Lawmakers are looking at ways to put community resources at the center of the mental health crisis.
Wednesday, the Senate Subcommittee on Primary Health and Retirement held a hearing focused on closing the gaps in behavioral health care by bringing services and prevention into the community.
Provider witnesses stressed the importance of care integration and developing the mental health workforce when tackling access issues.
“The challenges are complex, but the solution is simple: affordable, accessible, mental and substance use care for any and all, … when they need it and where they need it. This is easier said than done,” Sen. Edward Markey (D-Mass.) said at the hearing. “We can invest in community health providers; we can pass legislation to break down antiquated barriers to medication treatment for opioid use disorder. We can support local communities’ public health response to rising overdoses and mental health needs.”
CCBHCs providing integrated community mental health
At the heart of the recent localized behavioral health efforts are certified community behavioral health centers (CCBHCs). Launched in 2017 through a U.S. Centers for Medicare & Medicaid Services (CMS) demonstration, CCBHCs are clinics designed to provide a “comprehensive range of mental health and SUD services,” treating anyone seeking care.
In 2023, there are more than 500 CCBHCs across the country funded through Medicaid or Substance Abuse and Mental Health Services Administration (SAMHSA) grants, according to the National Council for Mental Wellbeing.
“We’ve all witnessed too many people experiencing mental health crises in the wrong setting and receiving the wrong type of care,” Sen. Ron Marshal (R-Kan.) said. “While still new, the data [for CCBHCs] looks promising. People who receive care at a CCBHC spend 60% less time in jail, 70% less time in the hospital, and are much more likely to have access to a primary care provider. CCBHC has also contributed to a 41% reduction in homelessness.”
The CCBHC model also aims to help reduce wait times and enhance care coordination. For example, Kansas passed new state legislation that identified the CCBHC model as a solution for the behavioral health crisis.
As a result, Dr. Steven Denny, deputy director of Four County Mental Health Center in Kansas, said that the CCBHC model has enhanced care coordination and involvement with primary care.
“The CCBHC model increases access to care. Since implementation, [our] county provides 70% of the admissions on the same day that individuals seek services,” Denny said at the hearing. “For those who elect to wait, the average wait time is three days compared to the national average of 48 days. They also receive enhanced care coordination and involvement with primary care. If they don’t have a primary care provider. We work hard to get them connected.”
The National Council for Mental Wellbeing has long been a supporter of the CCBHC model.
“CCBHCs are more than an experiment,” Chuck Ingoglia, National Council for Mental Wellbeing President and CEO, said in a statement. “They are more than a promising model. CCBHCs have become a vital part of our health care system, so we urge lawmakers to treat them as such.”
Workforce development
Still, CCBHCs are just one part of ensuring that people can access behavioral health services in their community. Provider shortages threaten to limit the services available to patients in need.
Expert witnesses at the hearing proposed more training opportunities and education reimbursement plans as a solution.
While some local community organizations have developed internal professional pipeline programs, leaders in the space are calling for the federal government to do more.
“None of our work in addressing this crisis is possible without robust and well staffing,” Dr. Maria Celli, deputy CEO of Brockton Neighborhood Health Center (BNHC), said at the hearing. “BNHC has developed, designed and launched several grant-funded professional pipeline projects, including one designed for the training, recruitment and retention of behavioral health clinicians. We would love for this committee to provide more flexible funding to support projects like ours.”
The federal government appears to be taking behavioral health workforce development seriously. The White House’s 2024 budget proposal allocates $387.4 million of the Health Resources and Services Administration’s (HRSA) budget to training more than 18,000 behavioral health providers and “expanding community-based experimental opportunities.”
There is an even greater shortage of providers in some areas of behavioral health, such as pediatric mental health.
Telehealth options are one way to meet patients where they are in their community.
“Telepsychiatry has been really important to bridge some of those gaps,” Dr. Warren Ng, president of the American Academy of Child and Adolescent Psychiatry, said at the hearing. “I think that partnership with families within communities is key, so that we can also encourage telepsychiatry to be able to be helpful to bring in key members of the community as well as family members to be a partner to that care.”
But there is no one magic bullet to fixing behavioral health shortages at the community level.
“There isn’t a quick fix to this because this problem existed well before [the pandemic],” Ng said. “But at the same time, the loan repayment as well as trying to finance integrated pay for health interventions, as well as leveraging telepsychiatry, … continuing to fund those innovations that have been helpful during the pandemic would be key.”
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