Behavioral Healthcare Shortages: Causes and Solutions

The National Council for Behavioral Health and the National Council Medical Director Institute released a far-reaching report this month: The Psychiatric Shortage: Causes and Solutions. As a recognized leader in behavioral health reviews, this BHM Healthcare Insider Blog brings selections from the executive summary focusing on the behavioral healthcare shortages and solutions. BHM offers solutions for physician advisor/peer review processes because shortages in BH providers mean even more severe shortages for reviewing and processing BH cases.BHM proudly offers options for one of the five NCBH/NCMDI recommendations:  “Improved efficiency of service delivery”.

Behavioral Healthcare Shortages

The lack of access to psychiatric services in health care service has been a constant challenge for decades, resulting in significant delays to treatment with concomitant consequences in reduced quality of care, low patient satisfaction, poor patient outcomes, reduction in the workforce and higher costs.

The providers of psychiatric services in outpatient psychiatric programs — mostly psychiatrists, but also psychiatric advance practice registered nurses, psychiatric physician’s assistants, and board certified psychiatric pharmacists — face a cramped daily routine with increasingly briefer appointments scheduled back to back that limit in-depth clinical assessment, collaboration with other members of the treatment team and consultation to primary care providers outside of the program. Such a schedule leads to lower quality care.[email-download download_id=”68025″ contact_form_id=”68022″]

In hospital EDs, lack of access to psychiatric services stands out among all other medical diagnoses, averaging up to 23 hours for some dispositions. The resulting extended waits have impacts on the full scope of care in the ED that, at times, can reduce access in the ED for more acute medical presentations and lead to poorer outcomes for psychiatric patients.

Consequences of Lack of Access

There is an inadequate workforce to deliver safe and effective care in outpatient and inpatient psychiatric programs. The cramped schedule leaves less time to review clinical information, provide expert guidance to the treatment team and practice up to the level of their licensure. The reduced supply and limited opportunities to expand competencies in training programs also leave the workforce less prepared to participate in the innovative models of care that are central to health care reform. These models are key features of accountable care organizations and alternative payment mechanisms that reimburse providers on outcomes instead of volume. behavioral healthcare shortages

Conclusions on Access and Environmental Scan

There is a shortage of psychiatrists that will only worsen with integration of primary care and behavioral health and the shift to Accountable Care Organizations (ACOs) as part of health care reform. Due to efficient screening for mental health and SUDs in primary care, there will be growing demand for access to psychiatric services.

Psychiatrists face a host of challenges in training and practice to learn about and participate in a host of innovative interventions in which psychiatric expertise would be invaluable to:

• Address co-occurring behavioral health and chronic medical conditions,
• Improve health outcomes of high-risk and high-cost populations where mental health and substance use disorders (SUDs) are prevalent and
• Address the social determinants of health that pose substantial barriers to primary care, specialty care, and behavioral health care.

Solutions, Recommendations and a Call to Action

An expanded supply of psychiatrists and other providers trained in these emerging competencies will be a positive development for the behavioral health workforce and have a lasting impact on a multitude of troubling patterns of care such as:

• Over-reliance on EDs to provide urgent assessments and care,
• Poor health outcomes for persons with chronic mental health conditions,
• High rates of overdose from opioid use disorders and
• Rising costs of health care for complex, high-risk populations.

Multiple solutions are needed in five areas:

• Workforce development,
• Improved efficiency of service delivery,
• Reducing burdensome regulations and confidentiality restrictions,
• Broader implementation of innovative models, and
• Adoption of novel reimbursement methods that provide adequate reimbursement for psychiatric services.

These changes can only occur if the multiple stakeholders (federal and state governments, payers, providers, provider trade associations and advocates) take action within their respective spheres of influence in the design, funding, regulation and delivery of behavioral health care. Each of the stakeholders have a role to play and must choose among these solutions to make an impact.

Many of your most challenging claims and cases likely present a behavioral health component. Due to the behavioral healthcare shortages described in this blog, BHM offers a reviewer network with the most sub-specialties. 6 of the top 10 largest health plans entrust BHM for behavioral health peer reviews.   CLICK HERE to learn more about how BHM helps your organization curb behavioral health costs.

The National Council for Behavioral Health (National Council) is the unifying voice of America’s mental health and addictions treatment organizations. Together with 2,900 member organizations, serving 10 million adults, children and families living with mental health and substance use disorders (SUDs), the National Council is committed to all Americans having access to comprehensive, high-quality care that affords every opportunity for recovery.

Authorized by the National Council Board in 2015, the National Council Medical Director Institute (the Medical Director Institute) includes medical directors from mental health and substance use treatment organizations from across the country.