Redefining Access: Disrupting the Fragmented Approach to Mental Health Care

We know the statistics: More than half of the nearly 50 million adults living with mental health conditions in the U.S. do not receive treatment. Neither do more than 60 percent of children and adolescents with major depression.

This treatment disparity is often characterized collectively as “lack of access” to mental health services, but several distinct factors contribute to the problem. They include:

• A shortage of behavioral health specialists. By 2024, analysts expect the U.S. to be at a deficit of as many as 31,000 psychiatrists.
• Geographic disparity. The behavioral health specialists we do have are concentrated disproportionately across the country, leaving some high-risk populations without any access to services. 570 counties in the U.S. have no mental health care providers at all.
• Financial barriers. Despite mental health parity laws enacted in 2008, insurance companies continue to reimburse mental health services less favorably than medical and surgical benefits. The Departments of Labor, Treasury, and Health & Human Services jointly issued a report in 2022 that signaled increased enforcement of the Mental Health Parity laws.

Regardless of the reason, lack of access to mental health care results in mental health crisis: Patients with no other options seeking late-stage care in the ER. Suicide rates are on the rise again, particularly among communities of color. According to the latest CDC data, 1.2 million Americans attempted suicide in 2020, and 90% of them had a diagnosable mental illness that could have been treated before it escalated to a crisis.

In this environment, how can we provide access to care and make a meaningful difference in patient outcomes? We must think more creatively about care delivery, working together to provide unified programs across the entire state.

A fragmented approach

Currently, government entities are addressing specific populations through targeted access programs. 

This is working best in the area of pediatric primary care. The Health Resources & Services Administration (HRSA) is funding pediatric programs in more than 40 states so far to provide consultations and resources to pediatric primary care providers. Thanks to the formation of the National Network of Child Psychiatry Access Programs (NNCPAP), an organized coalition of clinical and health agency leaders, primary care access has for the most part moved to a single model across the country, with standardization, coordination, and a unified infrastructure to treat children in the primary care setting.

However, there are other types of access programs for children and adolescents, most notably school-based crisis management programs, that would benefit from the single-model approach. Unlike the coordinated effort in primary care, school districts around the country are designing and delivering their own mental health programs. Statistics show that just over half of public schools are providing just diagnostic mental health assessments and 42% are providing treatment. They are fragmented, disjointed programs with limited connection to each other, few ways to collaborate on best practices, and no standardized way to measure impact across the entire community. 

Similar challenges exist with other types of access programs, including maternal mental health and substance abuse. Individually, each effort is laudable, making great strides to address needs in a specific area. Taken together, however, they paint a picture of a fragmented approach to mental health care, where each initiative plugs a hole, but the boat still leaks. 

What will it take to address access as a whole rather than in pieces? 

A unified model for mental health care

We must redefine what it means to provide access, working toward standardized care and unifying programs under fewer umbrellas. 

The NNCPAP has played an extraordinary role in helping to shepherd and standardize Child Psychiatry Access Programs across the country. What could be learned from a unified approach? The Texas Child Mental Health Care Consortium, for example, administers several types of access programs under one governing body. What if other states followed this model, delivering not just primary care access programs but also school-based crisis management and even addiction and substance abuse treatment for adolescents from within a shared structure? They are all psychiatry access programs, after all. Although they initiate in different environments and may provide differing levels of intervention, they serve similar populations, and they often deliver care in the same manner through telehealth technology.

This consolidated structure would offer the ability to integrate the entire ecosystem around each child—from primary care, to school, to specialty and behavioral health—ultimately providing a truly patient-centered approach. An integrated system would then yield the critical outcomes data needed to drive real change and transform mental health care.

We believe it is possible to deliver an effective unified approach to mental health care delivery that will address the mental health crisis. The first step is for government and clinical leaders to integrate and standardize access programs at the state and, ultimately, the national level. Only then will we be able to accurately measure program effectiveness and be assured that we’re making a real impact on patient health outcomes.

--

Malekeh Amini is founder and CEO of Trayt.Health, a data analytics and clinical workflow platform that expands access to mental health care and measures patient health outcomes. Designed exclusively for behavioral health, Trayt is the first application of its kind with the scale and functionality to fully address the needs of statewide behavioral health access programs. Learn more