Across the behavioral health sector, long-standing assumptions — from separating mental and physical health to equating access with outcomes — are being challenged as systems face rising demand, workforce constraints and growing complexity in patient needs.
In response, leaders are challenging these assumptions and advancing new approaches centered on integration, scalability and outcomes. Here’s what 20 executives say needs to change and what they’re doing about it.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is one commonly held assumption in behavioral health that needs to be challenged right now — and how is your system responding?
Integration as the foundation of whole-person care
Brett Graham. Interim CEO of Huntsman Mental Health Institute (Salt Lake City): A commonly held assumption is that behavioral healthcare should operate separately from primary healthcare. This separateness has applied to how the care is delivered and financial sustainability. Our experience shows the opposite: integration is essential. At University of Utah Health, our Behavioral Health Integration program began in 2015 with just four embedded Huntsman Mental Health Institute social workers in primary care clinics. The next year we integrated psychiatry residents in the primary care setting, with attending supervision for better access to psychiatric evaluations.
As demand grew, we transitioned from a no‑cost model to billing for 30‑minute consultations to maintain sustainability. We expanded into every primary care practice, then into specialty clinics like gynecology and neurology and virtual consultations for patients in dozens of outpatient practices including cardiology and rheumatology. Today, 35 behavioral health integration social workers are integrated into 15 sites, in six counties.
Several core components strengthen this integrated approach. Universal depression screenings occur 48 hours before a patient’s appointment, helping providers identify concerns early. Collaborative care connects primary care providers, behavioral health clinicians and consulting psychiatrists to support patients as a unified team. The “You Matter” outreach program supports individuals after treatment for suicidal ideation, suicide attempts or crisis evaluation — ensuring continuity beyond the inpatient, ER, receiving center or primary care visit.
Many still equate “integration” with single elements, like co‑location, warm handoffs or faster referrals. But true integration requires aligning operational, financial and clinical systems. Programs that thrive and sustain impact are those that successfully align all three, building a seamless model of care that treats behavioral health as an essential part of whole‑person health rather than a separate system.
This approach is key to overcoming access-to-care barriers and ensuring support is available the moment patients are ready.
Tracey Izzard. Vice President of Behavioral Health for Sentara (Norfolk, Va.): One commonly held assumption about behavioral health is that mental health treatment should be separate from physical health which can lead to siloed services and fragmented care. Because we know that behavioral health and physical health are deeply interconnected, we are challenging the traditional model where behavioral health is seen as ancillary or “add-on,” rather than integrated with primary care or overall health services. Some of our early interventions include:
- Our health plan is taking a whole-person care approach with care team support from both medical and behavioral health specialists providing case management and coaching to bridge integrated care for both mental health and physical health.
- We have integrated behavioral health navigators into EDs and high-traffic residential providers to help navigate to lower levels of care with proper support.
- Primary care has implemented the use of the PHQ-9 to screen and refer when a BH condition is suspected or identified.
- We have embedded behavioral health therapists into several primary care provider practices.
- We offer telebehavioral health options to improve access and reduce stigma.
- We have hired school liaisons to provide ongoing staff education on trauma-informed care, suicide prevention and substance use.
- We have fostered training and partnerships between medical and behavioral health clinicians.
JohnRich Levine, DNP. Chief Nursing Officer for Reeves Regional Health (Pecos, Texas): One assumption that deserves reconsideration is the idea that behavioral health exists as a separate lane within healthcare. In many organizations, it still functions as a specialty service rather than an integrated element of everyday care, yet the reality on hospital floors, emergency departments and outpatient settings tells a different story. Behavioral health shows up everywhere. It shapes how patients understand illness, follow treatment plans, cope with pain, recover from surgery and engage with clinicians.
In a rural hospital like Reeves Regional Health, this reality becomes even more visible. A patient admitted for diabetes, trauma, heart failure or infection frequently carries behavioral health needs at the same time. When care teams treat those needs as secondary or outside the core workflow, the system fragments. When teams acknowledge behavioral health as part of the clinical picture from the start, care becomes more effective and more humane.
Our approach focuses on integration at the point of care. Nurses receive training that helps them recognize behavioral and emotional signals during routine assessments. Care management collaborates closely with bedside teams to address psychosocial needs alongside medical treatment. Community partnerships extend support beyond discharge, a practice that holds particular value in rural regions where behavioral health resources remain limited.
This shift changes the question from, “Who handles behavioral health?” to “How does every caregiver incorporate behavioral health awareness into the care they provide?” Once that perspective takes hold, behavioral health evolves from a referral category into a shared responsibility across the entire clinical team.
