Mental Health Systems Solutions Explorer

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• Public service announcements and public campaigns

  Messages in the public interest that are disseminated without charge to raise awareness about the importance of mental health and shift public attitudes and behaviors related to mental health stigma and treatment-seeking.

  Examples of this solution in action

  • California’s Each Mind Matters campaign
  • United Kingdom’s Time to Change campaign
  • Canada’s Bell Let’s Talk campaign
  • Australia’s Beyond Blue campaign

  Strategy

  Population-based mental health campaigns

  Broad initiatives—such as social marketing and mass media—to destigmatize and raise awareness about mental health issues.

  Topics

  • Help more people in need seek care
  • General mental health
  • Youth mental health

  Resources

  • National Academies of Sciences, Engineering, and Medicine, 2016 (pp. 79–92)
  • Corrigan, 2012
  • Niederkrotenthaler et al., 2014

• Target-population initiatives

  Messages tailored to vulnerable or high-risk populations for mental health needs (e.g., refugees) to raise awareness about the importance of mental health and to shift attitudes and behaviors related to mental health stigma and treatment-seeking.

  Examples of this solution in action

  • U.S. Army’s Breaking the Stigma initiative (see p. 170 of report)
  • Tell Your Story stigma reduction initiative for refugees
  • U.S. Public Health Service’s Asian Pacific American Officers Committee’s Healthy Mind Initiative

  Strategy

  Population-based mental health campaigns

  Broad initiatives—such as social marketing and mass media—to destigmatize and to raise awareness about mental health issues.

  Topics

  • Help more people in need seek care
  • General mental health
  • Serious mental illness
  • Substance use disorders
  • Suicide
  • Youth mental health

  Resources

  • American Psychiatric Association, undated
  • Eylem et al., 2020
  • Greene-Shortridge, Britt, and Castro, 2007

• Exposure-based initiatives

  Initiatives that teach about mental health, including by having someone who has experienced mental health issues share their experiences.

  Examples of this solution in action

  • National Alliance on Mental Illness’ (NAMI’s) Ending the Silence program
  • NAMI Provider training program

  Strategy

  Targeted educational initiatives on how to address mental health needs

  Training initiatives focused on specific populations—such as students, police officers, and first responders—to increase situational awareness when interacting with individuals who have mental health needs.

  Topics

  • Help more people in need seek care
  • General mental health
  • Youth mental health

  Resources

  • National Academies of Sciences, Engineering, and Medicine, 2016 (pp. 73–74)
  • Jorm, 2020
  • Mehta, et al., 2015

• School-based curricula

  Initiatives that teach children, adolescents, and young adults about the importance of mental health, treatment-seeking, and other issues in the context of school curricula.

  Examples of this solution in action

  • Mandatory mental health education laws
  • Johns Hopkins’ Adolescent Depression Awareness Program

  Strategy

  Targeted educational initiatives on how to address mental health needs

  Training initiatives focused on specific populations—such as students, police officers, and first responders—to increase situational awareness when interacting with individuals who have mental health needs.

  Topics

  • Help more people in need seek care
  • Youth mental health

  Resources

  • Salerno, 2016
  • Link et al., 2020
  • Wei et al., 2013
  • Perry et al., 2014

• Gatekeeper training

  Training for individuals, often in leadership roles, to identify people who are at high risk of mental health problems and refer them for treatment.

  Examples of this solution in action

  • Mental Health First Aid training for university students
  • National Council for Behavioral Health’s Mental Health First Aid at Work program
  • Youth Mental Health First Aid training in school settings
  • American Psychiatric Association Foundation’s “Notice.Talk.Act.™ at School” program

  Strategy

  Targeted educational initiatives on how to address mental health needs

  Training initiatives focused on specific populations—such as students, police officers, and first responders—to increase situational awareness when interacting with individuals who have mental health needs.

  Topics

  • Help more people in need seek care
  • General mental health
  • Youth mental health

  Resources

  • Morgan, Ross, and Reavley, 2018

• Embed mental health champions within existing institutions

  Professional advocates and point persons for advancing mental health care within institutions, including work settings.

  Examples of this solution in action

  • National Football League Director of Player Wellness
  • Britain’s Minister of Loneliness
  • Montana State University’s graduate student wellness champions

  Strategy

  Integrate mental health supports within the workplace

  Mental health education, screening, and treatment programs that extend beyond wellness programs and are embedded within workplace settings.

  Topics

  • Help more people in need seek care
  • General mental health
  • Employment

  Resources

  • Greenwood, Bapat, and Maughan, 2019
  • Staglin, 2019

• Workplace engagement in mental health support

  Programs and initiatives within the workplace, such as on-site employee assistance programs, that extend beyond wellness programs to provide employees with substantive tools, training, and resources for mental health supports.

  Examples of this solution in action

  • Prudential Financial (see section titled “Case Study—Prudential Financial”)
  • Boeing’s on-site employee assistance program (see p. 21)

  Strategy

  Integrate mental health supports within the workplace

  Mental health education, screening, and treatment programs that extend beyond wellness programs and are embedded within workplace settings.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Employment

  Resources

  • Goetzel et al., 2018
  • Willis Towers Watson, 2020 (search for “behavioral health” and “mental health”)
  • CDC, 2019
  • Kangasniemi, Maxwell, and Sereneo, 2019
  • Song and Baicker, 2019

• Workplace-based therapy (e.g., cognitive behavioral therapy)

  Provision of psychotherapy and other evidence-based practices within the workplace, with the inclusion of work-related goals for participants.

  Examples of this solution in action

  • Cognitive behavioral therapy implementation at Airedale NHS Foundation Trust in the United Kingdom

  Strategy

  Integrate mental health supports within the workplace

  Mental health education, screening, and treatment programs that extend beyond wellness programs and are embedded within workplace settings.

  Topics

  • Connect people seeking care with the best treatment
  • Employment

  Resources

  • Cullen et al., 2018
  • Reme et al., 2015

• First responder training

  Training for first responders, including police officers and emergency medical services technicians, to identify mental health symptoms and needs and how to intervene appropriately.

  Examples of this solution in action

  • Crisis Intervention Team training
  • Law Enforcement Assisted Diversion program
  • Gloucester, Mass., Angel Program
  • Boston, Mass., co-responder program

  Strategy

  Targeted educational initiatives on how to address mental health needs

  Training initiatives for focused populations—such as students, police officers, and first responders—to have greater situational awareness when interacting with individuals who have mental health needs.

