Behavioral Health Care@100%
Center for
Behavioral Health Care@100%
Behavioral Health Care@100% means all children and families can easily access care.
Inside The Center
Here’s a quick overview of what you will find below.
What Families Face
Short stories from families facing challenges, illustrating the need to address barriers to vital services.
10 Innovations Await
The sidebar menu takes you to ten innovations areas, each one providing projects action team members are implementing to remove barriers to services.
The Root Causes
We provide an overview of why families struggle to access vital services in what we might call “normal times” and in times of public health or economic crisis.
A Pandemic’s Impact on services
A brief review of how the pandemic impacts each county across the state.
Where on Earth
How solutions exist today.
The Center’s Mission
Behavioral Health Care for 100%
Welcome to the Center for Behavioral Health Care@100%, the nation’s first center to provide county and city stakeholders with research, data-driven strategies, insights and support to end behavioral health care disparities on a countywide scale, ensuring all resident’s mental health care needs are met. Behavioral health disparities, lack of timely access to quality care, has been with us for as long as we have been using the science of mental health care on the planet. In the last few decades societies of all sizes have found ways to provide accessible behavioral health care to all residents.
In modern societies the cause of behavioral health disparities can often be tracked down to lack of investment in the human capital and resources to secure a healthy supply of care providers and programs. In the USA, a country with vast amounts of wealth and resources, we have all the technology and know how to make behavioral health care insecurity history.
One quick online search will overwhelm you with solutions to the behavioral health disparities problem. Google shows you how many visitors are searching for answers — interested in understanding the root causes of behavioral health disparities and how to solve it.
When we begin to “Google it” for results:
Emotional health goals: 186,000,000
Mental health care in rural areas: 142,000,000
Mental health care system case study: 219,000,000
Mental health care and human rights: 251,000,000
Mental health, faith and spirituality: 41,600,000
“Health disparities is a man-made problem, not an act of nature, requiring human ingenuity to solve.”
— From the book Behavioral Health Care@100%: How we ensure all county residents can access behavioral health care
What Families Face
*These are fictionalized profiles based on real New Mexican residents.
Eric's Story
All this might have been prevented if the adults Eric grew up with had accessed mental health care and other vital family services to address their own challenges. But for Eric, his friends and their parents, the norm is not counseling, which is too difficult to access and talking to strangers feels really uncomfortable. Instead, the default for Eric may be “manning up” or suffering in silence.
Jen and Marie's Story
Jen has discovered that finding services is not a straightforward process. She isn’t sure how much services cost or how quickly Sam can get access. Jen wonders why there isn’t there a single online directory listing all mental health care providers and their fees, their availability and a bio describing the counselor’s expertise and experience.
Time for action
It’s Time For Heroic Acts
You are about to review approximately 20 projects within ten innovation areas that can, if done successfully, improve the quality and accessibility of current services. The long-term goal of these innovations and projects is to ensure that 100% of county residents have access to this vital service. Your task is to review all projects, individually and as part of an action team, to identify which one you wish to implement. In the time it takes to enjoy a latte, you can give our menu of innovations a quick read, starting with Innovation #1: Tracking Supply and Demand and ending with Innovation #10: Developing the City Dept. of Behavioral Health Care. These include projects initiated by action teams focused on a county and all the communities within its borders.
Behavioral health disparities have a long history
Behavioral health disparities are impacting our most vulnerable children and families with consequences for education, job readiness and public trust of government.
Why Disparities?
BEHAVIORAL HEALTH DISPARITIES CAUSE DAMAGE
BEHAVIORAL HEALTH CARE HAS EVERYTHING to do with our quality of life. If we can access quality care in a timely manner, we function better and we are healthier. If our access to care is threatened, we are in serious trouble.
Behavioral health care should not be thought of as a luxury. It is a vital component of comprehensive health care. It belongs in our list of five surviving services, along with medical care, housing, food and transportation. Behavioral health care is a powerful tool for creating a safe and healthy community and workforce.
