Fragmentation, budget cuts and social media misinformation are among the most dangerous trends in behavioral health, according to 18 leaders.
Becker’s asked 18 behavioral health executives what they see as the most dangerous trend in behavioral health. All of the leaders featured in this article are speaking at Becker’s Behavioral Health Summit, set for June 19-20 at the Swissotel in Chicago.
Responses have been lightly edited for length and clarity.
Question: What is the most dangerous trend in behavioral health?
Stuart Archer. CEO of, Oceans Healthcare (Plano, Texas): Right now, the overall tone and approach to behavioral health at the national level feels like we are taking a step back. President Trump’s administration may rescind mental health parity and is not enforcing the mandate for equal coverage. Looming Medicaid changes could mean millions losing coverage, and behavioral health patients would be severely impacted by work requirements. Behavioral health providers have been fighting for a seat at the table for decades, and for our patients’ right to accessible, affordable care. The path we are on now is a dangerous trend.
Tammer Attallah. Executive Clinical Director of the Behavioral Health Clinical Program at Intermountain Health (Salt Lake City): When thinking about the most dangerous trends in behavioral health, I worry about the “more care equals better care” fallacy. We’ve observed a significant increase in spending for behavioral health from various plans, up by 50%. Furthermore, the direct-to-consumer market continues to expand. While expanding access is commendable, the evidence regarding improved outcomes for populations remains uncertain at best. This trend can contribute to over-pathologizing normal emotions and may strain the limited resources needed for individuals with more severe functional impairments.
Despite these challenges, there are incredible innovations in our field, presenting promising opportunities. Our goal should be to help individuals identify and connect with the most effective treatments and supports while measuring outcomes to ensure they receive the best possible care.
Scott Baker. Vice President of Array Behavioral Care (Chicago): The most dangerous trend in behavioral health isn’t the rise of AI or chatbots, it’s what their unchecked use reveals: a growing disconnection between technology and care. When digital tools are deployed without clinician oversight or integration into a broader care strategy, they risk deepening the very fragmentation they promise to solve. Patients bounce between apps, providers, and platforms with no continuity, and clinicians are left without the context needed to make safe, effective decisions. The real danger isn’t the tech itself—it’s the absence of a connected, clinician-led system that ensures every tool supports the patient journey, not derails it. Behavioral health doesn’t need more point solutions. It needs a unified continuum of care, built on a shared platform that enables clinicians to deliver the right care, at the right time, in the right dose.
Ken Dunham, MD. Executive Director Medical Operations for Behavioral Health at Sentara Health (Norfolk, Va.): The budget cuts to behavioral health and related “social programs” will not only impact the everyday American, but it will also disproportionately impact our most vulnerable populations. We will see unprecedented exacerbations to existing disparities in mental healthcare access to include longer wait times for services, increased utilization for high priced services (like ED utilization), broken quality of care on an already stressed system, higher labor costs for our licensed providers, decreased payer reimbursement for services provided, decreased breadth of services provided (including lower cost ED diversion programs) and overall increased barriers to treatment. The long-term impact will be worsened health outcomes that will skyrocket long term socioeconomic and medical costs. You will also see a large migration of licensed BH professionals away from their current business model to an out of pocket “self-pay” market that will be unattainable or unsustainable for most Americans seeking BH care.
Omar Fattal, MD. Deputy Chief Medical Officer and System Chief of Behavioral Health at NYC Health + Hospitals (New York City): One of the most dangerous trends in behavioral health is the continued siloing of mental health and substance use treatment. These services are often overseen by separate regulatory bodies and delivered through distinct systems of care, which can lead to fragmented and disjointed services. Even within substance use treatment, different program types may operate under separate regulations, further complicating access and coordination. Yet, most patients experience co-occurring mental health and substance use conditions, with needs that evolve over time. To improve outcomes, we must invest in integrated, person-centered models that provide seamless, holistic care and meet individuals where they are.
