The community health center perspective

The federal health centers program, administered by the Health Resources and Services Administration (HRSA) in the Department of Health and Human Services, has long recognized that the nation's healthcare safety net must weave together primary care, mental health, and substance abuse services to adequately serve uninsured and underserved individuals. As staff at community mental health centers (CMHCs) and community health centers (CHCs) know well, nowhere is the integration of mental health and physical healthcare delivery more important than in the delivery of healthcare to medically underserved populations.

America's CHCs are the healthcare home for nearly 16 million individuals, 7 million of whom are uninsured. There are 1,000 CHCs serving 5,000 urban and rural communities across the country. CHCs are required to be open to all in their communities, to be controlled by a patient-majority board, and to offer a comprehensive array of preventive and primary healthcare services.

Behavioral health issues have an ever-expanding presence at CHCs; indeed, mental health conditions constitute the fourth leading reason for a visit to a CHC. According to 2005 federal data, CHCs reported more than 2.7 million encounters for mental health conditions, and another 865,000 encounters for drug or alcohol dependence. In 2005, 74% of federally funded CHCs provided on-site mental health treatment and counseling, and 50% provided on-site substance abuse treatment and counseling services.

In response to the growing need for behavioral healthcare among CHC patients, HRSA has prioritized the issue by making mental health service delivery an integral focus of CHCs' work. Furthermore, a number of CHCs are participating in HRSA's Health Disparities Collaborative on Depression, which has assisted CHCs in reengineering and improving the way in which depression is diagnosed and treated in their centers.

CHCs have demonstrated significant commitment in addressing behavioral health issues. However, a number of key challenges continue to shape CHCs' ability to treat the mental and emotional as well as the physical well-being of their patients, such as access to adequate coverage for behavioral healthcare, the presence of an adequate behavioral health workforce at CHCs, and the development of successful models of integrated primary and behavioral healthcare at CHCs. CMHCs are facing similar challenges.

CHCs and CMHCs have been working together on a national level to tackle some of the barriers preventing greater access to behavioral healthcare and the integration of behavioral health and primary care delivery. We are very proud to have the National Council for Community Behavioral Healthcare as a key member of our Partnership for Medicaid, a coalition of leading organizations convened in 2005 by the National Association of Community Health Centers (NACHC). Coalition members have come together to protect and strengthen Medicaid and suggest common-sense recommendations. We believe that this focus is all the more timely given that CHCs see 5.5 million Medicaid patients and continue to confront the ever-growing challenge of obtaining same-day reimbursement for behavioral and physical health services. CHCs are very fortunate to have the National Council at the table with NACHC and other organizations to raise awareness about issues that impact both behavioral and primary care services.

Over the past few years, the Substance Abuse and Mental Health Services Administration (SAMHSA) and HRSA, together with the Centers for Medicare and Medicaid Services (CMS), have focused on the need to integrate the delivery of primary and behavioral health services, and have held listening sessions and forums to gather recommendations. CHCs encourage SAMHSA, HRSA, and CMS to continue this work and continue to include both CHCs and CMHCs in this process. We are hopeful that these agencies' efforts will yield the clarity of federal policy—long overdue—to promote integration and collaboration.

Behavioral health clearly stands out as a compelling and immediate issue confronting the national healthcare system and CHCs. Controlling healthcare costs requires that behavioral health needs be adequately addressed. CHCs stand ready to continue our vital work with CMHCs in the hope of improving national policy to better meet the critical behavioral and primary healthcare needs of all of our patients.

Lisa Cox is Assistant Director for Federal Affairs at the National Association of Community Health Centers.