  Topics

  • Connect people seeking care with the best treatment
  • Serious mental illness
  • Substance use disorders
  • Crisis mental health

  Resources

  • Pfefferle et al., 2019
  • National League of Cities, 2019 (see pp. 3 and 4 for sections on “First Responder-Provider Partnerships” and “First Responder-Led Referral Programs”)
  • President’s Task Force on 21st Century Policing, 2015 (see recommendation 4.3 on p. 44 and recommendation 5.6 on p. 56)

• Housing and homeless services

  Behavioral health outreach, screening, treatment and rehabilitation offered through housing and homeless services, often for individuals with serious mental illness.

  Examples of this solution in action

  • Projects for Assistance in Transition from Homelessness (PATH) grants
  • Medical Home for Homeless Children project

  Strategy

  Transitional assistance and supportive care

  Programs that serve vulnerable populations—such as the formerly incarcerated or the homeless—by establishing a direct link and coordinating contact with mental health systems.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Serious mental illness
  • Suicide
  • Homelessness

  Resources

  • SAMHSA, 2015 (see pp. 1-4 to 1-8)

• Diversion programs in medical settings

  Medical programs, often within emergency departments, that rapidly screen individuals with acute mental health needs and divert these individuals in a timely manner to an appropriate level of care (e.g., a 24/7 crisis center).

  Examples of this solution in action

  • Alameda County, Calif., model
  • Center for Medicare and Medicaid Innovation’s Emergency Triage, Treat, and Transport (ET3) model

  Strategy

  Diversion programs

  Initiatives in which people with mental illness are redirected from a less appropriate care setting (e.g., emergency room, jail) to a more appropriate care setting.

  Topics

  • Connect people seeking care with the best treatment
  • Serious mental illness
  • Suicide
  • Crisis mental health

  Resources

  • Nordstrom et al., 2019
  • Laderman et al., 2018

• Postarrest diversion programs in criminal justice settings

  Criminal justice system programs in which offenders are connected with behavioral health services postarrest (e.g., pretrial or instead of being booked for low-level offenses) to help remedy the behavior leading to the original arrest and/or conviction.

  Examples of this solution in action

  • Intervention Program for Substance Abusers in Montgomery County, Md.

  Strategy

  Diversion programs

  Initiatives in which people with mental illness are redirected from a less appropriate care setting (e.g., emergency room, jail) to a more appropriate care setting.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Incarceration

  Resources

  • Abreu et al., 2017
  • Honegger, 2015
  • Tanner-Smith, Lipsey, and Wilson, 2016
  • Bonfine, Wilson, and Munetz, 2020

• Prison-to-community transition programs

  Interventions aimed at improving outcomes for individuals leaving prison who have mental health conditions, often by enrolling individuals in Medicaid and connecting them to mental health resources and supports at release.

  Examples of this solution in action

  • Oklahoma Medicaid discharge planning program
  • Washington State’s Mentally Ill Offender Community Transition Program

  Strategy

  Transitional assistance and supportive care

  Programs that serve vulnerable populations—such as the formerly incarcerated or the homeless—by establishing a direct link and coordinating contact with mental health systems.

  Topics

  • Connect people seeking care with the best treatment
  • Serious mental illness
  • Incarceration

  Resources

  • Hopkin et al., 2018
  • Mallik-Kane and Visher, 2008

• Mental health assessment through child welfare services

  Administration of mental health screeners and diagnostic tools for children receiving child welfare services.

  Examples of this solution in action

  • Los Angeles County’s interagency collaboration to screen children in welfare involved with the child welfare system
  • Project Focus Colorado caseworker training on screening children

  Strategy

  Expand screenings to identify mental health needs

  Screenings for mental health conditions that take place in settings outside the mental health system, such as schools, churches, and primary care.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Youth mental health
  • Crisis mental health

  Resources

  • Lahti et al., 2018
  • Levitt, 2009 (pp. 27–49)

• Mental health screenings in primary care

  Administration of mental health screeners, such as the Patient Health Questionnaire-9 (PHQ-9), in the context of individuals’ primary care.

  Examples of this solution in action

  • SAMHSA’s national Screening, Brief Intervention, and Referral to Treatment (SBIRT) program
  • Collaborative Care Model

  Strategy

  Expand screenings to identify mental health needs

  Screenings for mental health conditions that take place in settings outside the mental health system, such as schools, churches, and primary care.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Depression and anxiety

  Resources

  • Siu and U.S. Preventive Services Task Force (USPSTF), 2016
  • Akincigil and Matthews, 2017

• Community-based mental health screenings

  Administration of mental health screeners, such as the PHQ-9, in nonmedical community-based settings, such as places of worship.

  Examples of this solution in action

  • New York’s Connections to Care (C2C) initiative
  • Church-based screening
  • REACH NOLA Mental Health Infrastructure and Training Project
  • Maternal, Infant, and Early Childhood Home Visiting Program

  Strategy

  Expand screenings to identify mental health needs

  Screenings for mental health conditions that take place in settings outside the mental health system, such as schools, churches, and primary care.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Depression and anxiety
  • Suicide

  Resources

  • Westfall et al., 2020

• School-based mental health screenings

  Administration of mental health screeners, such as the PHQ-9, in schools and universities.

  Examples of this solution in action

  • Youth Mental Health First Aid training program
  • American Psychiatric Association Foundation’s “Notice.Talk.Act.™ at School” program

  Strategy

  Expand screenings to identify mental health needs

  Screenings for mental health conditions that take place in settings outside the mental health system, such as schools, churches, and primary care.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Youth mental health

  Resources

  • SAMHSA, 2019
  • Anderson et al., 2019
  • Soneson et al., 2020

• Phone apps and internet-based screening and prevention

  Availability of mental health screeners, such as the PHQ-9, for self-administration through phone apps or online.

  Examples of this solution in action

  • Mental Health America screening tools
  • University of Washington online screening

  Strategy

  Expand screenings to identify mental health needs

  Screenings for mental health conditions that take place in settings outside the mental health system, such as schools, churches, and primary care.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Substance use disorders
  • Crisis mental health

  Resources

  • Kim et al., 2011

• Financial incentives for mental health screening

  Programs that incentivize mental health screenings for vulnerable and underserved populations.

