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Can We Fix the Behavioral Healthcare System?

By Bill Frack and Matt Sabbatino at L.E.K. Consulting

As the recent spate of high-profile suicides have made clear, mental illness does not discriminate, is chronic, and can have deadly consequences — even for those considered to be the most successful in our society.

But while such well-publicized tragedies are helping to erode the stigma around mental illness, the behavioral health care delivery system remains broken. Fixing it requires rapid, radical innovation that is supported and facilitated on a national level and includes both public and private innovation. Like NASA, but for behavioral health.

The doctor isn't in, but the firefighter will see you now

Some 20% of American adults will experience mental illness, according to the National Institute for Mental Health, and 3% to 4% will suffer from a serious mental illness. And yet the organization estimates that roughly half of Americans with a mental illness do not receive treatment.

That's due, in large part, to a clinician shortage. Not just psychiatrists, but the gamut of behavioral health professionals, including psychologists, social workers, psychiatric nurses, and behavioral health counselors.

Meanwhile, the dearth of clinicians is further compounded by a lack of necessary infrastructure. By 2016, bed capacity at state-run psychiatric hospitals had fallen more than 96% from its all-time high in 1955, according to national mental illness-focused nonprofit The Treatment Advocacy Center, and most states continue to reduce the number of beds they provide. Moreover, roughly half of the community mental health centers originally slated to replace the reduced bed capacity were never built. As a result, prisons, jails, and emergency departments are being used to make up for the bed shortfall. And police officers, firefighters, EMS technicians — even teachers and clergy — have become de facto behavioral primary care providers for untreated patients, a role they are neither trained nor supported to fulfill.

As such, while in many cases the “If you build it, they will come” strategy is scoffed at as no strategy at all, when the issue is behavioral health in America, that is exactly what must happen. Additional clinician capacity and infrastructure are desperately needed to address what is increasingly being characterized as a mental health crisis. And with a large baby boomer population that is becoming more susceptible to dementia as it ages, rising rates of PTSD in veterans, and a devastating opioid addiction epidemic that shows no of signs of abating, that crisis will only deepen.

It's time for Dr. Freud to get a new kit bag

Although the science showing that behavioral health and physical health together comprise a person’s overall well-being and determine their ability to function in society is irrefutable, integrated — and outcomes-based — solutions remain largely non-existent. Those that do exist are rare, nascent, and difficult to scale. And outcomes-based models are difficult to deploy because there are no standard methods for collecting and analyzing behavioral health outcomes data, and by extension, no established way to assess such outcomes. As a result, it is difficult for patients and caregivers to navigate the behavioral health system and select those providers best suited to treating their condition.

Meanwhile, looming in every corner is the stigma that mental illness continues to carry. Until behavioral health conditions are viewed through the same lens as physical illness, that stigma will prevent many Americans from seeking treatment in the first place, sometimes before it's too late.

A ripple that must become a wave

The shortcomings of the current behavioral health care delivery system create opportunities for innovators that develop scalable solutions.

Home-based integrated care models that address physical, behavioral, and social determinants of health represent one opportunity to develop and deploy targeted, evidenced-based treatment. Digital tools — such as telehealth, counseling “chat bots,” and computerized cognitive behavioral therapy — are another area of innovation, in this case aimed at addressing the clinician shortage and improving access to care.

However, regulations around scope of practice and mental health clinician licensure must be updated so as to ensure such innovative digital behavioral health solutions can scale. And while there is already meaningful investment activity in the space, such investments require new models, too. For example, The Centers for Medicare and Medicaid Services, state Medicaid administrators, and health plans must provide behavioral health providers with opportunities to pilot innovations in order to prove their efficacy and validate the need for any additional financing. And all innovation models, from those that integrate physical and behavioral health to any digital solutions, must be recognized and reimbursed as appropriate.

Indeed, such innovation cannot be carried out in isolation. Both the need, and the impact of potential failure, are too great.

NASA for behavioral health

Between clinician shortages, infrastructure capacity constraints, increasing demand, and a lack of integrated, evidence-based, outcomes-driven treatment models, behavioral health care delivery in the U.S. faces massive challenges.

In fact, the challenges are so great and the mental health crisis so acute that at this point, the only thing that will fix it is a national, federally-led innovation effort that leverages requisite funding and involvement from both states and private constituencies as necessary. Such a NASA-like model for behavioral health may seem especially ambitious in our era of political gridlock. But mental illness is party-agnostic, and Americans have seen some signs of bipartisan agreement when it comes to finding solutions to this crisis.

Beyond political support and governmental intervention, however, private sector constituencies must also “pick up and carry the flag” for behavioral health care delivery innovation and improvement. Not only are the potential upsides for behavioral health innovators that develop efficient, scalable solutions to our most pressing needs potentially enormous, but all Americans would share in the beneficial impacts on society that would result.

At this point, we simply can't afford to do anything less.

Bill Frack is a Managing Director at L.E.K. Consulting

Matt Sabbatino is a Principal at L.E.K. Consulting

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