Introduction
Behavioral health conditions account for mental and substance abuse disorders. It is estimated that by 2020, mental and substance use disorders will outperform all physical conditions as a critical source of disability globally (Williams, 2013). Data also indicate that about 26% of Americans aged 18 and more are living with at least one mental health condition in a specific year, and about half will experience mental health issues through the span of their lifetime. Although the behavioral health system is largely supportive of proper information sharing across different settings and a multidisciplinary approach, generally, behavioral health frameworks work autonomously from the broad healthcare system. Providing patient-centered healthcare by ensuring an inclusive team consisting of every individual from the care team is perfect for enhancing patient healthcare outcomes. Behavioral healthcare settings are an essential constituent of the continuum of care influencing millions of patients in the US. Notably, among patients with behavioral health conditions, there are more cases of cardiovascular conditions, diabetes, and respiratory diseases.
They have also been associated with increased morbidity and mortality relative to rates observed in patients without a co-morbid behavioral health disorder (Williams, 2013). Moreover, evidence suggests that patients with mental illnesses and substance abuse disorders have a shorter lifespan relative to the general population generally because of avoidable risk factors related to smoking and manageable heart conditions (Mechanic, 2014). It is also noted that patients with mental health issues and substance abuse disorders may face treatment challenges and possibly poorer outcomes because they fail to get integrated treatment options that ensure multiple conditions are managed. This essay evaluates current issues in the behavioral healthcare system with reference to noted trends, private and public variations in care delivery and outcomes, major obstacles in inpatient data collection in care settings, and quality standards.
Issues and Trends
The most uncommon part of the care and financing framework for mental health and substance abuse is the availability of a particular and significant publicly controlled care framework that acts as a security. In this way, individuals with public insurance can utilize public services and persons with private insurance can use the same. Public funding is a major issue in the behavioral healthcare system. Public funding, for instance, is met through multiple different programs managed by various agencies, resulting in both duplication and gaps in administration, and these programs quite often have distinctive eligibility prerequisites. Additionally, financing is highly fragmented, which prompts uncoordinated service provisions.
Another challenge is that much of the care involving behavioral health, for perhaps more than half of the case is delivered in primary care settings, not in specialty care settings. Primary care providers tend to underdiagnose cases of depression, substance abuse, and other behavioral health issues notwithstanding clinical practice guidelines based on evidence, continued training and education, and other programs to improve patient outcomes. Improvements are noted, however, there is a need to enhance the nature of mental health and substance abuse interventions provided at primary care settings and furthermore to better manage the coordination between specialty care and primary care. This leads to data collection and sharing challenges particularly due to poor health IT infrastructures to support the system (Droppa & Luczak, 2004).
An important segment of the public care system for people with the most incapacitating cases goes beyond care services to rehabilitative and support services to include housing, work, training, and other supportive services. These services, to some extent, are poorly coordinated due to the lack of cooperation and collaboration among multidisciplinary agencies, including mental health, public health, social care, literacy, work management, housing, and others. The vast majority of these services are not covered by private insurance and have not been made available to patients by most private behavioral healthcare services providers.
Lately, many more people are expected to join the medical insurance schemes, particularly the government-funded healthcare programs, putting more pressure on Medicaid and the available facilities. Additionally, it is expected that Medicaid will extend payment to community psychiatric hospitals as many patients have continued to receive care from such facilities (Evans, 2016). Further, changes in demographic and economic trends also influence the behavioral healthcare system (Clay, 2011). America now has a more aging population and perhaps heavily taxed than ever before, and this population is most likely to need behavioral healthcare services because of conditions associated with depression, for example.
Patient information within the system emanates from disparate sources. Collecting these data to ensure evidence-based interventions has been a major challenge (Williams, 2013).
In recent years, notable trends have focused on addressing the major challenges witnessed in the system. First, the Health Information Technology for Economic and Clinical Health (HITECH) Act offers incentives and technical support to aid eligible care facilities apply approved technologies to become meaningful users of electronic health records (EHR). This trend has also been noted in the behavioral healthcare system with the aim of collecting data to drive decision-making within behavioral health, as payers and other players now focus on empirically proven treatments and performance measures for providers (Williams, 2013; Clay, 2011). New policies have also been formulated to address the spending and revenue issue in the public care system (Deakin, 2004). Previously, patients paid directly for care while special facilities had a different set of rules. Although new policies have strived to address the spending gap, care delivery and financial issues still persist in the behavioral healthcare system relative to the general healthcare (Frank, Goldman, & McGuire, 2011). As cost also rises, the entire healthcare sector is reacting through consolidation. It is observed that the behavioral healthcare system will also experience a significant change, particularly when payers want providers to integrate their care delivery models. Hence, the thinking is that behavioral healthcare will not be left isolated, but be integrated into the entire medical system, as greater coordination and collaboration are also expected (Clay, 2011).
Trends: Private Sector vs. Public Sector Behavioral Healthcare Inpatient Facilities
The clinical shifts and variations are observed behavioral healthcare inpatient facilities between the private sector and public sector. No place is the difference more evident than in the public and private behavioral healthcare system in the healthcare sector. Self-pay care providers and publicly funded care facilities offer such an unmistakable difference in the level and quality of care to mental and substance abuse patients that they are basically not even considered similar. That is, inpatient private facilities provide higher levels of care to patients because such patients can meet costs. On the contrary, public facilities rely on underfunded government services and insufficient insurance cover. Thus, outcomes are better in private facilities.
