We Can Take Action Ahead of Biden’s Plan to Extend Behavioral Health Services

A short time ago, we were delighted to learn in the State of the Union address that President Joe Biden intends to confront our current behavioral health crisis. We also learned that both mental health and opioid use will be major budget priorities for fiscal year 2023. The plan unveiled by the president that evening has 3 primary components:

• Address the current behavioral health workforce shortage
• Expand parity to all health insurance including a minimum of 3 behavioral health visits each year
• Extend behavioral healthcare into non-traditional settings

I would like to explore the third element—extending behavioral health care—in greater detail. I will address the other 2 elements in future commentaries.

We already have been on the cusp of incorporating behavioral healthcare into new settings for some time. Our constraints have been human resource limitations and lack of appropriate payment mechanisms. For example, we already have extended onsite behavioral health services into numerous schools. However, in most instances, this has involved the placement of a single provider into a school, frequently on a part-time basis, with a payment arrangement only for students with Medicaid or the Children’s Health Insurance Program (CHIP).

Tragically, COVID-19 has shown us that at least one-third of children and adolescents are experiencing behavioral health conditions, frequently anxiety or depression. Hence, we do need to expand behavioral health services into schools much more rapidly. The president’s proposal to train more providers, including school psychologists, will help in the longer run. What can we do in the meantime?

We will need to work with local school systems and communities to craft solutions that fit specific circumstances. A few examples may be useful:

• Train local community health workers, physician assistants, and nurse assistants on a short-term basis so that they can lead socio-emotional learning programs in schools
• Train retirees and family members to serve as mentors for students who are struggling
• Train student peers to provide support to their colleagues
• Promote family and community social events that focus on child and adolescent interaction.

This list easily could be extended.

Other settings targeted by the president include jails, community centers, and homeless shelters. For jails, as our work over the past decade has shown so clearly, the goal of care must be to help those with mental health and substance use conditions to resume their lives in the community as rapidly as possible. Hence, this care could best be provided through county and city behavioral health programs, rather than by building a new delivery system in the jails. This issue already has received much attention and discussion, and the field is ready to make concrete proposals for how this can be done.

Like schools, community centers and homeless shelters will represent a challenge because of human resource limitations and the need to update payment mechanisms to reflect the realities of 2022. However, these sites are destinations where critical populations gather. Efforts to extend behavioral healthcare services into these settings can literally bring behavioral healthcare services to the community, as well as normalize care.

Further, all these settings also are good community sites to identify and address the social and physical determinants of health that lead to trauma and subsequent behavioral health conditions. For example, schools are ideal settings to identify adverse childhood experiences—ACEs—and to address them. Homeless shelters are ideal settings to work on housing problems. Community center events can be employed to address social isolation and lack of engagement. Clearly, we need to undertake much more work on the entire topic of addressing social and physical health determinants in community settings.

In this commentary, I have just begun to scratch the surface of new ideas about how we are going to extend behavioral healthcare into community settings. I hope that I have whet your appetite for thinking about and helping the field develop this exciting new possibility.               

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.