8 JUNE 2024Rollercoasters are supposed to be fun, but not when they apply to the delivery of behavioral health. In our American healthcare system, we have made some major strides with several diseases, yet not with behavioral health. Unfortunately, our behavioral health patients still face many of the same issues that they've faced in the past. However, there is hope on the horizon.Going down... Mental health disorders are chronic diseases, just like diabetes. The challenge lies in that expected outcomes are often less clearly defined than those we have in other medical diseases. Continuing the metaphor of diabetes, we can follow response to treatment based on objective measures like glucose and kidney function, then make rational treatment decisions based on those numbers. A similar metric is much less clear in, for example, schizophrenia. Because of this, attempts to define "standard treatment" for mental health disorders have been elusive.The challenge, then, for payers is that outcomes and expenditures are often difficult to predict. Payers can predict costs for the treatment of a tumour, for example, but not as much for major depression. For general health care, third-party payers can allocate funds based on tables of known outcomes. However, the outcomes are often not known in mental health. Government and private payers are often seriously underfunded, and the funding for mental health care in our country has not even kept pace with inflation. They are being asked to do more with less.There are serious barriers to receiving care in behavioral health. There are personal and cultural barriers, with stigma being a major obstacle in several populations. Attempts to destigmatize mental health care have met with some powerful successes as well as many failures. Not all insurance programs cover mental health care, and out-of-pocket costs can become prohibitive. Effective care may require multiple weekly visits, making compliance an issue for people with jobs or limited transportation. Laws passed in the past few decades to protect patient privacy have created a new layer of difficulty when it comes to information sharing, and building a comprehensive multidisciplinary system of care is more challenging when each provider is only allowed access to limited information regarding a patient.Given these barriers, each party--patients, providers, health care systems, third-party payers, and government programs--have each created well-meaning approaches to care, resulting in a system that is disjointed, inefficient, and poorly accessible, sometimes with different components acting at odds with each other. Each party is pointing fingers at each other.Paul has worked in the field of Mental Health and Substance Abuse treatment since 1989. He holds a BS and MS in Psychiatric Mental Health Nursing from the University of North Carolina, Charlotte and Certificate of Achievement from the University of Southern California Institute For Mental Health Leadership. Paul's experience spans numerous care and treatment settings including residential substance use disorder, acute inpatient, long-term adolescent, correctional, and outpatient. Paul serves on the Centers for Behavioral Health Advisory Board, the Behavioral Health Action Coalition and numerous other workgroups and committees that address a wide variety of mental health issues.THE ROLLERCOASTER OF BEHAVIORAL HEALTH CAREBy Paul Rains, System SVP Behavioral Health, CommonSpirit HealthAS WE UNDERSTAND THE POWER OF COMBINING GENETICS, EPIGENETICS, NUTRITION, BIOMARKERS, FUNCTIONAL MRIS, PET SCANS, POPULATION DEMOGRAPHICS, ENVIRONMENTAL TOXINS, WEATHER, AND A HOST OF OTHER DATA POINTS AS THEY MAY APPLY TO A SINGLE PATIENT, WE WILL SEE DRAMATIC IMPROVEMENTS IN CARE OUTCOMES, ACCESS, TREATMENTS, AND COSTSIN MY OPINION
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