During a crisis (whether from a virus, natural disaster, terrorism or economic disruption), existing behavioral health care systems become a critical tool for survival. Uncertainty puts incredible strain on all people, especially those who were already dealing with childhood trauma, untreated adult trauma, or a myriad of untreated mental health challenges. Behavioral health care, in all its many forms, needs to be easily accessible, affordable and culturally appropriate.
Here we take on a very complicated system with a long history of challenges. We provide an overview of behavioral health care including many strategies for addressing mental health disparities and related problems. We will guide you through the steps needed to turn ideas about increasing services and improving services into action.
A world of colliding crises
In a world of colliding crises, change and uncertainty, we require a robust behavioral health care system in every community. The key word is system, because scattered and disconnected public and private agencies, or individuals who offer various forms of behavioral health care, simply won’t get the job done. Whether we use the term behavioral health care, mental health care or systems promoting emotional well-being, the focus is to create a network of healing.
Every county has residents experiencing health care disparities and some have segments of the population reporting extreme difficulty accessing care. In times of crisis like a pandemic, access to medical care becomes even more critical.
In the Center for Behavioral Health Care@100% (and corresponding chapter in the book 100% Community) we provide an overview of a very complicated system and its numerous challenges, as well as programs that reduce disparities. Get ready to be inspired. We will guide you through all the steps needed to put ideas for addressing health care security into action.
With literally millions of people reading articles on ending behavioral health disparities and thousands of foundations, governmental and non-governmental organizations focusing for decades on ending mental health care insecurity in the United States, why is access to timely care still so prevalent across all fifty states? Why are students arriving at school with problems related to lack of mental health care care? Why do parents working full time not have enough money for mental health care? Why do therapy clinics have long waiting lists and how could long term care centers for those with chronic problems run out of beds along with enough providers to care for residents who require assisted living environments?
We don’t mean to question our good-hearted leaders in political, academic and philanthropic circles, but there appears to be a complete disconnect between those who claim to have answers and the actual implementation of solutions to ensure 100% of our residents are able to access care. What are our morals, ethics and values that allow health disparities to exist amid so much abundance?
What kind of society would allow a policy of benign neglect to doom entire zip codes to behavioral health care disparities? Why should our most vulnerable children and families ever endure debilitating emotional stress because care providers are out of reach? If we ever needed a public and private sector solution to behavioral health disparities, this is the moment.
We are not unfamiliar with the attitude that can best be summed up as, “Well, I grew up with a violent parent but I turned out OK. You just gotta man up.” We don’t subscribe to this attitude of “fix yourself without help” that is not uncommon in some circles and with some lawmakers. Truly, why are we all not asking, “What is the root cause of behavioral health care disparities in the US and around the world?”
What this article is not
We wish to acknowledge up front that this is not an article on all the various forms of care that may be used to address behavioral health challenges. This is written to be useful information for people who believe all of us deserve mental health care. Each state confronts a diverse spectrum of people who need help in this area, from those that require long-term medical care and residential programs to those who would benefit from less intensive, short-term counseling that focuses on practical solutions to situational problems.
This is a blueprint for creating a countywide system of comprehensive behavioral health care in a variety of traditional, indigenous and experimental approaches. It’s a guide to ensuring that all residents have access to a community of compassionate people who find peace-of-mind and meaning in their lives by helping others.
While in this section, innovations focus on more “Western” approaches to behavioral health care, we also acknowledge the role of faith-based and other organizations that teach spiritual practices shown to create calm, stability and a sense of meaning. There are practices from civilizations both ancient and modern that contribute to mental health. We hope our readers explore them.
“Why don’t parents just call a therapist?”
Dubra Karnes-Padilla, who worked for many years at a college teaching health and wellness in New Mexico, shares, “The stories that faculty were hearing from students about their traumatizing life situations were heartbreaking, affecting the students’ mental and physical health. We weren’t equipped to handle the behavioral health issues we were encountering on campus. I advocated repeatedly to the campus leadership that a mental health counselor be hired to address our students’ needs, to keep our campus safe and help students succeed. Instead of a behavioral health counselor, I witnessed more security staff being hired.”
