4 Strategies to Increase Access to Behavioral Health Care

Persistent challenges prevent people from accessing behavioral health care in the United States today, despite an overwhelming need for these services. But significant opportunities for improvement exist through the expansion of evidence-based practices, according to The Brookings Institution. With support from The Pew Charitable Trusts, researchers interviewed behavioral health practitioners, experts, and stakeholders and conducted environmental scans of existing literature to identify these evidence-based practices and how they’re being used.

“There is a mismatch between the strategies that research suggests are likely to benefit people and the availability of those strategies to people who may benefit from them,” the researchers found.

Brookings examined these strategies through the lens of several policy issue areas, including crisis services.  

1. Support time-sensitive interventions and care coordination

Behavioral health interventions and support must be timely, whether for predictable events such as prison release and childbirth, or unpredictable ones, such as mental health crises or first episodes of psychosis. These unusual events require a unique capacity to respond, often outside traditional clinical settings, and with mechanisms to connect patients to follow-up services.

At the core of building capacity is strengthening the continuum of care, which can support an individual from their first point of contact (such as a call to emergency services for help) with whomever responds throughout follow-up services. Key practices include investing in staffing and case management, technology to support those efforts, and payment solutions to optimize local efforts.

2. Contend with complex needs across multiple sectors

Local governments often struggle to fund behavioral health care because services are fragmented across numerous sectors including corrections systems, health, mental health, and substance use disorder services, with different budgets and little coordination between them. This presents the “wrong pockets” problem, which happens when one sector or agency incurs the costs while another reaps the benefits, stripping away incentives to improve. For example, the financial savings resulting from investments in community behavioral health centers are often realized by local police and emergency departments, making the funding model unsustainable for the health centers themselves.

Local governments can braid funding streams with the support of better data sharing across systems, and technical assistance from philanthropies on understanding the complexities of financing across sectors and legislative authorities. For instance, Ohio has 50 Alcohol, Drug Addiction, and Mental Health Boards, which plan, develop, fund, manage, and evaluate community-based mental health and addiction services across agencies and departments throughout the state.

3. Prepare to scale up pilot programs

Sustainable funding can present significant hurdles to any expansion of behavioral health services, but shorter-term opportunities can pave the way for larger scaling up over time.

Crisis programs require three new lines of infrastructure: an emergency hotline (such as the 988 Suicide & Crisis Lifeline), crisis response teams to respond, and facilities to send people for stabilization or follow-up services. Each element has complex staffing and funding needs, and until federal grants and policies are streamlined to connect these services through a continuum of care, scaling up may not be feasible. Meanwhile, state and local governments have an opportunity to use pilot programs to determine what will be successful for the communities they serve. When funding becomes available, government officials will be prepared to scale these promising pilot programs into larger solutions.

4. Be creative with funding streams

In addition to braiding existing funding streams, local governments can also loop in shorter-term solutions, including grants from government and/or philanthropy, to creatively boost their continuums of care. For example, a state could use private grants to fund the initial costs of building a crisis team, and then rely on Medicaid, Medicare, and private insurers for billing once the service is off the ground.

In short, providing comprehensive crisis care has proved challenging for state and local governments. Increased collaboration across sectors and investment in local efforts can improve behavioral health outcomes for everyone.

Julie Wertheimer is the project director of The Pew Charitable Trusts’ mental health and justice partnerships project and Brandee Izquierdo, Ph.D., is the director of Pew’s behavioral health programs.