  Examples of this solution in action

  • Opportunity NYC–Family Rewards conditional cash transfer program
  • Medicare’s free Annual Wellness Visit
  • Medicaid Healthy Behavior Incentive Programs

  Strategy

  Expand screenings to identify mental health needs

  Screenings for mental health conditions that take place in settings outside the mental health system, such as schools, churches, and primary care.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Depression and anxiety
  • Substance use disorders
  • Suicide

  Resources

  • Bradley and Neumark, 2017
  • Lagarde, Haines, and Palmer, 2009
  • Commonwealth Fund, undated
  • Medicaid and CHIP Payment and Access Commission, 2016

• Population-based mental health screenings

  Broad scale initiatives to identify individuals with mental health needs through biomarkers, health information exchange and data mining, and other techniques.

  Examples of this solution in action

  • Biomarker screening tool for PTSD in veterans
  • Machine learning–based depression screening using Indiana health information exchange data
  • Certified Community Behavioral Health Clinics’ wide reach and partnerships (see pp. 10 and 11)

  Strategy

  Expand screenings to identify mental health needs

  Screenings for mental health conditions that take place in settings outside the mental health system, such as schools, churches, and primary care.

  Topics

  • Connect people seeking care with the best treatment
  • General mental health
  • Serious mental illness
  • Depression and anxiety

  Resources

  • Venkatasubramanian and Keshavan, 2016
  • Vest and Gamm, 2010
  • Foney, Mace, and Boccanelli, 2019 (see pp. 10 and 11)

• Federal legislation to cover more people

  Legislation passed by U.S. Congress with the intention of expanding the number of beneficiaries on insurance that covers mental health services.

  Examples of this solution in action

  • Affordable Care Act

  Strategy

  Expand eligibility for publicly subsidized insurance

  Legislation at the federal and state levels that expands mental health care coverage to more individuals or otherwise enhances mental health coverage among those already insured.

  Topics

  • Help make care more affordable for patients
  • General mental health

  Resources

  • Saloner et al., 2017
  • Olfson et al., 2018
  • Mechanic, 2017
  • Sommers et al., 2015

• State legislation to cover more people

  Legislation passed by states with the intention of expanding the number of beneficiaries on insurance that covers mental health services.

  Examples of this solution in action

  • Medicaid expansion in states

  Strategy

  Expand eligibility for publicly subsidized insurance

  Legislation at the federal and state levels that expands mental health care coverage to more individuals or otherwise enhances mental health coverage among those already insured.

  Topics

  • Help make care more affordable for patients
  • General mental health
  • Suicide

  Resources

  • Guth et al., 2020 (see pp. 9 and 16 for discussion of impact on behavioral health and state savings in spending)
  • Dey et al., 2016
  • Kravitz-Wirtz et al., 2020
  • Sharp et al., 2018
  • U.S. Government Accountability Office, 2017

• Federal legislation to enhance insurance benefits

  Legislation passed by U.S. Congress with the intention of expanding the depth of mental health services coverage for existing beneficiaries.

  Examples of this solution in action

  • Mental Health Parity and Addiction Equity Act of 2008

  Strategy

  Improve coverage for mental health conditions by insurance products

  Efforts to strengthen requirements for public and commercial payers to cover behavioral health care services.

  Topics

  • Help make care more affordable for patients
  • General mental health

  Resources

  • Ettner et al., 2016
  • Harwood et al., 2017
  • Frank, 2017
  • Haffajee et al., 2019

• Enhanced mental health coverage in Medicaid

  Policymaking with the intention of expanding the depth of mental health services coverage for existing beneficiaries.

  Examples of this solution in action

  • Certified Community Behavioral Health Clinics’ cost-based payment model
  • Washington, D.C.’s institution for mental diseases exclusion waiver

  Strategy

  Improve coverage for mental health conditions by insurance products

  Efforts to strengthen requirements for public and commercial payers to cover behavioral health care services.

  Topics

  • Help make care more affordable for patients
  • General mental health
  • Incarceration
  • Youth mental health

  Resources

  • Mark et al., 2020
  • Bishop et al., 2014
  • Musumeci, Chidambaram, and Orgera, 2019
  • Miller and Sandoe, 2019

• Limitations on out-of-pocket payments, deductibles, and copayments

  Insurance regulations that limit the amount of financial risk and liabilities borne by patients.

  Examples of this solution in action

  • Annual out-of-pocket caps under the H.R.3 Elijah E. Cummings Lower Drug Costs Now Act, bipartisan Senate Prescription Drug Pricing Reduction Act of 2019, and Trump administration’s fiscal year 2020 budget

  Strategy

  Improve coverage for mental health conditions by insurance products

  Efforts to strengthen requirements for public and commercial payers to cover behavioral health care services.

  Topics

  • Help make care more affordable for patients
  • General mental health

  Resources

  • Trish, Xu, and Joyce, 2018
  • Barry, Goldman, and Huskamp, 2016
  • Roy, 2019
  • Lambregts and Van Vliet, 2018

• Enforced network adequacy through regulation

  Regulations that support mental health parity by ensuring that insurers have in-network coverage that is adequate and comparable to in-network coverage for physical health conditions.

  Examples of this solution in action

  • Multiple states’ adoption of three quantitative measures of network adequacy: geographic distance, wait time, and provider-enrollee ratio (see p. 7)
  • “Don’t Deny Me” campaign for equal access to mental health and addiction treatment services
  • Proposal for CMS to require states to implement static and dynamic network adequacy measures
  • New Hampshire’s in-depth investigation into compliance with parity requirements related to network adequacy

  Strategy

  Improve coverage for mental health conditions by insurance products

  Efforts to strengthen requirements for public and commercial payers to cover behavioral health care services.

  Topics

  • Help make care more affordable for patients

  Resources

  • Legal Action Center, 2020
  • Hall and Ginsburg, 2017
  • Melek, Davenport, and Gray, 2019

• Legal enforcement for noncompliance with existing statutes

  Legal action, including injunctions issued by state and federal courts, mandating that public and private providers are in compliance with such statutes as the Mental Health Parity and Addiction Equity Act and Americans with Disabilities Act.

  Examples of this solution in action

  • Wit v. United Behavioral Health
  • Massachusetts attorney general’s behavioral health parity agreements
  • Danny P. v. Catholic Health Initiatives

  Strategy

  Improve coverage for mental health conditions by insurance products

  Efforts to strengthen requirements for public and commercial payers to cover behavioral health care services.

  Topics

  • Help make care more affordable for patients

  Resources

  • Appelbaum and Parks, 2019

• Oversight and monitoring of nonquantitative treatment limits

  Investigations of, and associated responses to, nonquantitative treatment limits, which are criteria (e.g., prior authorization) that are posed by insurers and that curb patients’ access to mental health services.