With data from the 100% New Mexico survey and other sources, you will learn from parents and youth where in your county behavioral health care access challenges exist and why. While global, national and state data are informative(and deeply troubling), the real data that informs your work are generated by your 100% New Mexico initiative and your deeper dive into the communities within your county borders. You may find that access issues are clustered in certain localized areas or across the entire county. The challenge may be bigger or smaller than you originally imagined.
We can’t stress enough that access to timely behavioral health care is a survival issue. In our 100% New Mexico initiative, we brand behavioral health care as one of our survival services. Simply put, untreated mental health challenges can drag down school performance, strain relationships and generally stand in the way of a good life for kids, parents and anybody else. Neglect, the main reason parents have their children taken into child protective services’ custody, may be the result of parents not being able to get medical or dental care for their child.
For those who wish to explore decades of research on the short and long term consequences of emotional trauma due to adverse childhood experiences, we recommend you start with the book Anna, Age Eight: The data-driven prevention of childhood trauma and maltreatment. The authors make the case of preventing ACEs before the adversity starts in the home, by ensuring all residents have access to trauma-informed behavioral health care.
Our best bet for addressing a host of health challenges is ensuring easy access to a quality, comprehensive health care system at an affordable price. We need not become the United Kingdom — where everything is free at the point of service — but we should make sure that parents don’t skip their (or their teen’s) behavioral health care because they can’t afford it.
Whose neighbors are hurting?
It won’t take much research to see the symptoms of mental health challenges in your county; look at rates of child maltreatment, suicides, sexual assault, domestic violence, DWI and assault. Add to that drug overdose numbers and health problems related to alcohol and other mind-altering substances. Finally, student and parent scores from the adverse childhood experience (ACEs) survey will provide a fairly complete picture of how local residents are doing on the mental health front. It would not be hyperbole to state we live within an epidemic of trauma.
What We Know
Our county survey will tell you why families struggle to access behavioral health care services and programs. Reasons include lack of programs, cost, no transport to programs, unaware of programs and unfriendly hours.
Who Lacks Care?
Mental health care disparities have many causes
With clinics, hospitals and telemedicine we have the tools for care yet disparities exist. In a nation this wealthy, it seems inconceivable that children, teens or adults in any state should suffer from lack of mental health care.
In fact, the reality on the ground has been, up to now, difficult to gauge when it comes to specifically measuring behavioral health care disparities in communities. Are lots of people roaming your downtown with untreated mental health challenges, unable to care for themselves or become self-sustaining? Are people slowly dying on the streets, due to lack of behavioral care across the USA? This is an important question, but the real question is, “What do health disparities look like?” Two girls skipping rope in a school yard may not conjure up images of emotional abuse from struggling parents due to lack of mental health care. However, we don’t know how long it’s been since each child, and their family members, had the opportunity to meet with a behavioral health care specialist. We don’t yet provide emotional health check ups in the schools, but given the epidemic rates of childhood trauma, we may wish to (assuming we have the capacity to address problems with school-based mental health care). We have no idea what type of emotional pain our students have been told to endure because behavioral health care is either too costly or too far away.
What percentage of people lacking access to timely care is acceptable to you and your elected leaders? How does a pandemic impact the question of how difficult access to care may be in both rural and urban communities? Would you be okay being told your mental health care requires waiting weeks or months to access? And if you do manage to see a professional, it’s only for a very short time. Should any child or parent, anywhere in your county, face barriers to needed care that could prevent abuse, neglect or trauma?
We ask: what are the root causes of mental health care disparities?
Why might we struggle to access affordable behavioral health care? It’s a complex picture, but let’s dive in and get the dialogue rolling.
- Lack of Health Insurance: In the United States, your health insurance varies depending on where you (or your spouse or parent) work, which means that every time employment or familial relationships are disrupted, so is health insurance. If you get a great new job or get married, you also get to deal with health insurance paperwork, and that’s the best case scenario. We also inflict this burdensome chore on those who were recently laid off and those who are getting divorced — even those fleeing an abusive relationship. Enrolling in health insurance, especially if you don’t get it through a job, can be cumbersome and complex. Inevitably, a certain percentage of the population won’t figure it out or won’t recognize that they really need to figure it out, limiting their access to behavioral health care. The soaring costs of purchasing even employer sponsored health insurance prevent many individuals and families from enrolling.
