New Year Brings Opportunities—and Challenges—for Behavioral Health

The New Year’s celebration frequently signals change, transition, and new beginnings. Thus, it is very important for us to anticipate what 2023 will bring for behavioral health.

New potential human rights violations. Red flag warnings already are apparent regarding lack of social justice and lack of human rights for our behavioral health care clients. Both California and New York City have taken steps to mandate inpatient treatment for persons who are both homeless and mentally ill. In these jurisdictions, such individuals can be picked up from the street and forced into locked inpatient settings.

Such untoward developments can be expected to generate much controversy and conflict throughout the coming year. They likely violate the Supreme Court decision in Olmstead v. L.C., which requires that care be made available in the least restrictive settings possible, and in settings that are integrated with community life. In this new year, we must continue to develop and improve humane care that can be provided on a voluntary basis with peer support in our communities. We also must defend the human rights of all who have behavioral health conditions.

A continuing workforce crisis. Just days before Christmas, Congress passed an omnibus federal budget for FY2023 with essential service expansions for mental health and substance use care. We are very grateful for these expansions because they are critically needed. At the present time, only 1 in 4 people with behavioral health conditions actually receives any care.

However, with very few exceptions, this budget does not address today’s behavioral health workforce crisis, which underlies many of the care shortages now apparent across the country. The exceptions are an expansion of 200 slots in the Health Resources and Services Administration (HRSA) National Health Service Corps, 100 of which will be devoted to psychiatry, and approval for more than 225,000 current clinical mental health counselors and marriage and family therapists to bill under Medicare.

The original budget proposal by President Joe Biden for FY23 specified $750 million in new funds for new professional and paraprofessional behavioral healthcare training. Yet, for all practical purposes, these funds were not included in the approved FY2023 omnibus federal budget. Although HRSA does operate a behavioral healthcare training program that will continue in the new year, this program has neither the scope nor the magnitude to address our current workforce shortages. Therefore, we must continue our advocacy this year for   urgent federal support to address this continuing crisis.

Expanded crisis response capacity. Much-needed progress will be made on implementing behavioral health crisis response systems this year. The approved omnibus federal budget includes authorization of a Behavioral Health Crisis Coordinating Office at the Substance Abuse and Mental Health Services Administration (SAMHSA), coverage of crisis response services under Medicare, Medicaid, and CHIP, $500 million for expanding behavioral health crisis services, and $20 million for developing mobile crisis response teams. Although these will be very welcome developments, some efforts will be hampered by our continuing workforce crisis, as described above. Situations are likely to arise in which funds are available for implementing crisis services, but for which there are no trained staff available.

Continuing integration of care. The very long-term quest to integrate mental health, substance use, and primary care services will continue in the new year. The omnibus federal budget authorizes $60 million in grants to support collaborative-care practices that integrate behavioral and primary health care and $385 million in grants for community mental health centers to enter the Certified Community Behavioral Health Clinics program. It also extends pandemic rules allowing coverage of health and mental health services via telehealth, including audio only, for all of FY2023. Each of these developments will advance the implementation of integrated care. Like crisis care, however, workforce shortages can be expected to create additional constraints in these efforts.

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Clearly, the new year presents a very mixed picture for behavioral health. Obviously, there is much to be hopeful about. It seems equally clear that we must focus on addressing human rights violations and our own workforce crisis.

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.