  Examples of this solution in action

  • Illinois Department of Insurance’s fines against insurers for violating nonquantitative treatment limitation (NQTL) restrictions
  • Rhode Island’s intensive investigation into NQTL compliance (see p. 7)
  • Multiple states’ workbooks, checklists, and templates to ensure NQTL compliance

  Strategy

  Improve coverage for mental health conditions by insurance products

  Efforts to strengthen requirements for public and commercial payers to cover behavioral health care services.

  Topics

  • Help make care more affordable for patients
  • General mental health

  Resources

  • Peterson and Busch, 2018
  • Mental Health and Substance Use Disorder Parity Task Force, 2016

• Improved accuracy of network directories

  Mechanisms, such as legislation and regulation (in addition to private industry efforts), that aim to improve the accuracy of network directory information.

  Examples of this solution in action

  • Federal legislation to improve directory accuracy
  • California Symphony Provider Directory

  Strategy

  Improve coverage for mental health conditions by insurance products

  Efforts to strengthen requirements for public and commercial payers to cover behavioral health care services.

  Topics

  • Help make care more affordable for patients
  • General mental health

  Resources

  • Busch and Kyanko, 2020
  • Williams et al., 2017

• Charge-price-transparency regulation

  Regulations that increase the transparency of medical service prices for consumers.

  Examples of this solution in action

  • HHS rules making hospital charges more transparent
  • Online price transparency tools

  Strategy

  Lower cost of health insurance to consumers

  Changes to state and federal health insurance that would make health insurance more accessible by lowering its costs.

  Topics

  • Help make care more affordable for patients
  • General mental health

  Resources

  • Christensen, Floyd, and Maffett, 2020
  • Reinhardt, 2013
  • Whaley, 2019

• Increased negotiation of prices for medications

  Improving competition by allowing insurers, providers and patients to negotiate the price of medicines with vendors.

  Examples of this solution in action

  • Congressional bills to enable drug price negotiation for Medicare Part D

  Strategy

  Lower cost of health insurance to consumers

  Changes to state and federal health insurance that would make health insurance more accessible by lowering its costs.

  Topics

  • Help make care more affordable for patients
  • General mental health

  Resources

  • National Academy of Social Insurance, 2015

• Targeted or broad-based price regulation

  Regulations that set a ceiling or establish stipulations on the prices that can be charged for goods and services.

  Examples of this solution in action

  • Proposed cap on prices and price growth in the commercial health care market
  • Maryland’s all-payer model for hospital payment

  Strategy

  Lower cost of health insurance to consumers

  Changes to state and federal health insurance that would make health insurance more accessible by lowering its costs.

  Topics

  • Help make care more affordable for patients
  • General mental health

  Resources

  • Altman and Mechanic, 2018
  • National Academy of Social Insurance, 2015
  • Barber, Lorenzoni, and Ong, 2019

• Subsidized educational opportunities

  Mechanisms, such as scholarships and loan forgiveness, that lower the cost of training for prospective mental health professionals.

  Examples of this solution in action

  • National Health Service Corps education loan repayment awards
  • National Health Service Corps Substance Use Disorder Workforce Loan Repayment Program
  • Community Behavioral Health Academy for licensed clinical social workers and licensed clinical addiction counselors
  • Virginia Health Care Foundation “Make Life Great!” Scholarship Program for psychiatric nurse practitioners
  • Minnesota Mental Health Care Loan Forgiveness program for urban health professional shortage areas

  Strategy

  Stimulate mental health workforce entry

  A broad array of efforts—including financial incentives, nonfinancial incentives, diversification, and capacity-building strategies—to encourage more individuals to be trained as mental health professionals.

  Topics

  • Help increase care system capacity
  • General mental health
  • Rural mental health

  Resources

  • Olfson, 2016 (see p. 985)

• Higher reimbursement rates

  Elevated levels of compensation for provision of mental health services, particularly the services that generate the most value to patients.

  Examples of this solution in action

  • New Mexico’s increased Medicaid payments
  • Health Professional Shortage Area Physician Bonus Program
  • Reimbursement for evidence-based practices, such as collaborative care
  • Mental Health Parity and Addiction Equity Act and state parity laws

  Strategy

  Stimulate mental health workforce entry

  A broad array of efforts—including financial incentives, nonfinancial incentives, diversification, and capacity-building strategies—to encourage more individuals to be trained as mental health professionals.

  Topics

  • Help increase care system capacity
  • General mental health

  Resources

  • American Hospital Association, 2016 (see second bullet point on p. 8)

• Enhanced attractiveness of entry-level workforce posts

  Reforms that make entry-level jobs—such as peer support counselors and home health aides—more attractive, including better wages, career ladders, and work schedule flexibility.

  Examples of this solution in action

  • Peer provider career advancement programs in Arizona, Georgia, Texas, and Pennsylvania
  • Mental Health America’s National Certified Peer Specialist Certification

  Strategy

  Stimulate mental health workforce entry

  A broad array of efforts—including financial incentives, nonfinancial incentives, diversification, and capacity-building strategies—to encourage more individuals to be trained as mental health professionals.

  Topics

  • Help increase care system capacity
  • General mental health

  Resources

  • SAMHSA, undated (Recruitment and Retention Toolkit)
  • Gattman et al., 2017
  • Gilsdorf, Hanleybrown, and Laryea, 2017

• Expanded diversity of the behavioral health workforce

  Efforts to enhance the diversity of the mental health workforce, including by increasing the representation of minorities, such as African Americans and Latinx Americans.

  Examples of this solution in action

  • American Psychiatric Association’s Workforce Inclusion Pipeline Programs
  • SAMHSA’s Minority Fellowship Program
  • University of Cincinnati’s comprehensive efforts to diversify pipeline for nursing graduates (see “College of Nursing” section)

  Strategy

  Stimulate mental health workforce entry

  A broad array of efforts—including financial incentives, nonfinancial incentives, diversification, and capacity-building strategies—to encourage more individuals to be trained as mental health professionals.

  Topics

  • Help increase care system capacity
  • General mental health

  Resources

  • Buche, Beck, and Singer, 2017
  • Lokko et al., 2016

• Increased institutional capacity for training

  Support for institutions to train more prospective members of the mental health workforce and to provide more-comprehensive curricula to equip the entering workforce to meet the needs of patients.

