Stemming the Tide of the Behavioral Health Crisis

When you do even the most fundamental review of U.S. behavioral health data, the numbers are staggering. And our nation’s hospitals are outmatched by the demand for services in their local communities.

As you can see in the map from the Health Resources and Services Administration, most states simply don’t have enough mental health professionals. The Treatment Advocacy Center reports the following:

• More than half of the counties in the US do not have a mental health professional
• From their peak in 1955, the number of state hospital beds in the United States had plummeted almost 97% by 2016
• The mentally ill are 10 times more likely to be jailed than hospitalized

States cut $4.35 billion in public spending on mental health from 2009 to 2012. States heavily impacted by the downturn in the oil & gas industry have had even greater challenges. As our population grows increasingly older, we’re not well prepared to address geriatric psychology needs either. Less than 20 universities offer graduate level programs in geropsychology.

The trend lines of social determinants of health are no better. Last year’s report from the Surgeon General sounded the alarm on rising rates of addiction.

Nearly 21 million people met the standard for a substance use disorder in 2015 but only 2.2 million individuals received any treatment. The number of people who misused opioid pain relievers within the last year was 12.5 million people. Across the country, there are grassroots movements to address the growing crisis of addiction and declining mental health. But meanwhile, ERs and behavioral health departments are simply overrun.

Going All-In on Team

So when I meet with hospitals CEOs and ask where their operations are under the most stress, it’s no surprise that increasingly the answer is behavioral health. For safety net hospitals in particular, these teams are the safety net of the safety net. They’re treating patients with complex combinations of mental and medical health needs in out patient and in patient settings. Coordination and continuity of care has extremely high degrees of difficulty. And quite naturally, working relationships among staff are often strained.

In our experience, hospitals that succeed in even the most dire of conditions share some common traits. First, they value communication as a competitive advantage. Instead of thinking of communication as an individual style or trait, they institutionalize it as a common set of procedures, tools and best practices. Getting on the same page is continuity by communication. There is no other way to do it.

Secondly, everyone is all in. No more silos. From the clerks and security guards to the department chairs, they operate as team. Different people can come and go into the system, but the operating model remains unchanged. Leadership can and must set the example. And no one can be treated as outside the chain of the team. Nothing tears teams apart faster than an outlier empowered by hierarchy.

When staring down our crisis in mental health, we need to be realistic about the short term but solve for it with an eye to sustainable population health gains. Integrating behavioral health with primary care will need to become the norm as our aging population places even more demand on the limited supply of services.

For most hospitals dealing with the acute impact of today’s realities, new beds or new FTEs aren’t going to materialize soon. Leverage needs to be created within the gaps that exist among the resources you do have – namely your people.