- Lack of comprehensive coverage: Health insurance isn’t always comprehensive, and behavioral health benefits are more limited than other kinds of care. Sometimes, you can get the care you need for a $5 copayment. Sometimes, you have to pay the full price until you hit your $6,000 deductible. It just depends on your plan. Those with less comprehensive plans, and not a lot of pocket money, are effectively shut out of the system.
- Inability to access: The people who need it most are often unable to pay for it, or lack the wherewithal to fill out the insurance paperwork. Teens running away from (or getting thrown out of) abusive homes, women fleeing abusive relationships, and those descending into addiction are unlikely to come to the system of their own accord; the system is not likely to find them either.
- Stigma: Lots of people still view mental health problems as a personal character weakness and think those afflicted should suck it up and deal. Not helping matters is the obvious fact that broken mental health is not as visible as broken physical health. Needless to say, this deters a lot of people from getting the help they need, even if the money or insurance situation allows it. Others don’t wish their employers to know about a mental health diagnosis, so won’t use their insurance to pay for mental health care.
- Lack of providers: In some areas, there are chronic shortages of mental health providers. If you have to make 10 calls just to find someone accepting new patients in order to make an appointment three months from now, access is effectively quite limited. Ditto if the provider works on the other side of a large city or in the next county over and you lack transportation. Also, the digital divide means that web-based care is not always available to many in rural and urban areas either because wifi is non existent or technology is not affordable.
- Lack of options: For the toughest cases, caseworkers don’t have the rapport that might lead people to get help and in the even tougher cases, they don’t have great options for forcing people to get help. Here we’re talking about severe mental illness, like the schizophrenic homeless guy who yells at nobody in particular while wandering around downtown. With a time machine, maybe we could go back before things got so out of hand and make sure he got into the sort of assisted residential situation he needed. Or with enough time and energy invested in building a rapport, we might be able to still get him there, but that’s an investment not a lot of local governments make (when local governments invest in mental health, they generally expect the patients to come to them). It’s also possible that his mental illness would prevent him from ever responding to such outreach, but even then, our options for getting him care are few. Unless he’s or she’s a danger to himself or others, authorities generally can’t intervene to force treatment on the theory that we all have the right to refuse medical treatment. Even when emergency care is mandated, it is usually of such short duration that it doesn’t help solve the problem. Whether this is good or bad policy is a subject on which reasonable people can disagree, but it does have the effect of putting our fragmented, hard-to-access system beyond the reach of the people who could really use it.
Data Guide Us
With data from the 100% New Mexico Survey and other sources, you will have a good idea about where in your county the need for mental health care services exist and why they are difficult to access for both parents or children. You may be surprised by your survey results and learn that a challenge is far bigger or smaller or more localized than originally thought.
Ensuring Services: A Local Challenge
People face different levels of hardship and risk during a pandemic directly related to their level of access to the 10 vital services for surviving and thriving. Inaccessible medical care, a lack of housing and food programs, and greatly increased joblessness during the associated economic downturn take a tremendous toll on families. It doesn’t have to be this way.
A Pandemic’s Impact on Services
Vital Questions Require Answers
In so-called “normal” times before the COVID-19 pandemic, health disparities were a fixture of our society. The pandemic has only increased the stresses on the health care systems as well as created more urgency for people to have timely access to prevention and treatment. The most pressing questions for your city, county and state elected leaders and stakeholders include:
- How do we collect, analyze and publish the most timely data to guide prevention strategies?
- How do we ensure enough COVID-19 tests and testing sites?
- How do we ensure providers have the protective equipment required to be safe?
- How do we ensure enough contact tracing?
- How do we prevent homelessness and hunger if people in lock down or quarantine lose their job?
- How do we strengthen mask-wearing and social distancing?
- How do we ensure treatment, both hospital beds and providers?
- How do we distribute the vaccine with buy-in from the public?
- How do we address depression and trauma by ensuring access to behavioral health care?
