Behavioral health needs are rising, and systems are getting creative in how they remove barriers to care.
“One of the biggest challenges in U.S. mental health care is that we don’t really have a unified mental health system,” Katharine Dalke, MD, vice chair for clinical operations in the department of psychiatry at Philadelphia-based Penn Medicine, told Becker’s. “Instead, we have a loosely connected network of providers. Even within many health systems, mental health services can be fragmented — often due to the way mental health insurance is carved out. For example, your primary care provider may accept your medical insurance, but the mental health provider they refer you to in the same system may not.”
This lack of unity is compounded by a rising number of patients in need of mental health care. From 2018 to 2020, the average rate of mental health-related ED visits among adults was 53 per 1,000 adults, according to CDC data. Among children, the rate was 14 per 100,000. The U.S. also has the highest maternal mortality rate of any high-income country, with suicides, drug overdoses and other mental health-related causes accounting for more than 22% of all pregnancy-related deaths, according to HHS.
Here are five unique strategies and models systems are using to address behavioral health needs.
Behavioral urgent cares
Many systems across the nation have turned to behavioral urgent cares to fill the gaps. These clinics provide same-day outpatient mental health care at a lower cost than emergency departments. The first mental health urgent care was opened by Edison, N.J.-based Hackensack Meridian Health in 2019. In about two years, at least 77 more behavioral urgent care sites were opened across the nation. In 2024, 20 more systems opened urgent cares.
And more systems are getting involved. In February, BayCare Health opened Florida’s first behavioral health urgent care center in New Port Richey.
Supporters of the model applaud it for its ability to reduce barriers to care, free up ED beds and provide care at a lower cost. But critics are concerned over the model’s ability to provide follow-up care. There are no numbers available about how many patients in total all the nation’s behavioral urgent cares see or how many follow-ups are conducted.
Collaborative care in clinics
Penn Medicine is focused on shifting the burden of coordinating care off of patients and providers and onto the system, in part by embedding mental health professionals into primary care clinics and streamlining symptom tracking.
Penn Integrated Care puts mental health therapists into primary care practices, allowing patients to see their therapists right after seeing their primary care provider either in person or via telehealth.
“A key strength of PIC is that the therapists regularly consult with psychiatrists,” Dr. Dalke said. “This allows therapists to refine treatment plans and, if appropriate, discuss medication guidance. The psychiatrist can recommend medication strategies to the primary care provider — without the patient ever needing a separate psychiatric appointment.”
The PIC model allows psychiatrists to treat hundreds of patients in a fraction of the time, which expands access and improves efficiency. The model has been incorporated into 44 primary care practices and one OB-GYN practice, and has helped 48,509 patients so far. The system is looking at embedding the program in more OB-GYN clinics as well as radiation oncology.
Patients are qualified as showing an improvement when there is at least a 20% reduction in scores on validated symptom scales. The average patient had 12 encounters of 30-minute sessions every other week before reaching this benchmark. About 45.7% of patients had improvement in depression and 45.5% achieved improvement in anxiety.
Penn Medicine has also been using a TEAM (time-efficient, evidence-based, accessible and measurement-based) model in their psychiatric clinics, which has patients complete a battery of online assessments to measure symptom severity before seeing a psychotherapist and medication provider. Providers review the assessments and create a treatment plan. As patients move through the clinic during a 4 month period, they complete monthly assessments to track symptoms.
“This time-limited model preserves access by preventing long-term clinic crowding,” Dr. Dalke said. “It was originally developed for health system employees during COVID, and now includes evening hours to meet demand.”
Short-term therapy in clinics
A psychologist at New Orleans-based Ochsner Health developed a program called short-term psychotherapy, or STeP. It’s an evidence-based model that’s solution-focused and designed to help patients get care in a high-touch, high-frequency format, but over a shorter duration. Instead of spending years with a therapist, STeP patients attend weekly sessions for 10 to 12 weeks.
“That structure creates a clear goal and endpoint agreed upon by both therapist and patient,” Lisa Gentry, LMSW, vice president of behavioral health services at Ochsner, told Becker’s. “In turn, this increases access — once a patient completes their course, that slot opens up for someone else.”
The program was launched in early 2024 and has already helped several hundred patients. Results have shown promise: no-show rates dropped by 50% and patients are more engaged and reliable.
“We actually have a waitlist for the program now, which shows that people are excited about having access to this kind of care — structured, goal-oriented, with frequent follow-ups but not an indefinite timeline,” she said. “It’s been very effective.”
The program has also been good for providers who report feeling less burned out and more able to use evidence-based models effectively. About 20% to 60% of their caseload is reserved for short-term therapy patients and they serve both adults and pediatrics.
Fully integrated behavioral health in GI clinics
Six years ago, Cleveland Clinic started putting psychologists in its gastrointestinal clinics to provide fully integrated behavioral health care alongside medical treatment. The model makes psychologists an equal partner in the clinic, often introducing patients to their physician and psychologist at the same time.
“We work as a team to make sure you’re treated as a whole person, from every angle,” Stephen Lupe, PsyD, gastrointestinal psychologist and the director of behavioral medicine in the department of gastroenterology, hepatology and nutrition at Cleveland Clinic, told Becker’s. “That includes identifying behavioral or mental health concerns and addressing them — not just depression or anxiety, but also behavioral changes, which is a big part of what a psychologist does.”
The program has expanded to include a digital platform that gives patients behavioral support before they know they need it. These tools help manage thoughts and emotions, and can flag concerns directly to the clinic for in-depth care.
The model has reduced patients’ depression and anxiety scores, decreased disease activity and reduced unplanned care like hospitalizations and emergency department visits. One insurer told Dr. Lupe that patients in the model were 20% less likely to require inpatient care.
“We should be bringing care to where patients already are, instead of making them find us,” he said. “There are huge access issues in healthcare, and this approach helps reduce barriers.”
Certified community behavioral health clinics
Iowa and Illinois are some of the first states to embed certified community behavioral health clinics into their Medicaid plans, and West Des Moines, Iowa-based UnityPoint Health is one of the first systems to integrate these centers into their service areas.
UnityPoint was awarded this project in early 2024 and has been actively working to transition its five community mental health centers into certified community behavioral health clinics in two states. Two clinics were opened in Illinois in October, and the first clinic in Iowa is set to open July 1.
“Most organizations transitioning to CCBHCs are standalone behavioral health providers, but we bring the advantage of whole-person care,” Aaron McHone, behavioral health operations director at UnityPoint Health, told Becker’s. “Many of our patients also receive primary care, emergency care, or have had hospital admissions with us. That allows us to connect the dots in ways others can’t — reducing unnecessary ED visits or admissions by providing more proactive community-based care.”
These clinics provide nine core services: crisis services; outpatient mental health and substance use services; person- and family-centered treatment planning; community-based mental health care for veterans; peer family support and counselor services; targeted care management; outpatient primary care screening and monitoring; psychiatric rehabilitation services; and screening, diagnosis and risk assessment. The system is still collecting data on the impacts of the clinics.
Next, UnityPoint is working to launch its functional family therapy program through its certified community behavioral health clinics. This evidence-based program targets youth 11 to 18 with challenges like substance use, risky sexual behavior and conduct issues by sending therapists into patient homes to work with the entire family.
“This is something we’re deeply passionate about,” he said. “We believe in meeting patients where they are — physically and emotionally. By embedding behavioral health directly into clinical settings and aligning it with primary care, we can remove access barriers, improve outcomes, and make the system work better for patients and providers alike.”
