New Settings Will Offer Field Many Opportunities to Extend, Expand Service Offerings

Earlier this year, President Joe Biden announced and then incorporated a major behavioral healthcare initiative into the administration’s fiscal year 2023 federal budget request. Over the past 4 months, I have presented an overview of his plan, followed by summaries of its 3 principal components:

• Growing the behavioral healthcare workforce
• Extending parity protections to all health insurance
• Expanding behavioral healthcare services into new community settings

I also prepared an analysis that amplifies and adds further specificity to the president’s workforce proposal. Finally, I compared each of the 3 components to several core values of the behavioral healthcare field. The results suggest that Biden’s initiative aligns closely with our core values.

Here, I would like to explore and extend the president’s proposal to implement behavioral healthcare in novel settings.

Biden proposes that behavioral healthcare services be offered where “people live and work.” He specifically identifies schools, community centers, libraries, and homeless shelters. The underlying principle is to bring services to the person rather than requiring the person to come to an office for care, thus easing access to care.

Several additional settings also are obvious candidates for extension of behavioral healthcare services. The first is religious organizations—such as churches, synagogues, and mosques—a primary source of support and a gathering place for many on a regular basis. The second is workplaces—where people spend the bulk of their time each week when not at home. The third is congregate living arrangements—retirement communities, group homes, assisted living facilities, and skilled nursing facilities, among others.

Provision of behavioral healthcare services in novel settings has the advantage not only of bringing services to those in need, but also of increasing the knowledge that behavioral health providers have regarding the distinct cultures in which people live their lives and the life determinants that are part of these cultures. Such knowledge is essential for developing interventions that mitigate the traumatic effects of negative life determinants and the adverse health and behavioral health conditions that ensue. Facilitating prevention in this manner is a very desirable objective for behavioral healthcare going forward.

Moving care into these new settings also can promote the development of functioning, empowered communities. Current, ongoing work in the US and elsewhere already has shown that empowered communities foster the emergence of local informal leaders who begin to address the community’s problems. This work can include personal outreach and support to community members with behavioral health conditions, the creation of local drop-in centers, and direct work to address the negative life determinants present in the community.

During the COVID-19 pandemic, anecdotal evidence has suggested that many people who receive behavioral health services have better outcomes from virtual care than they do from office-based care. Although this field finding currently is just anecdotal, it suggests that the greater equality afforded by virtual care is valued greatly by clients and that it contributes to better outcomes. Bringing behavioral healthcare to community settings is expected to have similar salutary effects.

Just now, the US Senate is undertaking gun control legislation that would include a dramatic expansion of Certified Community Behavioral Healthcare Clinics (CCBHCs). It would be very appropriate for this legislation to include provisions to extend behavioral healthcare services into community settings. We need your help with advocacy to accomplish this.

Ron Manderscheid, PhD, is the former president and CEO of NACBHDD and NARMH, as well as an adjunct professor at the Johns Hopkins Bloomberg School of Public Health and the USC School of Social Work.

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.