Behavioral Health Care: Time to Get it Right


Bob_circleFrom 2013 to 2016, Missouri Foundation for Health spent over $14 million on behavioral health-related work in Missouri. Yet the impact of those efforts is dwarfed by the enormous need for more and better behavioral health care across the state. The behavioral health umbrella is massive; it includes alcohol and drug abuse, opioid addiction, depression, anxiety, bipolar disorders, toxic stress, and other mental health issues.  It touches just about every aspect of health and well-being in our lives. States are struggling with finding ways to address behavioral health issues that have become far too common in our communities. Numerous states are attempting to renew a troubled public mental health system, but it’s been difficult to provide services consumers need in the face of budget constraints, inadequate staffing, and lack of insurance coverage for many of those most in need of care.

Despite the challenges there has been progress. As a country we’ve made notable strides in the last decade, including parity in insurance coverage, progress in overcoming stigma, increasing treatment options and effectiveness, and a growing understanding that these health problems affect people from all walks of life. There is increased public recognition that too many families are experiencing toxic stress and trauma and functioning without adequate mental health resources.

In Missouri we are fortunate to have a well-regarded Department of Mental Health that has stretched scarce resources to position Missouri for significant progress in its behavioral health care. Three examples highlight recent progress: Missouri is one of only eight states to receive an award for a demonstration project to develop Certified Community Behavioral Health Clinics using a Medicaid prospective payment system. The award, made possible through the Excellence in Mental Health Act, lays the groundwork for Missouri to lead the nation in developing this 21st century model of financing and delivering behavioral health care through an integrated, patient-centered approach. Second, Missouri has taken advantage of the health insurance exchange under the Affordable Care Act, with more than a quarter of the people enrolled having mental illness or substance abuse disorder. Third, the Department of Mental Health has applied for a waiver from Medicaid to provide an innovative program of intervention, treatment, and support services to individuals aged 19-35 identified to be in a behavioral health crisis. This effort, if approved, builds on existing cooperation among police, hospitals, clinics, and courts to get these young adults the help they need when they need it.

Yet all this potential progress, and more, is at risk. If people with serious behavioral health problems lose their health insurance coverage it would be a major setback to our system. The repeal of the Affordable care Act would add 75,000 people with mental illness or substance abuse disorder to those without insurance in Missouri. But the larger risk is to Medicaid, which covers three times as many people with behavioral health problems. Currently they can get care via this state-federal coverage program, but they are at risk if Congress follows through on major restructuring of the program that would reduce future funding.

People without health insurance that are experiencing behavioral health problems have extremely limited access to services, and often their conditions make it even harder. With limited options they turn to emergency rooms, can become a harm to themselves or others, undergo repeated hospitalizations, or end up in prison or jail. Remarkably, 83 percent of those coming out of the Department of Corrections have a history of severe substance abuse, 16 percent have serious mental illness.

Investing in behavioral health prevention, early identification, treatment, and ongoing integrated care is a wise health, social, and economic choice. It’s also the right thing to do to take advantage of the promising prospects underway in Missouri, like those afforded by the Excellence in Mental Health Act.