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Behavioral Healthcare Signifies a Field and an Identity Worth Defending
Some companies change their names in response to evolving business realities. New names (e.g., Alphabet, Meta) often struggle to achieve the brand value of the original. Our field is called behavioral healthcare and some stakeholders dislike it. Our name, history, and identity will become increasingly important as we evolve from being a separate field to a segment of the healthcare industry.
Behavioral healthcare became our field’s designation based on the need for a term for insurance benefits that encompasses mental health and substance abuse (MHSA) services. The name is less important than its history and how it has come to represent our work and values. There are pressures today to reject this designation. What would be lost with the passing of this innocuous name?
Our name should reflect how we think about care. Most would agree we need multi-dimensional solutions that fit into a holistic plan for each person. Care in siloes is care blind to its deficiencies. Fortunately, our arbitrary name rejects silos. Names also establish priorities, and 2 are emerging today. How should we understand and value therapy, and how should our services be funded?
Consider a new book by Tom Insel, MD, a psychiatrist who led the National Institute of Mental Health (NIMH). He rejects the behavioral healthcare rubric as artificial. He offers no alternative but seems to prefer the medical model’s scientific umbrella encompassing distinct disorders. As part of this thinking, Dr Insel has a medicalized view of therapy.
Dr Insel values structured, diagnostically oriented approaches (e.g., CBT) and dismisses many therapies as “more art than science.” However, empirical research supports several therapy models as being highly effective, and this includes approaches fitting both humanistic and medicalized descriptions.
This is more than a disagreement about therapy. Behavioral healthcare is an idea that sits at a level of abstraction beyond everyday services. While originally a hollow term, it can and should be a conceptual orientation to our field. This is the real challenge before us. We need to clarify our core messages and recommit to our name as an identity statement. Battles are coming as we integrate into healthcare.
Our name needs to be associated with a more substantive, defining orientation, and the biopsychosocial model seems ideal. It places the psychosocial dimension on par with the biomedical, and it was formulated in part as a framework for collaborating with physicians in primary care and other medical settings.
Another central concern for our field is funding. Health plans will drive our future in this regard, and their executives are starting to discuss elimination of separate behavioral health benefits in favor of managing care under a single healthcare plan. This may lead to more holistic care, or it may launch a struggle for recognition and funding following our field’s acquisition by the larger healthcare industry.
Health plans might eliminate behavioral health benefit categories (once championed in the fight for parity) so that all services exist on a medical playing field. They might insist our services are vital to total health, but many other services are vital. All care being viewed from a medical perspective means every clinical service (e.g., therapy) competes with every other (e.g., cardiology) as necessary for total health.
In the end, total health must fit into the budget for a population. Behavioral healthcare would lack separate funding or accounting. We fought to end benefit discrimination with parity. The Affordable Care Act then designated our services as “essential.” Should we now turn over our services to an ambiguous funding plan? Behavioral healthcare, an old insurance term, now seems to stand for broad, essential services.
Another unintended benefit of the behavioral healthcare name is that its root word, behavior, may be the missing element in primary care. Therapists seem to be the clinicians this setting has always lacked for improving health status by changing behavior.
Is our field a collection of unique diagnoses, as found with any other medical specialty? Behavioral healthcare may be such a specialty—indeed one with highly effective medical treatments—but it also addresses the ubiquitous behavioral component in every medical diagnosis. It is not hubris to think our field is more than a specialty. Our work spans all specialties.
We may see growing polarization around this name and concept. Although the name was initially incidental, our historical fight for equitable funding was waged under its banner. A new struggle may be forming with the rallying cry, “no primary care without behavioral care.” Whatever battles we may face with our newfound position inside the healthcare industry, let us not forget our identity or our history.
These issues should be owned by our executives. It is the business leader who ensures that medical and psychosocial services are both supported, and who manages new funding challenges and new corporate ownership. Executives know that success in this underfunded, stigmatized field has never been easy.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
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.
References
Insel T. Healing: our path from mental illness to mental health. Penguin Press. 2022.