  Examples of this solution in action

  • Teaching Health Center Graduate Medical Education program
  • University of California, San Francisco’s online certification program to expand training capacity for psychiatric mental health nurse practitioners

  Strategy

  Stimulate mental health workforce entry

  A broad array of efforts—including financial incentives, nonfinancial incentives, diversification, and capacity-building strategies—to encourage more individuals to be trained as mental health professionals.

  Topics

  • Help increase care system capacity
  • General mental health

  Resources

  • National Council Medical Director Institute, 2017 (see recommendations 9 and 10 on pp. 46–47)

• Federal funding for high-need positions

  Allocation of federal funds to aid local (often public) health systems with addressing understaffing in key positions, such as psychiatrists, psychologists, and social workers.

  Examples of this solution in action

  • States’ use of Mental Health Block Grant set-aside funds for first episode psychosis to support provider salaries
  • Alabama’s use of State Targeted Response to the Opioid Crisis and State Opioid Response grants to increase recovery support specialists

  Strategy

  Redistribute existing mental health workforce

  Funding and incentives to reallocate the existing mental health workforce to underserved communities.

  Topics

  • Help increase care system capacity
  • General mental health

  Resources

  • Lewis et al., 2019 (see “Survey Highlights” section)

• Redistribution to underserved areas and populations

  Programs that recruit members of the mental health workforce to serve in underrepresented communities, including health provider shortage areas.

  Examples of this solution in action

  • Behavioral Health Education Center of Nebraska’s Ambassador Program
  • New Mexico’s Rural Health Care Practitioner Tax Credit
  • Minnesota’s mental health care loan forgiveness program for urban health professional shortage areas
  • National Health Service Corps loan repayment awards

  Strategy

  Redistribute existing mental health workforce

  Funding and incentives to reallocate the existing mental health workforce to underserved communities.

  Topics

  • Help increase care system capacity
  • General mental health

  Resources

  • Baum and King, 2020
  • MacQueen et al., 2018

• Specialist training to nonspecialists

  Learning models in which professionals with specialized competencies (e.g., psychiatrists) provide mentorship and education to those without this specialization (e.g., internists)

  Examples of this solution in action

  • Project ECHO mental health training for nonspecialists

  Strategy

  Training nonspecialists and enabling specialists to work at the top of their capability

  Training, certification, regulations, and restructuring efforts to strengthen nonspecialists’ ability to support mental health needs and specialists’ ability to provide care to the most complex cases.

  Topics

  • Help increase care system capacity
  • Serious mental illness
  • Suicide
  • Youth mental health
  • Elderly care

  Resources

  • McBain et al., 2019
  • Wicklund, 2019
  • University of New Mexico, 2020

• Expanded scope of practice for members of the entry-level mental health workforce

  Expansion of the procedures, actions, and processes that a health care provider is permitted to undertake in accordance with their professional license or certification.

  Examples of this solution in action

  • Illinois’s law allowing psychologists to prescribe
  • Increased scope of practice for multiple states

  Strategy

  Training nonspecialists and enabling specialists to work at the top of their capability

  Training, certification, regulations, and restructuring efforts to strengthen nonspecialists’ ability to support mental health needs and specialists’ ability to provide care to the most complex cases.

  Topics

  • Help increase care system capacity
  • General mental health
  • Suicide

  Resources

  • POLITICO, 2016 (see “Policy Question 2: Should psychologists be allowed to prescribe?” in particular)
  • Chapman, Toretsky, and Phoenix, 2019
  • Scope of Practice Policy, undated

• Mental health training for mental health–adjacent professions

  Programs that equip individuals (such as college resident assistants and child welfare professionals) to identify signs and symptoms of psychological distress and respond appropriately.

  Examples of this solution in action

  • Peer Hero Training program for resident assistants to provide aid for behavioral health problems
  • Cognitive behavioral therapy training for community practitioners

  Strategy

  Training nonspecialists and enabling specialists to work at the top of their capability

  Training, certification, regulations, and restructuring efforts to strengthen nonspecialists’ ability to support mental health needs and specialists’ ability to provide care to the most complex cases.

  Topics

  • Help increase care system capacity
  • Serious mental illness
  • Youth mental health
  • Crisis mental health
  • Homelessness

  Resources

  • Booth et al., 2017

• Support for providers to function at the top of their license

  Institutional arrangements that allow providers to serve at their highest capacity by strategically allocating certain roles and responsibilities among other personnel.

  Examples of this solution in action

  • Atrium Health’s telehealth model employing providers at the top of their license

  Strategy

  Training nonspecialists and enabling specialists to work at the top of their capability

  Training, certification, regulations, and restructuring efforts to strengthen nonspecialists’ ability to support mental health needs and specialists’ ability to provide care to the most complex cases.

  Topics

  • Help increase care system capacity
  • General mental health

  Resources

  • National Council Medical Director Institute, 2017 (see “Expanding Workforce of Other Providers” on p. 31 and “Adequate Staff Support to Increase Psychiatrist Efficiency” on p. 33)
  • Joshi et al., 2014

• Standardization and reciprocal recognition of certification and licensing

  Efforts to harmonize the competencies for the certification and licensing of providers at state and federal levels and to allow reciprocal arrangements for certification in one state to be deemed suitable in another state.

  Examples of this solution in action

  • National Certified Peer Recovery Support Specialist credential
  • Multiple interstate compacts and model laws (see pp. 8–17)
  • HRSA Licensure Portability Program

  Strategy

  Training nonspecialists and enabling specialists to work at the top of their capability

  Training, certification, regulations, and restructuring efforts to strengthen nonspecialists’ ability to support mental health needs and specialists’ ability to provide care to the most complex cases.

  Topics

  • Help increase care system capacity
  • General mental health

  Resources

  • Page et al., 2017
  • National Council Medical Director Institute, 2017 (see “Expanding Workforce of Other Providers” on p. 31)
  • Federal Trade Commission, 2018

• Improved risk adjustment and risk-adjusted payment

  Advanced algorithms and weighting schemes that determine allotted payments according to the severity of an individual’s underlying health status and the value of services for improving patient outcomes.

  Examples of this solution in action

  • Certified Community Behavioral Health Clinics’ risk-adjusted monthly rate (see p. 1)
  • Anell, Dackehag, and Dietrichson, 2018
  • Montz et al., 2016
  • MoodGYM cognitive behavioral therapy program for depression

  Strategy

  Stimulate mental health workforce entry

  A broad array of efforts—including financial incentives, nonfinancial incentives, diversification, and capacity-building strategies—to encourage more individuals to be trained as mental health professionals.

