Just recently, I had the occasion to meet with a large gathering of professional representatives from a disability group outside the behavioral health and intellectual/developmental disability communities. An estimated one-third to one-half of persons with this disability also experience a comorbid mental health condition, typically depression. What shocked me was the belief shared by almost all in the room that virtually all persons in this disability group who have a mental health condition should be seen by a psychiatrist. Clearly, this belief is almost a caricature that flies in the face of today’s actual mental health practice.
At a national level, data show that about three-quarters of all behavioral healthcare today occurs in primary care settings, such as physician offices adn clinics. Only one-quarter occurs in specialty settings, such as individual and group practices, behavioral health clinics and specialty hospitals. We also know that peer support is growing rapidly in these specialty settings and that consumer-operated service programs are becoming much more prevalent. Finally, a very small fraction of behavioral healthcare now occurs in jails and prisons, which together represent an emerging care sector.
Behavioral health also is in the midst of a workforce crisis. As a result of the Affordable Care Act (ACA), an estimated 25 million more Americans have health insurance today. About 8 million of these newly insured persons have one or more behavioral health conditions. Yet, no parallel expansion has occurred in the behavioral health workforce. Simultaneously, providers of baby boomer age are beginning to retire in large numbers.
Appropriate sources of care
All of these factors point to the need for us to develop much greater clarity on appropriate sources of behavioral healthcare and to communicate these both within the field and within the broader disability communities. Toward that end, here are several principles that can serve to foster further framing of this very important issue: