Tackling America’s mental health and addiction crisis demands integrated care

Over the past year, symptoms of anxiety and depressive disorders in adults have almost quadrupled, drug overdose deaths have outpaced all previous records for a 12-month period, and 25 percent of young adults have seriously considered suicide over a one-month period in 2020. The unmet need for mental health and substance use treatment in the United State is staggering and expected to persist long after the coronavirus pandemic is contained.

Recognizing the strong connection between physical and behavioral health, the Bipartisan Policy Center launched a Behavioral Health Integration Task Force in 2020 to develop policy recommendations to improve the integration of physical health, substance use and mental health care services. As co-chairs of the task force — and given our work in this field — we understand the urgency of new federal policies to increase the availability and coordination of behavioral health care services for people in need. Research shows that integrated care delivers more patient-centered care that can be cost-effective, increase access to treatment, reduce health disparities and improve patient outcomes.

Although effective treatments exist for most forms of mental illness, too many Americans do not receive the care they need. Less than half of adults with a mental illness received treatment in 2019­ — the percentage is even lower in Black and Latino communities. Alarmingly, nearly 90 percent of Americans with a substance use disorder did not receive treatment in the same year. These treatment gaps are in large part because our nation’s behavioral health care system does not have the capacity to serve everyone who needs treatment and most primary care providers lack the training, financial resources, guidance and staff to deliver integrated physical and behavioral health care services.

Integrating primary and behavioral health care is necessary to ensure that individuals with behavioral health conditions and comorbid physical health problems receive high-quality access to care. By increasing primary care providers’ capacity to screen for and treat mild to moderate behavioral health conditions like anxiety and depression, we can begin to meet the growing need for services and ultimately save lives. It is estimated that 45 percent of those who die by suicide see a primary care provider in the month before their death —  making the timely screening of risk factors in primary care settings critical.

Some primary care providers have already jumped in eagerly to do this work. In East Tennessee, Cherokee Health Systems is a national model for integrating primary care and behavioral health services under one roof. A behavioral health care team is embedded in its primary care practice. Their philosophy is that behavioral health and primary care staff are equally responsible for closing patients’ gaps in care. If a mental health issue arises for a patient, their office is streamlined to immediately involve a behavioral health provider in that patient’s care; if a behaviorist sees a patient who is overdue for a recommended cancer screening, then it is their responsibility to act. More providers need incentives and training to operate in this manner and treat patients holistically.

The task force’s legislative and regulatory recommendations released this week constitute a comprehensive plan to promote primary and behavioral health care integration.

First, enable primary care clinicians to deliver treatment to their patients with mild to moderate behavioral health conditions by providing them with training, technical assistance, and compensation. While some primary care providers already do this, they report feeling ill-equipped to do it properly.

Second, make more behavioral health providers available for primary care consultation and referral for treatment. To expand the current behavioral health workforce and guarantee accessibility, we recommend extending federal health care program coverage to additional types of providers and increasing grant funding for state-wide psychiatric consultation services. Our recommendations would also tighten network adequacy rules to ensure enough behavioral health providers in health plan networks are truly available to patients.

Third, establish core standards essential for integration. Currently, there is no standard definition of integrated care across private and public health programs, nor are there fundamental service and quality standards.

Fourth, drive integration into new and existing value-based payment structures in Medicare and Medicaid. By creating new financial incentives, more providers will evolve their practices to deliver integrated, comprehensive care. These entities already have well-defined quality metrics, delivery standards, and payment methodologies through which integration can be applied, enforced, and incentivized.

Lastly, offer financial assistance for behavioral health providers to adopt electronic health records and permanently expand Medicare coverage of telehealth services that advance integration.

Our recommendations would benefit an estimated 1 million Americans. While some proposals would require new spending, others would generate savings, with net costs over 10 years estimated to be $2.2 billion. This would seem to be a very modest investment for a country that expends $3.8 trillion on health care — and where depression alone is estimated to cost employers $17 billion to $44 billion annually in lost productivity.

Creating a more coordinated and efficient health care system that treats the whole person is challenging but necessary work. While we are all eager to embrace our pre-pandemic lives, let us resolve to make gaps in mental health and substance use disorder treatment a thing of the past