled by opioid misuse have more than tripled from 1999 to 2016” (Elsevier, 2018).

  • Shortage of Providers

    In absolute terms, there are not enough behavioral health professionals to meet current and projected care needs. Elsevier mentions how a ”2016 report by the Health Resources and Services Administration (HRSA) on the projected supply and demand for behavioral health practitioners through 2025 indicated significant shortages of psychiatrists, psychologists, social workers, mental health counselors, and marriage and family therapists” (Elsevier, 2018).  Adding to the challenge is the intricate matter of applicable insurance coverage—“ Another challenge is that there are many psychiatrists in particular but all types of providers who don't accept insurance” (Oakes and Thompson, 2019).

  • Maldistribution of available services

    A special concern when it comes to behavioral health is the extent to which care is not available on an equitable basis across the country. There are many places where little to no professional care in this sector is readily available. According to Elsevier, “the magnitude of provider shortages, however, is not the only issue when considering access to behavioral health services. Another major concern is maldistribution, since parts of the US have few or no behavioral health providers available, and access to mental health services is especially critical in areas of poverty” (Elsevier, 2018).

  • Wait Times

    Even when those seeking treatment are able to access mental health care and treatment for substance abuse, there are challenges. A very significant one involves “just people getting into the system… when you're initially trying to get an appointment with the provider, you often have to wait a very, very long time” (Oakes and Thompson, 2019). What happens when wait times collide with urgently needed care? Here’s the experience in just one case—“Fifty-four percent of Massachusetts youth who experienced a major depressive episode received no mental health services in the year that the report covers” (Oakes and Thompson, 2018).

  • Facility Space Constraints

    A corollary to wait time issues is the lack of space in a facility, which can delay much needed care. Oakes and Thompson offer that people may “go to the emergency department for a mental health or substance use disorder issue and they need to be transferred to a bed, sometimes there isn't a physical bed available” (Oakes and Thompson, 2019).

     

    Solutions for Improving Outcomes in Behavioral Health

    Involving Other Clinical Disciplines in Behavioral Care

    Behavioral health experiences and outcomes could be improved by broadening the range of clinicians involved in this kind of care. Getting patients into the system more quickly could have an enormous impact on care success. For example, “primary care doctors and other clinicians should also be trained and paid for screening for mental health and substance use disorder conditions so they can help identify kids, adolescents or adults who need help and refer them to treatment” (Oakes and Thompson, 2019).

    Technology Solutions to Address Physician Barriers

    Technology offers significant promise in helping alleviate some of the shortage and distribution challenges in some parts of behavioral care. Several examples specific to our current opioid crisis illustrate the opportunity for technology solutions in this area. A recent Pew Trusts article mentions how rural physicians’ barriers to prescribing buprenorphine (a medication used to treat dependence/addiction to opioids) include time constraints and a lack of mental health or psychosocial support services for patients, specialty backup for complex problems, and confidence in their ability to manage Opioid Use Disorders. Treatment models that use technology to address these barriers have been shown to increase access in rural populations. Here are two examples:

  • Project ECHO (Extension for Community Healthcare Outcomes), in New Mexico, contributed to a nearly tenfold increase in buprenorphine-waivered physicians over a 10-year period.24 In this model, prescribers are recruited to obtain a waiver and are provided regular opportunities for mentoring and education, thereby increasing treatment capacity in rural areas.
  • West Virginia’s Comprehensive Opioid Addiction Treatment program uses videoconferencing to prescribe buprenorphine and for medication management, including virtual group-based medication management followed and in-person group therapy. A study “found that rates of treatment retention and abstinence from drug use were comparable to the rates observed when MAT is provided in person” (Pew, 2019).