  Topics

  • Help increase care system capacity
  • General mental health
  • Serious mental illness

  Resources

  • Shrestha et al., 2018 (only introduction is relevant)

• Reforms to behavioral health system infrastructure

  Modernization of mental health system infrastructure, including the arrangement and distribution of facilities and beds, the composition of services provided, and digital health resources.

  Examples of this solution in action

  • Worcester Recovery Center and Hospital (see “A Way Forward” section on p. 244)
  • USDA’s Rural Development Investments to support telehealth (see p. 5 and “Financing and Support for Infrastructure Development” section on p. 13)

  Strategy

  Reorganize mental health services

  Redesign mental health infrastructure—in communities, schools, businesses, and elsewhere—to improve access to care.

  Topics

  • Help increase care system capacity
  • General mental health
  • Serious mental illness
  • Rural mental health

  Resources

  • Pinals and Fuller, 2020
  • La et al., 2016
  • Ranallo et al., 2016

• Mental health treatment and wellness apps

  Smartphone applications that provide therapeutic benefits to those with mental health needs.

  Examples of this solution in action

  • Talkspace app
  • Calm mindfulness app
  • American Psychiatric Association’s App Advisor initiative

  Strategy

  Increase uptake of digital health care

  A diversity of technology-based mediums (telephone, computer, internet, apps, wearables) to extend and automate access to mental health services and supports.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Depression and anxiety
  • Substance use disorders

  Resources

  • Weisel et al., 2019
  • Jayawardene et al., 2017
  • Chandrashekar, 2018
  • App Evaluation Database (Division of Digital Psychiatry at Beth Israel Deaconess Medical Center, undated)
  • Webb, Rosso, and Rauch, 2017

• Telehealth services

  Use of telecommunications technology by health care professionals to provide behavioral health care remotely.

  Examples of this solution in action

  • Wyoming Trauma Telehealth Treatment Clinic
  • Department of Veterans Affairs’ Accessing Telehealth through Local Area Stations program

  Strategy

  Increase uptake of digital health care

  A diversity of technology-based mediums (telephone, computer, internet, apps, wearables) to extend and automate access to mental health services and supports.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Youth mental health
  • Rural mental health
  • Elderly care

  Resources

  • Langarizadeh et al., 2017

• Training for digital health

  Training for current and future behavioral health providers in providing high-quality telehealth services.

  Examples of this solution in action

  • Department of Veterans Affairs Puget Sound Health Care System’s telemental health training program
  • University of Hawaii’s child and adolescent psychiatry telemental health program
  • American Psychological Association’s Continuing Education resources on telehealth
  • Uniformed Services University of the Health Sciences’ telehealth training for medical students

  Strategy

  Increase uptake of digital health care

  A diversity of technology-based mediums (telephone, computer, internet, apps, wearables) to extend and automate access to mental health services and supports.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Rural mental health

  Resources

  • Slovensky, Malvey, and Neigel, 2017
  • Guerrero et al., 2019
  • Colbow, 2013
  • Saeed et al., 2017

• Expanded reimbursement for digital health

  Increased compensation for provision of remote care to incentivize providers to routinely offer this type of care as an alternative to in-person care.

  Examples of this solution in action

  • State actions to expand telehealth in response to COVID-19 (see “Telehealth” within “SPA and Other Administrative Actions to Address COVID-19” table)
  • Commercial payers’ telemental health reimbursement changes in response to COVID-19
  • Medicare’s expansion of telehealth reimbursement in response to COVID-19

  Strategy

  Increase uptake of digital health care

  A diversity of technology-based mediums (telephone, computer, internet, apps, wearables) to extend and automate access to mental health services and supports.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Rural mental health

  Resources

  • Warren and Smalley, 2020
  • American Psychological Association, 2020
  • Lepkowsky, 2020
  • Shachar et al., 2020

• Increased use of medical wearables

  Electronic devices that consumers can wear, such as smart watches and biosensors, that provide real-time feedback about an individual’s health status or that can deliver or assist treatment.

  Examples of this solution in action

  • Feel, an emotion-sensing wristband
  • Pivot, a breathalyzer-based smoking cessation program
  • Muse, a meditation assistance headband
  • Flow, a direct-current therapy headband for depression

  Strategy

  Increase uptake of digital health care

  A diversity of technology-based mediums (telephone, computer, internet, apps, wearables) to extend and automate access to mental health services and supports.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Serious mental illness
  • Depression and anxiety

  Resources

  • Reinertsen and Clifford, 2018
  • Mohr, Zhang, and Schueller, 2017
  • O’Hara, 2019

• School-based mental health services: K–12

  Provision of mental health education, screening and services in school-based settings for children and adolescents in kindergarten through 12th grade.

  Examples of this solution in action

  • Safe Schools/Healthy Students Initiative
  • Mental Health in Schools Act
  • Increasing Access to Mental Health in Schools Act
  • University of Michigan’s TRAILS program training school professionals in cognitive behavioral therapy and mindfulness

  Strategy

  Reorganize mental health services

  Redesigned mental health infrastructure—in communities, schools, businesses, and elsewhere—to improve access to care.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Suicide
  • Youth mental health

  Resources

  • Brueck, 2016
  • Sanchez et al., 2018
  • Hess et al., 2017

• School-based mental health services: colleges and universities

  Provision of mental health education, screening and services in school-based settings for adolescents and adults in colleges and universities.

  Examples of this solution in action

  • University of Pennsylvania’s improvement of counseling wait times
  • Drexel University’s screening kiosks

  Strategy

  Reorganize mental health services

  Redesigned mental health infrastructure—in communities, schools, businesses, and elsewhere—to improve access to care.

  Topics

  • Help make care more accessible for patients
  • General mental health

  Resources

  • Lipson et al., 2019
  • Prince, 2015
  • Champlin, 2019

• Behavioral health urgent care clinics

  Facilities that individuals experiencing a mental health crisis can turn to for services during hours when a typical health facility would be closed, such as on evenings and weekends.

  Examples of this solution in action

  • Alliance Health’s urgent care services
  • Brigham and Women’s Hospital’s urgent care services

  Strategy

  Reorganize mental health services

  Redesigned mental health infrastructure—in communities, schools, businesses, and elsewhere—to improve access to care.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Crisis mental health

  Resources

  • Sunderji, Tan de Bibiana, and Stergiopoulos, 2015

• Behavioral health integration with primary care

  The integration of mental health services into primary care settings, either through colocation or collaborative agreements.