- How are vital family services for surviving and thriving made accessible to 100% of residents?
As you can see, question #10 places access to ten vital services into a comprehensive state and local strategy to prevent the pandemic. The 100% New Mexico initiative’s framework for ending barriers to services is vital and our work is urgently needed in each county. New Mexico State Senator Bill Soules, PhD, wrote in his Op-ed in the Las Cruces Sun News, “100% New Mexico: A model for COVID-19 Prevention and Treatment”:
“…an effective response to the pandemic goes beyond the medical sector. The countywide response required ten accessible services, allowing families to keep stabilized, supported, fed and housed, in order to comply with the state’s public health guidelines and to endure quarantining, isolating, social distancing and mask-wearing.”
Solutions Abound
We can happily report that many localities across the nation and globe have successfully prevented behavioral health disparities by ensuring universal access to care which may include a public sector solution or a combination of public and private sector solutions.
Where on earth?
WHERE ON EARTH HAS THIS CHALLENGE BEEN FIXED?
Behavioral Health Care@100% is looking at tested behavioral health solutions, focused on innovations, projects, policies and programs being implemented in large and small cities around the world.
If you have come this far, you know that ending untreated mental health care challenges starts with knowing the magnitude of the problem and where and why access to services is a problem and why access is a challenge for both youth and adults.
Our mental health relies on many factors. It ultimately depends on having access to caring people, both lay types like parents, friends, colleagues and teachers, as well as professionals. This means our solutions must go beyond fee-for-service providers. It’s up to all of us, and our elected leaders, to permanently end mental health disparities.
We present a challenge to you, and your local business people and government leaders: create a seamless countywide system of accessible behavioral health so untreated mental health challenges are history and every child, student, family and community can thrive.
Below, we offer only a sliver of the innovations that have been shown to reduce untreated mental health challenges. Some are quite new, thanks to changes in technology. They merit experimentation and evaluation. We do not lack for possible solutions, just the political will.
Three important frameworks
As we say in all ten sector chapters, we want to reference the data-driven framework called Continuous Quality Improvement and its four phases: assessment, planning, action and evaluation (100% Community, Chapter 29). This four-step process will guide your development of innovations in the arena of medical and dental care. And, as a reminder, you will want to use Collective Impact (100% Community, Chapter 31) to organize your project and Adaptive Leadership (100% Community, Chapter 30) to determine if the particular challenge you seek to solve is technical, with established protocols for moving forward, or adaptive, where you are entering new uncharted territory without a clear path.
Designing a Countywide System
The past: How did we get to this point of needing a family-friendly behavioral health care system? Who exactly needs services to be “family-friendly” anyway? What are the problems the system is supposed to solve? Why don’t people just figure out the systems on their own? Can’t everyone access care in a timely manner?
The present (action agenda): Within this subject, we’ve identified ten strategies — called innovation areas — that can be used to tackle the mental health health care access problem. Within those we suggest about twenty 100% New Mexico initiative projects that you (yes, you) can take on, thus propelling your community towards family-friendly health care in its many forms.
The future (goals): With enough work on these innovations/projects, we’ll get to the point where Innovation #10 — the creation of a City/County Department of Family-Friendly Behavioral Care — becomes a reality. With a state-of-the-art system of care in place, 100% of our county’s families (and all residents) could report excellent support and service.
Since we are currently in the present creating the future, your commitment to innovation is most eagerly sought and needed.
Partnerships and teamwork
At the heart of innovation are change agents implementing data-driven projects shown to fix barriers to services.
10 INNOVATIONS TO EXPLORE
CHANGE AGENTS NEEDED NOW
The following innovations represent strategies that have the capacity to increase access to food support programs to ensure our children are safe and successful.
As you will see as you explore Innovations #1–#10, a countywide system of food security engages all stakeholders within the county’s borders that include data specialists, the private sector, technology experts, public awareness specialists, educators, behavioral health care security program leaders, city mayors, council members and county commissioners. Your work will be groundbreaking as it unites leaders in all sectors to achieve one goal: Behavioral Health Care for 100%.
