When patients experience acute behavioral health issues, the hospital emergency department is often the first place they turn. However, even if ER staff can help a patient in crisis, they are limited in their ability to promote the long-term health and wellness that will prevent future crisis episodes.
Health systems must look for opportunities to adopt contemporary behavioral health strategies that can improve patient outcomes while ultimately lowering the cost of care. But hospitals can’t—and shouldn’t—do it on their own. Behavioral health patients’ needs extend beyond the four walls of a hospital, so an effective mental health strategy needs to incorporate partnerships with community resources that can supplement clinical care with support systems.
Tessa Kerby is a healthcare strategy expert and one of the leaders of ECG’s behavioral health service area. We spoke with Tessa about the ways that health systems are trying to address one of the most underserved needs in healthcare.
How and why are health systems evolving to meet the needs of the community as it concerns mental health?
Health systems are starting to realize that behavioral health is a key underlying issue that impacts the organization’s ability to advance its value-based care and population health goals. Some 30% or 40% of patients with a physical issue also have a behavioral health comorbidity. When a hospital tries to determine what’s causing its costs to be so high, they see their length of stay is too long and they’ve got patients who are just boarding in the ER, and there’s nowhere to send them. That’s often related to behavioral health, because there isn’t a place that can support physical and behavioral recovery to safely discharge a patient.
What challenges do hospitals face when they try to address those issues?
There are four major challenges. Number one is reimbursement. The current model doesn’t pay enough, doesn’t cover the costs, and doesn’t recognize how patients are actually cared for or how the health system implements patient care.
Second is the provider workforce. There aren’t enough psychiatrists to cover all of the patients. We aren’t training enough psychiatrists, and they’re incredibly difficult to recruit. So health systems use APPs, MSWs, psychologists, and nurses, but there aren’t enough training programs or staff who want to be in those roles.
Health equity is a big issue. There are disparities by economics and race that impact access to, and quality of, behavioral healthcare. And that’s something that organizations are starting to tackle, and there have been provisions in the COVID relief bills and the Family Cares Act that begin to recognize and assign dollars to equity issues around behavioral health—all a step in the right direction.
Finally, there’s a safety issue for both patients and staff. If a patient is experiencing psychosis or becomes violent, the right way to treat them is to probably give them some space and talk them through the episode. But what usually happens is that the hospital isolates the patient in a secure area, though in the process this can lead to the patient harming themselves or the staff. It gets back to the fact that we’re not training staff properly on how to take care of these patients, and ERs aren’t designed for it either.
Are there organizations we can look to as a model of how to provide comprehensive mental healthcare?
There are places that are doing parts of it well, but behavioral healthcare is a big, long spectrum of services across outpatient, inpatient, and a multitude of other components external to the hospital—community partnerships to support housing, to support drug rehab, to support job placement, and peer support networks. A health system is only going to be successful if it has the right place—a system of care–to safely discharge a patient.
A behavioral health service line truly requires a community system of care to succeed?
Absolutely. As a service line, it faces the same challenges as any other—a mix of fee-for-service and value-based models, workforce shortages, etc. But behavioral health providers need the support of community partnerships. As a provider, you could take a patient who is having a mental health episode, bring them in, treat them, get them the right medication, and ensure they’re stable. Without a community network, often these patients walk out the door, and some may be homeless; often they can’t get access to the medications they need; many would like to get a job, but can’t. For many, it becomes a cycle.
You need to have relationships in place so you can direct a patient to a partner that does job training; a partner that helps find housing for the homeless; a partner that can help someone apply for grants to get a computer and a smartphone, or make sure they’re connected to the right programs to get the medication they need.
If you can help someone make those connections in life and understand their condition, you can make that person successful. But we’re failing patients because we’re looking at those two systems separately and not as a system of care.
Published May 28, 2021