  Examples of this solution in action

  • University of Washington’s Behavioral Health Integration Program
  • Certified Community Behavioral Health Clinics

  Strategy

  Integrate mental health care into the broader health system

  Care delivery systems in which mental health services are provided in settings that address conditions other than mental health conditions, including physical health conditions and substance use disorders.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Serious mental illness
  • Depression and anxiety
  • Youth mental health

  Resources

  • Ramanuj et al., 2019
  • Bradford et al., 2013
  • Page et al., 2019
  • Vogel et al., 2017

• Behavioral health integration with substance use treatment facilities

  The integration of mental health services into substance use treatment settings (and vice versa), either through colocation or collaborative agreements.

  Examples of this solution in action

  • New York’s Center for Excellence in Integrated Care
  • Certified Community Behavioral Health Clinics

  Strategy

  Integrate mental health care into the broader health system

  Care delivery systems in which mental health services are provided in settings that address conditions other than mental health conditions, including physical health conditions and substance use disorders.

  Topics

  • Help make care more accessible for patients
  • General mental health
  • Suicide

  Resources

  • Kelly and Daley, 2013
  • Hartzler, 2017

• Increased patient control of data

  Systems that permit patients to easily review their electronic medical records (as documented by providers) and to electronically transport this information among providers and health systems.

  Examples of this solution in action

  • HHS rules promoting patient control of data

  Strategy

  Enhance patient-centeredness of care

  Models of care delivery and system design that are more appealing to prospective mental health patients and encourage their participation in the care delivery process.

  Topics

  • Help enhance patients’ experiences
  • General mental health

  Resources

  • Mandl and Kohane, 2016
  • Savage, Neinstein, and Adler-Milstein, 2020
  • Druss et al., 2020

• Culturally and linguistically competent care

  The capacity of health systems to provide care that responds effectively to the cultural and linguistic needs of patients.

  Examples of this solution in action

  • Certified Community Behavioral Health Clinic criteria for cultural competence
  • CRASH cultural competency training model

  Strategy

  Enhance patient-centeredness of care

  Models of care delivery and system design that are more appealing to prospective mental health patients and encourage their participation in the care delivery process.

  Topics

  • Help enhance patients’ experiences
  • General mental health

  Resources

  • SAMHSA, 2014
  • Gilmer et al., 2017
  • Ng et al., 2017

• Novel modes of provider-patient communication

  New venues through which providers and patients can engage one another, such as text messaging and patient portals.

  Examples of this solution in action

  • Supportive text messaging to complement cognitive behavioral therapy
  • Enhanced outreach at South Boston Community Health Center
  • Messaging through a patient portal

  Strategy

  Enhance patient-centeredness of care

  Models of care delivery and system design that are more appealing to prospective mental health patients and encourage their participation in the care delivery process.

  Topics

  • Help enhance patients’ experiences
  • General mental health

  Resources

  • Parish et al., 2017 (see second half of “Technology and Provider-Patient Rapport” section on p. 90)

• Interventions to support caregivers

  Ways that the health system can support caregivers who are providing for the needs of someone with a mental health condition.

  Examples of this solution in action

  • National Family Caregiver Support Program
  • National Alliance on Mental Illness Family-to-Family Education Program

  Strategy

  Enhance patient-centeredness of care

  Models of care delivery and system design that are more appealing to prospective mental health patients and encourage their participation in the care delivery process.

  Topics

  • Help enhance patients’ experiences
  • Serious mental illness
  • Elderly care

  Resources

  • Coulombe et al., 2018
  • Sin et al., 2017

• Shared decisionmaking

  A process in which patients and providers work together to make health decisions that support patient goals and preferences.

  Examples of this solution in action

  • DECIDE interventions promoting shared decisionmaking in Massachusetts
  • CommonGround computer program supporting shared decisionmaking

  Strategy

  Enhance patient-centeredness of care

  Models of care delivery and system design that are more appealing to prospective mental health patients and encourage their participation in the care delivery process.

  Topics

  • Help enhance patients’ experiences
  • General mental health

  Resources

  • Langer, Mooney, and Wills, 2015
  • Chu et al., 2019
  • Lovell et al., 2018
  • Guidry-Grimes, 2020

• Incentives for evidence-based practices that address gaps in care and social needs

  Financial and nonfinancial incentives that encourage providers to offer forms of care and supports that are evidence-based and underused within the care continuum.

  Examples of this solution in action

  • Maryland’s enhanced payment for high-fidelity evidence-based practices (EBPs; see sections from “EBP Services” through “EBP Supported Employment”)
  • Certified Community Behavioral Health Clinics’ alternative payment mechanisms
  • Social impact bonds in California, Colorado, and Utah
  • Proposed case rate model for coordinated specialty care (see p. 14)

  Strategy

  Incentivize evidence-based practices that bolster the continuum of care

  Financing and payment models that incentivize evidence-based practices that address gaps in the continuum of care and expand the continuum of care to include the social needs of individuals with behavioral health conditions.

  Topics

  • Help improve patients’ quality of care
  • General mental health
  • Depression and anxiety

  Resources

  • Bruns et al., 2016
  • Stewart et al., 2017
  • Mauri et al., 2017 (see p. 11 onward)
  • Bao et al., 2017
  • Trupin, Weiss, and Kerns, 2014

• Quality reporting requirements for evidence-based practices that address gaps in care

  Requirements for providers to report the provision of forms of evidence-based practices.

  Examples of this solution in action

  • CMS-funded development of evidence-based practice measures
  • American Psychiatric Association’s PsychPro data registry

  Strategy

  Regulate quality standards for evidence-based practices that bolster the continuum of care

  A robust set of quality standards and monitoring practices that enforces compliance with evidence-based practices that address gaps in the continuum of care and address social needs of individuals.

  Topics

  • Help improve patients’ quality of care
  • General mental health
  • Homelessness

  Resources

  • Pincus et al., 2016
  • Kilbourne et al., 2018

• Quality reporting requirements for patient-centered clinical practices

  Requirements for providers to report compliance with patient-centered policies, such as developing individualized care plans and ensuring patient access to medical records.

