What is Behavioral Health?
Behavioral health encompasses the promotion of mental well-being and the prevention and treatment of mental health and substance use issues. It spans a spectrum from illness to positive mental well-being and is influenced by genetic and environmental factors. Behavioral health conditions include anxiety, depression, substance use disorder, attention deficit hyperactivity disorder, bipolar disorder, schizophrenia, and others. Standardized behavioral health care comprises elements such as substance use disorder screening, psychotherapy, medication, inpatient treatment, case management, crisis response, and support services. The workforce comprises various specialty providers, such as psychiatrists, psychologists, counselors, and primary care physicians. Community-based organizations also contribute to nonclinical support.
However, mental health and substance use treatment nationwide is very fragmented and disconnected because these services were historically always locally developed. There has never been a nationwide emphasis on treating mental health and substance use disorders, allowing this fragmentation to go unaddressed and leaving the field riddled with infrastructural issues.
Problems Facing Behavioral Health
1. Accessibility, or lack thereof
Access to behavioral health services is a significant challenge for treatment, with many regions lacking available affordable care. Discrimination further compounds this issue. In 2020, a considerable portion of individuals with mental health conditions and substance use disorders did not receive treatment, with racial disparities persisting.
Behavioral health care in the U.S. is funded through various channels. Spending in 2016 reached almost $180 billion, with over half of mental health funding and around three-quarters of substance use treatment funding originating from public payers like Medicare and Medicaid. Medicaid is a substantial contributor, offering innovative services for various populations, but low reimbursement rates hinder provider participation.
Private insurance typically reimburses behavioral health services under categories like outpatient care and medications, often neglecting community-based supports and technology tools and providing limited coverage. Government grants, particularly from agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) and the White House Office of National Drug Control Policy, play a significant role in funding innovations, workforce training, and system improvement. Federal, state, and local agencies also contribute funding for behavioral health care in diverse settings such as schools, rural areas, and correctional facilities.
2. Lack of resources and staff burnout
U.S. substance use facilities collectively have a utilization rate of 96%, and combined with mental health facilities, they have a utilization rate of 137%. These facilities are bursting at the seams, but there are still vast swaths of the population who are not receiving adequate mental health or substance use treatments. The demand on hospitals and health systems regarding behavioral health conditions has only increased, but funding has not followed. Provider shortages, especially in rural areas, contribute to the overuse of facilities. The U.S. requires around 7,400 additional mental health providers to meet demand, and substance use treatment is notably scarce, leading to extended wait times. Even in urgent cases, individuals can wait hours or days in emergency departments. Bottlenecks and hospital overcrowding have increased due to growing wait times.
The lack of proper infrastructure for behavioral health centers has also contributed to staff shortages and high turnover rates, posing challenges in providing care, particularly to underserved populations. Behavioral healthcare involves managing mental health, substance use issues, trauma, and crises, which can lead to emotional strain for professionals. Factors such as work-related stress, low salaries, student debt, and heavy caseloads contribute to burnout among behavioral health workers, with over 50% reporting burnout symptoms.
Medicare's expanded payment codes encourage providers to take on more patients. Still, these codes must cover the necessary investments for providers to grow physically, leading to lower reimbursement rates for behavioral health caregivers and inadequate facilities. The scarcity of mental health specialists in insurance networks also compounds the workforce shortage. However, demand for behavioral health services continues to persist in the face of these rates of burnout and staff shortages, worsening the issue of inadequate compensation for behavioral health professionals. Burnout can lead to disengagement and turnover for healthcare providers, negatively impacting access to care and quality.
3. Underfunding and Stigma
Many behavioral health providers did not qualify for federal incentives compared to others who benefited from the Health Information Technology for Economic and Clinical Health Act of 2009. Lack of funding largely explains many problems facing the behavioral health field. More funding would make room to hire more professionals, better compensate the existing ones, invest in implementing technology tools, and build a more robust infrastructural system.
Stigmatization is a driving force behind the lack of funding allocated for behavioral health. Specifically, substance use disorders have been stigmatized through legislation, government programs, media portrayals, etc. All of these have created the societal outlook that substance use disorders are a self-inflicted moral failure and, therefore, a purely individual problem. Similarly, the stigma surrounding mental health is rooted in the societal belief that it is less important than physical health. Many Americans negate the importance of mental health treatment, especially in comparison to physical health treatments, and many feel a sense of shame when admitting their mental health issues. In reality, there are numerous racial, socioeconomic, environmental, and genetic factors at play when discussing mental health and substance use disorders. The result of this stigma is the lack of proper allocation of resources to the field, leading to many infrastructural problems.
This being said, implementing technological advances can be immensely beneficial in alleviating the effects of these issues.
How Implementing Technology Could Benefit Behavioral Health
With such a severe lack of funding invested in behavioral health, those resources that are made available must be allocated effectively. That is where technology can make the most significant difference. Technology can help integrate care, increase access to behavioral health providers, and improve workflow and communication among healthcare providers. Telehealth can expand access by connecting patients with linguistically and culturally suitable providers, offering virtual interventions for mental health and substance use issues. These technologies enhance the capacity of healthcare professionals to deliver quality behavioral healthcare to a broader range of people. Additionally, technology can improve clinical processes by aiding triage, providing decision support, tracking medication adherence, and measuring care quality. Integrating electronic health records and natural language processing can facilitate information sharing and quality reporting. E-consults also facilitate communication between primary care and behavioral health providers.
Behaivior’s technology ensures that appropriate care is given to patients based on their specific needs. Being able to identify which patients with substance use disorders are at a higher or lower risk of returning to use allows providers to determine where exactly their attention should go. Remedial treatments such as hospitalization and crisis interventions are a much more significant drain on resources than preventative measures that monitor patients beforehand.
Behavioral health has been incredibly slow in adopting new technology and advancements, primarily attributed to underfunding. However, integrating technology into behavioral health treatments may be the exact solution to mitigating the effects of underfunding.
Contributors: Vishva Iyer, Behaivior
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