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Linda Rosenberg

Former President and CEO, National Council for Behavioral Health

Strengthening the Safety Net: Bolstering Community Services for All

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We need a new type of health facility, one which will return mental health care to the mainstream of American medicine, and at the same time upgrade mental health services. – President John F. Kennedy

Now, more than ever – with drug overdoses skyrocketing, suicide deaths increasing and life expectancy continuing to decline – we need to return mental health care to the mainstream of American medicine. And a new funding opportunity from the Substance Abuse and Mental Health Services Administration (SAMHSA) is a good start.

SAMHSA recently released a funding opportunity announcement for Certified Community Behavioral Health Clinics (CCBHCs) Expansion Grants. SAMHSA anticipates awarding 25 eligible providers up to $2 million annually to increase access to, and improve the quality of, community behavioral health services through the expansion of CCBHCs. CCBHCs and community behavioral health providers in 24 states that participated in the CCBHC planning year are eligible to apply. Applications are due July 9.

We are very grateful for Dr. McCance-Katz’s leadership, and we appreciate the administration’s acknowledgment that financing must be aligned with treatment and that, just as with other illnesses, we need standardized care and a funding stream for those who are uninsured – all things that CCBHCs provide. However, we don’t fund treatment for heart disease or cancer with time-limited grants, and treatment for mental illnesses and addictions should be no different. We need CCBHCs in every community in America, starting with passage of the Excellence in Mental Health and Addiction Treatment Expansion Act. And we need to learn from history lest we repeat it. So how did we get here?

Starved for Funding

More than half a century ago, when he signed legislation creating community mental health centers (CMHCs), President Kennedy envisioned that CMHCs would create a safety net for people leaving institutions and help them integrate fully into their communities. But almost immediately, the safety net began to unravel.

Today, many nonprofit CMHCs have been starved to near death. They haven’t seen a rate increase in years. Underfunded, they’re labeled unresponsive.

We cry public health crisis about the opioid epidemic but invest primarily in beds and curbing prescribing – necessary but insufficient responses. We encourage alternatives to incarceration without investing in the alternatives.

Everywhere, people young and old, famous and not, are telling their stories. But for every recovery story, hundreds of individuals and families continue to struggle, unable to find the help they desperately need.

People like Annie Brown and her husband, Jeff Filbrandt, who tried to find an inpatient mental health treatment center in southwest Michigan when their teenage son, Jack, was in crisis. They were first told they could go to Detroit, but they are closer to Indiana, so they found a place in South Bend that accepted their health insurance. “Nobody would have to drive out of state to be treated for a heart attack,” Brown told a local reporter.

In a 2013 Kaiser poll, 76 percent of Americans said they didn’t know where to get care or how to pay for it, and five years later, the problems have only worsened. A report this year shows that nearly one in eight human service nonprofits are technically insolvent, meaning their liabilities exceed their assets.

Without funds, community providers can’t hire skilled staff and their patients receive limited and lackluster care. Inadequate rates also stymie adoption of evidence-based practices, integrated care and innovative technologies.

Leveling the Playing Field

CCBHCs can be a lifeline for patients and for struggling nonprofits. They help level the playing field by providing the same payment structure that Federally Qualified Health Centers get. And they ensure that no matter if you’re in Oregon or New York, a CCBHC delivers the continuum of evidence-based services.

CCBHCs authorized by the 2014 Excellence in Mental Health Act are currently operating in eight states, and they are transforming access to care in their communities. In the first six months of operation, CCBHCs hired 1,160 new staff from addiction psychiatrists to peers, began serving new patients and initiated or expanded medication-assisted treatment. And many have been able to start offering same-day access, because when a person seeks help, we can’t tell them to come back in a month or suggest they go across town or out of state. We must be ready to provide help when and where they are ready to receive it.

But not every behavioral health organization can become a CCBHC, and CCBHCs can’t be the only way to deliver comprehensive services. We must be open to new structures and new players.

Creating a Stronger Safety Net

This changing marketplace has some community-based members joining hospital systems,

and hospital members are expanding their community services. Other new delivery structures include the Cohen Veterans Network (CVN), which is improving the health of veterans and their families. Founded by philanthropist Steven Cohen, CVN partners with hospitals and community behavioral health organizations to provide services in communities with a high density of veterans. We hope philanthropists will apply the model to other populations – coupling ongoing financial support with care based on the best available science.

Other National Council members are joining forces through independent practice associations, mergers and acquisitions. Under the leadership of longtime CEO David Guth, Centerstone America has grown from a single nonprofit to become a national provider network serving individuals in multiple states, including a CVN clinic at the Centerstone facility in Tennessee.

Change is never easy, but we can’t shy away from it. To survive, we must become the competition, affiliate with them or risk becoming obsolete. Together, we can honor the commitment President Kennedy made to replace the “cold mercy” of custodial care with the “open warmth” of community. Let’s start today!