Lewis Marshall Jr., MD. Chief Medical Officer, Affiliate Dean, Assistant Professor of Clinical Medicine for Weill Cornell Medicine at Lincoln Hospital (New York City): The World Health Organization defines health as being in a state of complete physical, mental and social well-being. One commonly held assumption is that we can separate the three states of health. They are deeply interconnected.
Another misconception is that mental health is an individual problem. This is simply not accurate. We know in a lot of cases mental health conditions affect the family and community. We look at depression and use tools to determine a person’s level of depression. We then look at treatment and individual symptom reduction. But that is only one aspect of how mental health conditions may manifest in an individual. We have to consider co-morbidities and how they affect mental health and how mental health affects medical conditions.
Perhaps more importantly is how socio-economic factors play a role. Housing and food insecurity, social isolation and access to care all play a role in how mental health is manifested in individuals, family and the community. Our organization includes mental health providers in our community social health outreach and wellness activities bringing together medical care, social services and behavioral health where the patients are in the community. We are also pursuing behavioral health and cardiology, understanding that some antipsychotics and other psychiatric medications have long-term cardiovascular effects.
Courtney Miller, RN. Director, Service Line Administration, Behavioral Health, OSF HealthCare (Peoria, Ill.): At OSF HealthCare, behavioral health services have historically been delivered through siloed care models. While well intentioned, this approach has contributed to fragmentation of services, positioning behavioral health services as separate from traditional medical care rather than as an essential component of care that addresses the overall health and wellbeing of our patients.
To address this, the Behavioral Health Service Line is leading a strategic shift toward an integrated, systemwide care model. Partnering with operational and executive leaders, we are implementing a unified approach that embeds behavioral health across the continuum, enabling a coordinated whole-person care approach at every point of care. In 2025, we accelerated this work by expanding access to integrated behavioral health services by 32%, including the addition of 14 behavioral health clinicians embedded within primary care practices across all OSF markets. Additionally, in 2026, OSF expanded virtual behavioral health services to include both clinical providers along with patient navigation.
Our approach is grounded in the principle that behavioral health is inseparable from physical health. By prioritizing standardized access, streamlined referral pathways and enhanced care navigation, we are creating a more seamless patient experience by reducing fragmentation, minimizing delays and ensuring patients are connected to the right level of care at the right time.
Ultimately, this strategy advances OSF’s systemwide priorities by improving clinical outcomes, enhancing the patient experience and establishing a sustainable model for integrated behavioral healthcare delivery.
Matthew White, MD. Chair of Behavioral Health Service Line for Sutter Health (Sacramento, Calif.): At Sutter Health, we are challenging the idea that mental healthcare exists outside the rest of healthcare. In fact, mental health is at its core.
Behavioral health is closely connected to many aspects of medical care, from managing chronic conditions like diabetes and heart disease to supporting recovery after acute illness. When mental health services operate separately from primary and specialty care, patients may experience delays in care, lower quality of life and increased costs.
We are working to change this by actively integrating behavioral health into specialty settings with a special focus on perinatal health. In addition to increasing behavioral health support in specialty clinics, we have added mental health services using the collaborative care model over the last 18 months. This team-based approach integrates behavioral health specialists into nearly 70% of our primary care clinics — and that number continues to grow. Our goal is to make behavioral healthcare more accessible, coordinated and connected to the care patients already receive.
Challenging the perception that behavioral health is separate from the rest of healthcare is essential to improving outcomes. By making behavioral health a routine part of clinical care, we can better support patients, improve coordination and strengthen the overall effectiveness of the healthcare system.
Rethinking access, workforce and care delivery models
Dominique Dietz. Director of Virtual Behavioral Health for OSF Healthcare (Peoria, Ill.): One commonly held assumption in behavioral health that needs to be challenged is that every service or patient touchpoint must be delivered by a licensed clinical professional. While clinical expertise is essential for diagnosis, therapy and higher-acuity care, this model alone is not scalable and it unintentionally creates access barriers, long wait times and provider burnout.
At OSF HealthCare, we are intentionally redesigning this approach by building a more balanced, team-based model that expands support beyond the traditional clinical workforce. We are leaning into digitally enabled outreach and engagement strategies powered by trained, nonclinical team members who have backgrounds in behavioral health. These individuals are not replacing clinicians, they are extending the reach of care.