Tracey Izzard-Everett. Vice President of Behavioral Health Services at Sentara Health (Norfolk, Va.): One of the most dangerous trends in behavioral health is turning to social media to diagnose and/or treat mental health conditions. Especially now that social media promotions are monetized, there is a chance that people who need professional services will delay seeking help due to some suggestion that is “all the rage.” Chat rooms are also full of advice that might be counterproductive regardless of however well meaning it begins. A bit of caution should be used when turning to social media for critical healthcare information.
Karen E. Johnson. Senior Vice President and Chief Clinical Officer, Universal Health Services (King of Prussia, Pa.): The most dangerous trend is those individuals who need behavioral health services not getting it — for multiple reasons. Access is increasingly becoming a roadblock for many. There are far too many gaps in the care continuum that need to be filled by solutions that exist but are not available, whether due to geography, transportation, social determinants or even funding. While stigma has decreased, it has not been eradicated. There is reason for hope, as awareness of the challenges is raised and solutions are implemented.
Christina Mayfield, MSN, RN. Director of Behavioral Health Services at Mary Greeley Medical Center (Ames, Iowa): A dangerous trend in behavioral health is the increasing severity of psychiatric illness in patients presenting to emergency departments, including those brought in from county jails. We are seeing more individuals who are not only more acutely ill but also more violent and difficult to manage safely. This is often the result of inadequate mental health resources within jails, where behavioral health needs are frequently underdiagnosed, undertreated or altogether neglected. When these systems can no longer manage a patient, they often turn to emergency departments, which are not designed or equipped to provide long-term psychiatric care. This trend puts strain on already overwhelmed healthcare systems, endangers staff and other patients, and highlights a systemic failure to provide appropriate care for individuals with serious mental illness.
Patricia McClure-Chessier. Chief Healthcare Executive Leader at Streamwood (Ill.) Behavioral Healthcare System: Boarding patients in emergency departments for hours, and sometimes days, is one of the dangerous trends in behavioral health. It causes safety issues and a delay in intervention/treatment. Patients who present in the ED usually are more acute because these individuals often do not have a support system to help them navigate resources in the community. There is a lack of available psychiatric inpatient beds and limited access to other community based mental health services. Streamwood Behavioral Healthcare System is committed to working with the community to help patients in crisis access the care they need.
Stephen Merz. Vice President and COO of Sheppard Pratt Solutions (Baltimore): The most dangerous trend in behavioral health is assuming that greater access to behavioral healthcare improves healthcare outcomes for vulnerable and medically complex populations. Many healthcare systems incorrectly believe simply adding behavioral healthcare capacity will solve care problems (e.g., beds, crisis centers, EmPATH units, day hospitals). While these investments will help increase access, they alone cannot solve the congruent challenges of quality, equity and positive outcomes of care for the most fragile and vulnerable populations. For that, we need to deploy a full array of clinical service offerings, as well as maximize existing capacity, and address underlying gaps and drivers of social determinants of health.
Bonnie Moore, RN. Director of Inpatient Behavioral Health Services at Children’s of Alabama (Birmingham): While long wait times to see a mental health provider are not a new issue, one of the most dangerous and worsening trends in behavioral health today is the increasing inaccessibility of timely outpatient care, especially in rural communities. In our area, for example, patients face an average wait of nine months to see a psychiatrist and over a year to access therapy. For those needing a psychologist with expertise in specific diagnoses, the wait is often even longer.
This growing delay in access is deeply concerning, as it contributes to a cycle of crisis stabilization without sustainable recovery. Telehealth has expanded access and offered some relief, but it remains insufficient to meet the rising demand. Without timely, specialized outpatient care, patients discharged from inpatient settings are at a significantly higher risk of relapse and readmission.
This is a complex, multi-layered issue involving provider shortages, funding limitations and increasing demand. However, recognizing the critical role of accessible outpatient services in maintaining stability and preventing readmissions is a necessary first step toward comprehensive behavioral health reform.
Lisa Pearson. Vice President of Behavioral Health at Chase Brexton Health Care (Baltimore): The most dangerous trend in behavioral health is the wait. As a service line we must readjust the way we do business to serve clients with sensitive and timely needs.
