Beyond the ACA, Part One: Make Mental Health Part of Overall Health

Ron Manderscheid, Ph.D.
Executive Director, National Association of County Behavioral Health and Developmental Disabilities Directors

Without access to care, sustained recovery is not possible.Ron Manderscheid

That’s why each opportunity to break through barriers to access is critically important. When access to care becomes universal, millions of people with mental conditions who don’t get care today will get care. That care will be grounded in evidence-based practices and focused on the whole person, not a diagnosis.

Problems will be caught early; symptoms will be mitigated early in their course. And, ultimately, we can help make recovery not a potential outcome, but rather the expectation.

But change doesn’t happen overnight. Overcoming barriers to behavioral health care access requires persistent action and effort to target and sustain new ways of framing, delivering, and sustaining services and supports.

Behavioral health is part of overall health.

Slowly but surely, policy makers and researchers are reuniting brain and body in their thinking. That reunion has begun to help break down barriers to access, reduce the stigma that still surrounds mental health problems, and promote prevention and early opportunities for intervention. And it’s about time!

But to create an environment in which access is open to all, that policy and research reunion needs to be matched by a comparable reunion in program and practice. A number of structural changes—each an opportunity for our action and advocacy—can become the building blocks for full access to behavioral health care as part of overall health care.

Three Ways to Change the Structure of Community-Based Care

  1. Ending silos of care. In many places, state and county mental health and substance use service authorities are entirely separate from the state or county health care agencies. So too are their funding streams and the service programs those funds support. In some locations, behavioral health agencies are, themselves, split.

    When resources become limited, as they are today, program silos for behavioral and physical health—and between mental health and substance use services—often breed competition and adversarial relations, not collaboration and coordinated care. If we want to adopt a whole-person approach to health, organizational silos are not the ideal. Thus, we must advocate for breaking through a history of segregation.

  2. Providing integrated careIntegrated care recognizes the interplay of health and illness between body and brain. In practice, it may involve a health care team working under the same roof to prevent, assess, and treat an individual’s entire range of physical and behavioral conditions. Alternatively, integrated care may be achieved through collaboration across service sites.

    Integrated care makes every door to health care the right door to comprehensive, collaborative assessment and care for both physical and mental health. It patches gaps in the system so no individual falls through by emphasizing the whole person, not an individual disorder or illness. Is integrated care, however it is provided, practiced in our communities? If not, we should advocate for it.

  3. Establishing wrap-around service availability. We also need to provide supplementary supportive services to promote sustained recovery. Housing, job supports and placement, habilitation and rehabilitation, and transportation all play a role to a greater or lesser extent in a person-centered approach to community-based care and recovery.

A particularly promising model that can help achieve these structural aims comes in the form of a “health home.” It’s not a place. It’s a concept based on the premise that an individual’s health needs are served best in an environment in which there is a single door to all behavioral and physical health care needs across the continuum of care from health promotion through recovery.

With a health home, service silos become a thing of the past; supportive services are ways to build a person’s recovery and future. And early and integrated care becomes a standard for care, whether created by moving behavioral health into primary care settings or primary care into behavioral health settings.

Federal agencies are proposing adoption of the health home model through grant programs to communities across the country.

What’s happening where you live? Are these structural changes occurring in your community? 

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