For example, following emergency department discharge, we deploy digital outreach that is backed by real people in nonclinical roles who proactively engage patients. This allows us to maintain connection during a highly vulnerable transition period, ensure follow-up and address barriers like scheduling, transportation,or understanding next steps without overutilizing limited clinical resources.
In parallel, our Behavioral Health Navigation team plays a critical role. These are subject matter experts in both internal and community-based behavioral health services who guide patients through what is often a fragmented and confusing system. They help match individuals to the appropriate level of care the first time, reducing unnecessary escalations and avoiding bottlenecks in specialty services.
By differentiating between clinical and nonclinical needs, we can ensure licensed providers are practicing at the top of their scope, while patients still receive timely, meaningful support. This approach not only improves access and patient experience, but it also creates a more sustainable model one that meets growing demand without compromising quality of care.
Sam Huber, MD. Medical Director of HARP Behavioral Health Services and Medical Director at MVP HealthCare—West Region (Rochester, N.Y.): The most limiting assumption in behavioral health today is that more access automatically leads to better outcomes. While access matters, it is not the full solution. Behavioral health is complex, dynamic and deeply personal, and without guidance, coordination and accountability, greater access does not always translate into sustained progress. Too often, individuals are expected to know what kind of support they need and when to seek it, while providers are asked to deliver care without full visibility into a person’s broader context or what has, or hasn’t, worked before. Even when appointments are available, systems can struggle to offer clear pathways that help people navigate options, adapt care over time and define what meaningful improvement actually looks like.
At MVP Health Care, our Empowered Well-Being strategy challenges this assumption by
redefining how behavioral health fits into wholeperson care. Empowered well-being is
grounded in the belief that people benefit most when care is proactive, personalized and
designed around what they need now and what they are likely to need next.
In behavioral health, this approach translates into exploring self-triage and navigation models
that help members identify the right level and type of support earlier, before challenges
escalate. It includes investing in peer support and care coordination to strengthen engagement,
reduce isolation and better support transitions across levels of care. Just as importantly, we are
deepening collaboration with provider partners around shared goals for accountability by using
data, feedback loops and outcome measures to understand whether care is truly helping
people make progress, not simply whether services were delivered.
By moving beyond the assumption that access alone equals quality, MVP’s empowered
well-being strategy enables more responsive, coordinated and effective behavioral health
systems for all.
Tyler Jones, MD. Senior Medical Director for Optum (Eden Prairie, Minn.): There is a persistent belief that the behavioral health access crisis is fundamentally a workforce shortage. Train enough therapists and psychiatrists, the thinking goes, and the problem resolves. It will not. Patient needs, particularly among those with serious medical illness, are growing faster than any training pipeline can match. The one-to-one specialty referral model cannot scale to meet demand, regardless of how many clinicians we produce.
The path forward runs through higher-leverage care delivery. Physicians should not complete training without understanding how healthcare systems function, how care is financed and how workflow design determines what actually reaches patients. Clinical excellence matters enormously and its optimal impact depends on the structures surrounding it.
Stepped care, measurement-based treatment, interventional psychiatry and AI are force multipliers for skilled clinicians. Registries and care management let a psychiatrist oversee a panel of hundreds rather than dozens, while surfacing patients with severe or refractory illness who need escalation to interventional approaches.
One opportunity lies in extending the reach of experienced behavioral health providers across medical populations where the need is greatest. In my work in oncology through Colla Health, for example, untreated depression, anxiety and serious mental illness compromise treatment adherence, increase complications and worsen survival. Community oncologists have long recognized that psychosocial and mental healthcare are critical for cancer care, but have been unable to deliver it at scale. In most systems, behavioral health still requires a separate referral, often to a separate location, which means most patients who need support never receive it.
Behavioral health has to be embedded where patients already are. The access crisis has solutions that can already be utilized. It is a design problem and solving it requires building systems worthy of the clinicians working inside them.
Jim Serratt. CEO of Parkside Psychiatric Hospital and Clinics (Tulsa, Okla.): One assumption behavioral health needs to challenge immediately is the belief that chronic shortage is an acceptable operating model. It is not. Too often, we speak about workforce gaps, access delays and fragmented care as though they are unfortunate but inevitable features of the field. That mindset is no longer strategic. It is complacency.
In behavioral health, we have become too comfortable building systems around limitations rather than around outcomes. We manage waitlists. We triage scarcity. We hand families a maze and call it a continuum. Meanwhile, children worsen, staff burn out and communities pay the price downstream.
The assumption I reject is that we must choose between access, quality and financial sustainability. That tradeoff has been repeated so often that many leaders treat it like fact. It is not a fact. It is a design failure.