Ujjwal Ramtekkar, MD. Chief Medical Officer at LifeStance Health (Scottsdale, Ariz.): A concerning trend in behavioral health is conflating visit frequency with patient engagement. Tracking appointment frequency alone without thoughtfully incorporating measurement-based tools overlooks whether patients are meaningfully engaged in their care, making progress toward their goals or receiving the appropriate level and type of support. True engagement means patients are actively participating in their treatment, and it’s reflected in a strong therapeutic alliance, adherence to individualized care plans and measurable clinical outcomes. Access matters, but so does quality. Evidence-based, person-centered care is the goal — not just more visits.
Matthew Ruble, MD. Chief Medical Officer at Discovery Behavioral Health (Irvine, Calif.): The most dangerous trend in behavioral health is collusion with regression. The pandemic allowed/forced much of the world’s population to confront sadness, terror, illness, grief, isolation, anxiety/panic. The pandemic increased the prevalence, increased the acceptance, and decreased the stigma related to behavioral health/illness. The forced human progress made amid the pandemic is in danger of being lost.
Becky Stoll. Senior Vice President of Crisis Services at Centerstone (Nashville, Tenn.): From my vantage point in the crisis services and suicide prevention areas of behavioral health, I see the period immediately after a crisis episode, especially during transitions in care, as some of the most dangerous. Oftentimes this is not understood or acknowledged. In order to prevent suicide attempts and deaths and connect individuals to the care and resources they need, we need to focus more attention in these areas. In my opinion, we need to ensure:
- Post-crisis follow-up is an integral part of all pieces of the crisis services continuum.
- Behavioral health professionals conducting post-crisis follow-up have a comprehensive understanding of what happens to an individual’s brain after experiencing a crisis event. This ensures providers are not placing unrealistic expectations on those we serve.
- Not all of an individual’s issues/needs are treated the same. Some find themselves in a crisis because of a diagnosed mental health condition, but not all. Many people have a behavioral health and/or suicide crisis because of problems with social determinants of health and other life factors.
- Distinct and varied follow-up pathways of care are employed to address specific needs. These pathways should focus on assisting with unstable mental health conditions, referrals for mental health or substance use care and basic needs resource connection.
- During times of transition between different levels and locations of emergency/crisis care, all parties must accept responsibility for collaborating.
- Systems are in place with emergency rooms, outpatient behavioral health providers, and inpatient psychiatric facilities to help individuals and their support system navigate what can be a very complicated behavioral health system.
Robert Trestman, MD, PhD. Professor and Chair of Psychiatry and Behavioral Medicine at Carilion Clinic and Carilion School of Medicine at Virginia Tech University (Roanoke): The most dangerous trend in behavioral health is legislative intrusion into medical decision-making. For years, the field has been grappling with non-clinicians in the payer and pharmacy benefit manager space challenging, delaying or denying medical decisions for treatment. We are more recently experiencing state and federal regulatory and legal decisions that are having a profound effect on both access to appropriate care and at times threatening clinicians for delivering medically appropriate, scientifically validated psychiatric care.
Arpan Waghray, MD. CEO of Providence’s Well Being Trust (Renton, Wash.): Over-pathologizing normal emotions and diagnosing life challenges as mental health conditions is a concerning trend. Self-diagnosing normal life events and challenges can lead to unnecessary treatments. We naturally experience a range of emotions; feeling sad or lonely doesn’t mean one has a mental health condition. It’s essential to differentiate between typical emotional responses and mental health concerns requiring professional help. Striking that balance will help us ensure those in need receive appropriate care, while supporting well-being in a holistic and compassionate manner.
Jill Wiedemann-West. CEO of People Incorporated Mental Health Services (Eagan, Minn.): The most dangerous trend in healthcare today is an overly siloed approach. Human beings are complex — perhaps more so than ever. To effectively diagnose and treat an individual, we must fully understand all aspects of their health and circumstances. When we see the whole picture, we can collaborate with the consumer to create an integrated plan that leads to meaningful, sustainable outcomes.
