Ideally, 2018 should be the year of investment, according to Linda Rosenberg, president and CEO of the National Council for Behavioral Health. While the industry has long bemoaned the lack of public resources dedicated to treating addiction and mental health disorders, new pressures are emerging that sound a more urgent alarm for lasting solutions. Always the optimist, Rosenberg believes there are successes to celebrate as well.
She recently spoke to Behavioral Healthcare Executive, and here are a few items on Linda’s List for 2018.
1. More investment must be made in local services
Communities are struggling as they try to connect people in need with appropriate addiction and mental health resources. Even those who have insurance or the means to pay out of pocket still have ongoing access problems. Care is rarely immediate, and there are numerous barriers along the continuum.
This is the year of the community crisis, Rosenberg says.
“We’ve tried a number of things to solve the opioid crisis and serious mental illness, and one of the things we’ve learned so far is that beds alone are not the answer,” she says. “Expanding federally qualified health centers (FQHCs) alone is not the answer, and integration alone is not the answer.”
At the ground level, the lack of investment is only made worse by historical shortfalls and increasing pressure on rates as the healthcare system at large shifts toward value models. She says the result is more providers closing down and fewer clinical workers entering the field.
“That’s what we need to tackle—honest conversations about how we need to stop blaming community-based organizations for certain problems when we’ve not made any investment in them,” she says.
Additionally, Rosenberg says it’s irrational to expect not-for-profits to innovate and offer new services to respond to local needs when there’s no funding to back it up. By comparison, she says, it took Amazon about six years to make a profit even with substantial private investment. More cannot be expected of community organizations or their donors.
2. Investment must include better pay for behavioral health employees
Rosenberg says the workforce shortage is a crisis that’s been brewing for years. Now with unemployment in check across the nation, attracting quality employees—particularly clinical employees—represents a competitive advantage.
“You’ve got millennials who have a huge number of career choices, who can work for companies that are getting big tax cuts and are announcing perks and pay raises, and then you’ve got a nonprofit sector of community organizations that have not benefitted at all from the tax breaks,” she says.
Even the Veterans Administration and FQHCs are able to pay employees more, and considering that workers need to earn a living and take care of their families, the choice becomes obvious for them. Offering training as the special employee perk just doesn’t cut it anymore.
“In the end, you have to pay people, and you have to treat millennials to snacks in the office, sabbaticals, weekly dinners, parties and other events,” she says. “That’s what for-profit companies do for millennials, meanwhile, nonprofits can barely afford to hire staff. We get what we pay for.”
As for solutions, Rosenberg believes career ladders for peer coaches would be helpful because they’re a valuable and recognized resource that should be scaled up. However, the caution here is that commercial payers have embraced peer services largely because of the cost savings.
“They are an important part of the workforce, but payers like it because it’s cheap,” she says.
3. CCBHCs must be expanded
Continuing the advocacy from the past few years, Rosenberg again calls for expansion of Certified Community Behavioral Health Clinics (CCBHCs). Still limited to eight states, the programs aim to create a payment model that ensures fair reimbursement for the actual cost of services. In time, the hope is that the models will be replicated nationally and result in a sound, sustainable care delivery system that doesn’t rely as much on finite grant funding or philanthropy.
A number of federal policy proposals have attempted to expand the CCBHC program incrementally, but none have been adopted yet. Rosenberg says there are several congressional leaders who continue to champion expansion plans.
“It was all about giving community mental health and addiction treatment the same investment that FQHCs have gotten for the last 20 years,” she says. “It’s a chance to get paid and have rates that are high enough to hire people and have things like tuition reimbursement and to pay adequately and to pay for experts and supervision. None of that is allowable with the kind of rates community-based organizations are getting right now.”
Among the active CCBHCs today, workforce expansions have occurred in all the demonstration areas, with a total of 1,160 new staff hired—including psychiatrists and staff with addiction specializations. Additionally, 87% of the clinics report they have been able to serve more patients thanks to their new capabilities.
These are the bright spots. And Rosenberg says progress must continue on the practice side and the policy side because both are needed.
4. More recovery resources are needed for those with addiction disorders
The opioid crisis remains a designated public health emergency at the federal level with the original declaration now extended until late April. However, Rosenberg cautions that there are so many drivers of addiction today that a short-term focus won’t be enough to realistically combat the true scope of the problem.
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