Our organization is responding by redesigning the system, not just working harder inside a broken one. We are investing in workforce stability, specialized programming, better front-door management, stronger transitions across levels of care and more disciplined use of data to eliminate friction, reduce delays and improve outcomes. We are also pushing against the idea that behavioral health should remain reactive and underbuilt while every other sector modernizes.
The future of behavioral health will not be secured by asking exhausted people to do more with less. It will be secured by leaders willing to challenge outdated assumptions, rethink the care model and build systems worthy of the children and families we serve.
Behavioral health does not need better excuses. It needs bolder design
LalithKumar Solai, MD. Vice Chair of Clinical Services for the Department of Psychiatry and Behavioral Sciences at Medical University of South Carolina (Charleston): We assume it is OK to schedule an appointment when a patient is struggling with symptoms and signs of an illness. We sometimes accept patients suffering for a day or two or even weeks before we see them for an evaluation. I find that hard to reconcile. How is suffering accepted as OK? We have ERs to address them but even that is not ideal. Access has been an issue not only at MUSC but all over the nation. We in MUSC have taken access as an urgent matter and address them as a priority. Several initiatives are on the way across MUSC to address this particular issue, streamlining access to behavioral health services, creating an access clinic (with low threshold for services), integration of behavioral health within primary care (adult and children), schools and specialty clinics with high co-morbidities. Incorporating telepsychiatry services is also a key strategy for patients in rural areas with limited access to behavioral health services.
Measuring outcomes and shifting to value-based care
Mary Affee, EdD. CEO and Founder of Horizon Integrated Wellness Group (Cary, N.C.): One commonly held assumption in behavioral health that needs to be challenged is that increasing access to traditional talk therapy automatically leads to better outcomes. While expanding access is important, it does not guarantee meaningful clinical improvement.
This belief is rooted in two ideas: that more services equal better results and that talk therapy is the gold standard for all clients. While talk therapy is valuable, it is not universally effective.
Children, adolescents and trauma-impacted individuals often do not primarily process through language; children communicate through play and we know trauma can disrupt verbal expression. When care relies too heavily on talk therapy, clients may disengage, be misunderstood or progress more slowly. This also reinforces a hierarchy where other evidence-based approaches — such as play therapy, expressive arts, somatic strategies and family-centered work — are treated as secondary rather than essential.
Shifting toward more collaborative clinician–client engagement, grounded in active participation and integrative modalities, improves care alignment, increases client investment/engagement and helps mitigate clinician burnout by creating more meaningful and sustainable care.
Our organization is responding by moving from an access-driven model to an outcomes-driven, integrative model of care. Our clients are introduced to multimodal interventions, including play therapy, expressive arts, somatic and family-based care alongside traditional talk therapy. We also utilize a wraparound model, partnering with primary care providers and coordinating care across systems to ensure comprehensive, connected services. We believe success is measured beyond session volume — focusing on functional improvement, emotional regulation, engagement and relational health.
The future of behavioral health is not just about access — it’s about delivering effective, individualized and truly transformative care.
Ali Atabbi. COO, Aurora Charter Oak Behavioral Health Care Hospital (Covina, Calif.): One of the most entrenched assumptions in behavioral health is that reimbursement should remain tied to volume, visits, days or levels of care rather than outcomes. This model undervalues the complexity of behavioral health, where progress is often non-linear and influenced by social determinants, engagement and continuity of care. It also creates misaligned incentives, where providers are rewarded for utilization instead of stabilization, functional improvement and long-term recovery.
At our organization, we are actively working to challenge this paradigm by shifting focus toward outcomes-driven care and better care coordination across the continuum. Practically, this means strengthening step-down pathways from inpatient to PHP/IOP and outpatient services to reduce fragmentation and prevent avoidable readmissions. We are also investing in data infrastructure to track key metrics such as readmission rates, length of stay optimization, patient engagement post-discharge and payer-specific performance.
In parallel, we are engaging more strategically with payers and [independent physician associations] to explore value-based arrangements that align incentives around total cost of care and outcomes, rather than isolated episodes. This includes positioning our outpatient services not just as extensions of care, but as critical levers for population health management.
Ultimately, behavioral health should not be treated as a series of disconnected encounters, but as a longitudinal journey. Challenging the volume-based mindset is essential if we want to build a system that is both financially sustainable and clinically effective.