  Examples of this solution in action

  • Joint Commission Standard CTS.03.01.03 for individualized care plans
  • Montana State Hospital’s treatment plan policy
  • HIPAA Right of Access Initiative
  • Beth Israel Deaconess Medical Center’s OpenNotes trial project

  Strategy

  Regulate quality standards for evidence-based practices that bolster the continuum of care

  A robust set of quality standards and monitoring practices that enforces compliance with evidence-based practices that address gaps in the continuum of care and address social needs of individuals.

  Topics

  • Help improve patients’ quality of care
  • General mental health
  • Serious mental illness

  Resources

  • President’s New Freedom Commission on Mental Health, 2003 (see pp. 28–29, 35–36, 84, and 91)
  • Lye et al., 2018
  • HHS, undated
  • OpenNotes, undated

• Training for models of integrated care

  Efforts that support the capacity of practices to establish integrated care and adequately train personnel to follow new workflows.

  Examples of this solution in action

  • Transforming Clinical Practice Initiative
  • National Council for Behavioral Health’s Center of Excellence for Integrated Health Solutions
  • AIMS Center’s curriculum for psychiatric residents

  Strategy

  Fund and support models of integrated care

  Sponsorship of alternative care delivery models, such as Certified Community Behavioral Health Clinics and health homes, that have formalized systems and incentives that facilitate integrated care.

  Topics

  • Help make care financing less complicated
  • General mental health

  Resources

  • Hall et al., 2015

• Government funding for models of integrated care

  Federal or state funding to offset the capital costs of transitioning health systems to integrated care models or to support ongoing financial needs to make integrated care models economically viable.

  Examples of this solution in action

  • Certified Community Behavioral Health Clinics
  • Maryland’s Medicaid behavioral health home program
  • Medicaid and Medicare accountable care organizations

  Strategy

  Fund and support models of integrated care

  Sponsorship of alternative care delivery models, such as Certified Community Behavioral Health Clinics and health homes, that have formalized systems and incentives that facilitate integrated care.

  Topics

  • Help make care financing less complicated
  • General mental health

  Resources

  • American Psychiatric Association, 2018
  • Foney, Mace, and Boccanelli, 2019
  • Kathol et al., 2015

• Integrated funding and reimbursement for mental health and support services

  Forms of braided and blended funding, in which funding is merged or coordinated from one or more funding streams, as well as bundled payments that cover an array of potential medical and social services needs of patients.

  Examples of this solution in action

  • Louisiana’s permanent supportive housing program
  • Virginia’s Children’s Services Act

  Strategy

  Integrate financing systems into mental health care delivery

  Payment models that reimburse for expanded care coordination within health systems and among other sectors, as well as shared savings models that encourage greater care coordination.

  Topics

  • Help make care financing less complicated
  • General mental health

  Resources

  • Trust for America’s Health, 2018
  • Clary and Riley, 2016

• Reimbursement for care coordination

  Specific billing codes under fee-for-service models of payment that can be charged for care coordination.

  Examples of this solution in action

  • Medicare fee-for-service reimbursement for care coordination
  • Aetna’s coverage for care coordination

  Strategy

  Integrate financing systems into mental health care delivery

  Payment models that reimburse for expanded care coordination within health systems and among other sectors, as well as shared savings models that encourage greater care coordination.

  Topics

  • Help make care financing less complicated
  • General mental health

  Resources

  • Carlo et al., 2018
  • Carlo et al., 2020

• Health information exchanges for electronic health records and other forms of enhanced system interoperability

  Arrangements that allow providers across health systems and service sectors to securely access and share patients’ medical information for the purpose of care coordination.

  Examples of this solution in action

  • Connecticut law prohibiting health information blocking
  • Partnership between Colorado and health information exchanges to share data with jails
  • Kansas Health Information Technology Act aligning state laws with HIPAA

  Strategy

  Promote vertical integration within and between systems

  Efforts to formally redesign systems within and outside of the behavioral health sector to embed processes for coordinating services that meet the whole-person needs of individuals with behavioral health conditions.

  Topics

  • Help make care financing less complicated
  • General mental health
  • Suicide

  Resources

  • Johnson et al., 2016
  • Menachemi et al., 2018
  • HHS, undated
  • Office of the National Coordinator for Health Information Technology, 2019

• Develop state mental health plans that operationalize a continuum of care

  Strategic plans at the state level that bring together agencies and institutions to align funding, benchmarks, and goals for the mental health system.

  Examples of this solution in action

  • Maryland’s fiscal year (FY) 2018–2019 Behavioral Health Plan
  • Texas Statewide Behavioral Health Strategic Plan FYs 2017–2021
  • State Comprehensive Mental Health Services Plan Act of 1986

  Strategy

  Promote vertical integration within and between systems

  Efforts to formally redesign systems within and outside of the behavioral health sector to embed processes for coordinating services that meet the whole-person needs of individuals with behavioral health conditions.

  Topics

  • Help improve communication among care systems
  • General mental health
  • Serious mental illness
  • Suicide
  • Incarceration
  • Youth mental health
  • Homelessness
  • Employment

  Resources

  • President’s New Freedom Commission on Mental Health, 2003 (see p. 44)

• Incentivized handoffs between different levels of care

  Institutional arrangements and incentive structures that motivate providers to more effectively coordinate patients services between levels of care (e.g., transitional care between hospital discharge and outpatient services).

  Examples of this solution in action

  • Proposed bundled payment for care transitions (see p. 15)
  • Accountable care organizations
  • Transitional care management code reimbursement

  Strategy

  Promote vertical integration within and between systems

  Efforts to formally redesign systems within and outside of the behavioral health sector to embed processes for coordinating services that meet the whole-person needs of individuals with behavioral health conditions.

  Topics

  • Help improve communication among care systems
  • General mental health
  • Serious mental illness

  Resources

  • American Association for Community Psychiatry, 2020

• Merge and integrate systems of care

  Reorganizing the makeup of institutions within and connected to the mental health system such that a consolidated or formal connection is established.

  Examples of this solution in action

  • Wraparound Milwaukee community-based system of care
  • Arizona’s consolidation of its Medicaid and behavioral health agencies

  Strategy

  Fund and support models of integrated care

  Sponsorship of alternative care delivery models, such as Certified Community Behavioral Health Clinics and health homes, that have formalized systems and incentives that facilitate integrated care.

  Topics

  • Help improve communication among care systems
  • General mental health
  • Serious mental illness
  • Suicide
  • Incarceration
  • Youth mental health
  • Homelessness
  • Employment

  Resources

  • Soper, 2016
  • National Academies of Sciences, Engineering, and Medicine, 2019