Training more providers is just one of the challenges of delivering wider access to behavioral health, says Charles Herrick, MD, system chair of psychiatry at Nuvance Health.
Access to behavioral healthcare is worsening for many, Dr. Herrick said. Due in part to reimbursement challenges, many mental health providers choose to go into private practice, and many do not accept insurance.
“There are two aspects that need to be addressed in order to improve access. Providing more psychiatrists, social workers or APRNs is not the only solution,” Dr. Herrick told Becker’s. “The reason is, they can go into the private sector. The demand is so high that they do not have to take insurance, and they can charge whatever the market will bear, and they will be full.”
Primary care clinicians are providing more psychiatric care than they have in the past, Dr. Herrick said. At Danbury, Conn.-based Nuvance, Dr. Herrick said, embedded licensed clinical social workers have helped to support primary care providers overwhelmed by mental health needs.
There are not enough behavioral health providers that patients can afford to see for primary care providers to refer to, Dr. Herrick said. Additionally, many outpatient providers are hesitant to take on high-risk patients.
“There aren’t enough of those providers, and minting more providers doesn’t address those two issues. This is a way we can manage high risk patients in a manner that allows for continued access to psychiatrists, because they’re acting as consultants, more than as treaters,” Dr. Herrick said.
These licensed social workers often have experience working in hospital-based environments, and are able to identify and consult on care for higher-risk patients, he said.
Nuvance Health, a seven-hospital system, also leans on telehealth to ensure a psychiatrist is available to consult at all of its emergency rooms, Dr. Herrick said.
There are no simple solutions to a complex problem, but advocacy from behavioral health providers will play a key role. Continued support for telepsychiatry models and advocacy for better payment models could help ease some of the access challenges facing behavioral health, Dr. Herrick said.
“I think the biggest challenge facing hospitals is: How are we going to address the mental health needs of our community in a sustainable way? That at least covers the cost of care, cares for the highest risk patients, and creates enough access for those in the community,” Dr. Herrick said. “I don’t have the answer to that, but it’s going to come from advocacy.”
