Access to Care | Challenges
The worldwide COVID-19 pandemic has worsened the shortage of behavioral health professionals, making access to care even more challenging. In rural areas in particular, which is where I live, the struggle to hire and retain doctors existed long before the pandemic, but the challenges have increased.
The Bureau of Labor Statistics recently stated that employment in health care is down 524,000 workers since February 2020. That is a huge number.
This means that for many people with emerging mental health needs, getting that first appointment can take weeks or months. Data in this recent report from Mental Health America summarizes those challenges:
Over half of adults with a mental illness do not receive treatment – 27 million adults in the U.S. are going untreated.
In Hawaii, the bottom-ranked state, 67% of adults with a mental illness did not receive treatment.
Even in Vermont, the top-ranked state, 43% of adults experiencing a mental illness were not receiving treatment.
The percentage of adults with a mental illness who report an unmet need for treatment has increased every year since 2011.
In 2019, 24.7% of adults with a mental illness report an unmet need for treatment.
Over 60% of youth with major depression do not receive any mental health treatment.
Even in states with the greatest access, nearly one in three are going without treatment.
In Texas, the bottom-ranked state, nearly three-quarters of youth with depression did not receive mental health treatment.
I recently needed to find urgent behavioral healthcare for a family member. Living in a rural farm community in upstate New York, it became an ordeal that took 12 hours of calls to 56 agencies spanning three counties, through two days. My search included providers offering various levels of care and private providers. Most calls only got as far as recorded messages from agencies saying their doors were closed to new patients. A few offered contact information for other providers, but they were the exceptions. Others didn’t accept my private commercial insurance. Some didn’t work with the population my family member falls into.
When I was able to get an appointment, the agency’s intake opening was a week away, through telehealth, which was convenient but impersonal. After several telehealth sessions, my family member switched to a hybrid mix of remote and face-to-face sessions, which led to better progress
To say this was a stressful time is an understatement, and I am an experienced behavioral health professional who has worked in this field for decades. My challenges are multiplied for families with fewer resources, and for people who are ill and working to find care for themselves while experiencing active symptoms. It saddens me that so many healthcare professionals left the field during the pandemic due to burnout. Part of the exodus includes older people who are retiring sooner than planned or moving to teach. The shortage of providers is compounded by the increase in depression and anxiety and other conditions reported during these pandemic years.
What can be done to improve access to care for those in need of behavioral healthcare? There is no easy solution to this problem, but here are some structural changes that can help:
Healthcare workers need extensive training and specific qualifications, so providers cannot simply hire new workers off the street.
The Department of Health and Human Services is committing $100 million dollars through the American Rescue Plan to help solve the problem. The funding is marked to be used “for state-run programs that support, recruit, and retain primary care clinicians who live and work in underserved communities,” HHS says.
The department hopes that being able to retain healthcare workers in underserved areas will help improve health equity.
The Prospective Payment System (PPS) rate that funds some models of the Certified Community Behavioral Health Center (CCBHCs) approach reimburses for services based on cost, which enhances sustainability, retention, and growth. If a CCBHC can pay more competitive salaries, it can more effectively recruit and retain qualified personnel. Now that the Bipartisan Safer Communities Bill has been signed into law by President Biden, the future of CCBHCs is more secure as the PPS funding makes the model more sustainable. This is of great importance to behavioral healthcare, particularly in rural communities.
I’m optimistic about the changes the CCBHC treatment model can bring to people in need of behavioral healthcare. One of the most important criteria for this model is increased access to care. Early data shows this model is working and many clients who reach out to CCBHCs for care are being seen as soon as the same day. I long for the days when urgent behavioral healthcare needs are treated equally to urgent primary care needs (such as a broken ankle) and the client is always seen the same day.
Mary Givens, MRA
CCBHC Program Manager
Qualifacts
Mary Givens has been with Qualifacts for 13 years. She has a Masters in Rehabilitation Administration from the University of San Francisco. Before coming to Qualifacts, Mary was the CEO of a non-profit organization that served IDD, she was the Director of Client Services and a Director of Supported Employment for people with SPMI. Since coming to Qualifacts, she has been a Project Manager for Implementation and a Program Manager of Meaningful Use, and is currently the CCBHC Program Manager.