In public care facilities following the introduction and advancing of deinstitutionalization and supporting community facilities to offer behavioral and substance abuse care, the total number of inpatient beds in all psychiatric facility settings has reduced over the previous decades (Sisti, Segal, & Emanuel, 2015). Accordingly, there are psychiatric bed deficiencies, expanded utilization of emergency departments for acute case episodes and challenges in the community care facilities. Conversely, private care facilities have grown and improved their inpatient facilities with regard to capacity and design to support recovery. Sisti et al. (2015) now want public facilities to bring back the asylum because the current system is seen as unethical and generally expensive.
Private facilities offer better clinical services to deliver quality care and outcomes to patients. They offer coordinated integrated care for mental and substance abuse disorders, and a wide range of treatments are available (Sundararaman, 2009). However, the same cannot be said of public facilities. Behavioral healthcare services at public facilities are highly fragmented (American Hospital Association, 2012). Services offered at both inpatient and outpatient settings by specialists and generalists are mainly found in community resources. However, patients with other physical health issues must seek for treatments from different facilities with no link to behavioral care facilities. Majorities of adults with diagnosable behavioral issues may fail to get the required care perhaps due to acute shortage of treatment facilities. Additionally, psychiatrists, psychologists or social workers are not sufficient to meet the rising needs in public facilities, and most inpatient facilities lack better psychiatric units as state and county facilities continue to close more units due to the dwindling budget (American Hospital Association, 2012).
Challenges in Collecting the Needed Data to Support and Report Behavioral Health Outcomes
The behavioral healthcare system has developed, but its quality indicators and their use still lag behind physical health care. Many measure tools have been developed, but their validity, vetting, and rating by experts are not certain (Kilbourne, Keyser, & Pincus, 2010). Strikingly, just 16 of about 600 measures and just a small number of U.S. HEDIS measures focus on mental health, and identified measures are restricted by excessively limited focus on clinical issues or a specific diagnosis. Thus, care coordination becomes extremely difficult while measures are hardly linked to quality improvement efforts. First, the behavioral healthcare system lacks sufficient evidence for a specific care issue. Not much information is available on a specific issue, for instance, teen vs. adult use of antipsychotics or a combination of interventions and use antidepressants in bipolar spectrum disorders. Second, these measures also reflect poor definitions of parameters. For instance, definitions of interventions, precise factors for quality indicators and rigid inclusion/exclusion criteria, which may not account for many patients at risk, are also used. Third, the narrow definition of mental health issues in view of available information restricts their applications in regular care. Information on proper pharmacotherapy and psychotherapy are just accessible when retrieved from numerous sources, including patient data, pharmacy data, and claims while performance measures are not robust because of few sources.
Additionally, manual processes in handling data are cumbersome, prone to errors, expensive, and only account for limited samples. Some managerial case data are less meaningful because of indicators used or because they are incomplete. Further, the system lacks a single definition for a certain performance measure, causing massive confusions during data capture. Finally, the absence of electronic health information system does not encourage data capturing and storage. Although the US hospitals have made significant efforts in adopting electronic medical records (EMRs), the current applications may not sufficiently account for individuals with mental conditions and substance abuse disorders because these clinical services are not linked to general care. In a current review, just 12% of U.S. clinics had electronic therapeutic records (EMRs). Besides, a considerable fraction of behavioral health services is offered outside hospitals. Criminal justice and social services settings are other areas where patients may get care, resulting in difficulty in care coordination and collaboration and collection of data.
Current Regulatory and Accreditation Standards for Behavioral Health Industry
Evidence suggests that regulatory and accreditation standards enhance care provision processes and clinical outcomes and, therefore, they should be promoted as tools for improving quality of care services (Alkhenizana & Shaw, 2011). However, one must acknowledge transformations in the behavioral healthcare system and the entire healthcare sector since the enactment of the Obamacare. For instance, the introduction of Medicaid managed care means that a new regulatory structure is necessary to enhance and support the system and ensure improved healthcare outcomes at the lowest cost possible.
Regulations should improve accountability and guarantee care provider qualification. It is shown that accreditation processes also differ across states, but skills acquisition should be uniform and licensure should be reviewed to protect patients. In attempts to enhance the quality of care, the behavioral health system should address responsibilities of state agencies and any bodies involved in quality reviews to ensure that such processes are stringent and care facilities and practitioners must meet the required accreditation standards. Overall, given the relevance of regulation and accreditation standards to access care, ensure quality care, ensure efficiency, and improve population health outcomes, it is only necessary that the US should shift toward a regulatory system and accreditation standards that can improve the behavioral healthcare system.
Conclusion
As observed above, behavioral health conditions account for mental and substance abuse disorders, and the related conditions are expected to increase by the year 2020 globally and surpass physical conditions that are now the main cause of disability in the general population. Thus, the behavioral health system now requires much attention than ever before to ensure that patient-centered care is delivered to improve healthcare outcomes. Behavioral health issues currently affect millions of Americans, but its system is highly fragmented relative to the general healthcare system despite its importance. Some issues noted including the number of dwindling inpatient facilities, rising costs, poor collaboration and coordination, low adoption of technology (electronic medical records for communication and data collection), and low levels of care collaboration and coordination. However, the introduction of Medicaid has changed the system, but it still lags behind the general healthcare system.
With the exception of private facilities, government-funded behavioral care facilities require urgent change. The dwindling funding is currently a major issue that should be addressed immediately to increase the number of asylums, for instance. The system should adopt technology to facilitate care coordination, collaboration, and data collection. Moreover, regulations and accreditation standards should also be reviewed to reflect changes in the health sector.
It would be interesting to explore how technology and data-driven practices have transformed the behavioral healthcare system. The system is becoming more integrated, and it is not clear how prepared behavioral healthcare professionals and psychologists are to embrace technology in their practices to bring about long-term recovery for patients.
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