M. Justin Coffey, MD. CMO for Workit Health (Ann Arbor, Mich.): One assumption that surprisingly continues to come up in conversations is that, in behavioral healthcare, quality is difficult to measure. The [International Organization for Migration] defined the six dimensions of healthcare quality over 20 years ago and that powerful framework has been refined for use in a value-based world in tools like the quadruple aim and the clinical value compass. There are also well-established, person-level outcome measures in behavioral health, including experience of care measures. And there are condition-specific measures, like one we love to use at Workit Health called the substance use recovery evaluator, which was developed intentionally with extensive input from people with lived experience. Perhaps the difficulty folks refer to has more to do with implementation than measurement itself and the good news is that there are terrific resources for building improvement capability in your team. Just check out the Institute for Healthcare Improvement.
Sharat Iyer, MD. Incoming Vice President, Quality, Behavioral Health, Northwell Health (New Hyde Park, N.Y.): A common misconception in behavioral health is the inability to meaningfully measure, compare and benchmark cross-diagnostic outcomes of behavioral health systems of care. At Northwell Health, a health system spanning 28 hospitals and over 1,000 care locations across New York and Connecticut, our behavioral health service line hopes to adopt a strategic vision that includes facilitating standardized outcome measurement collected through implementation of a universal electronic health record system and an evidence-based patient-reported outcome scale, with the goal of meaningfully measuring performance of our behavioral health services across sectors and loci of care. The overall goal of our efforts will be to advance behavioral health outcomes for all.
Addressing root causes: social determinants, stigma and system design
Carl Hoopes. Executive Vice President and COO, Grand Mental Health (Tulsa, Okla.): One commonly held belief that is currently held and needs to be challenged is: transformation does not come from strategy alone but through culture. Grand is actively engaging both clients and staff to get very specific feedback on what is working well and what can be improved. A culture is being built that creates psychological safety with a preoccupation with what can go wrong. Our employees are bringing forward suggestions that are actively being implemented to increase access, quality and experience for both staff and clients. You can see the consistency improving day by day and hear the pride from the success stories as we move forward on this journey. Right now, it is all about … culture, culture, culture.
Glenn Simpson. COO for ECU Health Behavioral Health Hospital (Greenville, N.C.): Although we all know that behavioral health is health, it is often seen as a specialty that is less of a priority than other specialties. However, Behavioral healthcare is as important as physical healthcare. Research indicates that better physical health outcomes are often predicated on patients’ positive mental well-being. This lower prioritization is borne, in part, by stigma, which remains a significantly limiting factor for those with mental illnesses and/or substance use disorders. This stigma is demonstrated in the public at large, in the media, by legislators and even within the medical field itself. However, it is the payers who do not reimburse behavioral healthcare on par with physical healthcare that has the largest negative impact. Utilization management is more stringent than for physical healthcare. Behavioral health treatment is managed as “elective” and often requires prior approval before care can even be delivered or continued. This stigma is a reason that both public and private funding for behavioral healthcare does not align with the amounts invested in workforce, treatments and research for other health conditions. Investing, integrating and educating within the healthcare delivery industry is the first step in eliminating stigma and improving access to care. Over the last several years, ECU Health has invested in bricks and mortar by executing a joint venture partnership to build a free-standing behavioral health hospital, expanding psych residency slots at the ECU medical school, developing fellowships in sub-specialties including addictionology and adding collaborative care and telepsychiatry services in [primary care providers] and emergency services. Much more is needed to provide improved access to care and treatment for those with mental illnesses and/or substance use disorders. An initial step is often acknowledgement and education. Becker‘s annual Behavioral Health Summit is a step in the right direction.
Becky Stoll. Executive Vice President of Crisis Services for Centerstone (Nashville, Tenn.): In the behavioral health field, it is a common notion that individuals most often find themselves in a crisis episode due to their diagnosed mental health condition or an undiagnosed mental health condition experiencing a period of acuity. However, in today’s world, that is not the reality of who crisis services programs are often serving when individuals seek help. In fact, most often the “theme” of the crisis event is more issues with life stressors related to access to social determinants of health.
For many, the day-to-day struggles of having adequate access to food, housing, transportation, health, behavioral health, dental, vision and specialty care, and other life needs is creating depression, anxiety and increased use of substances. This is not to say that crisis service providers are not serving individuals who are experiencing an acute crisis related to their diagnosed behavioral health condition, but in our experience, it is not the majority.
Given this is the current reality, crisis services providers have to expand their lens when providing crisis services. The way in which to do this is twofold. First, when conducting crisis service activities like screening, assessing, intervening, creating dispositions and gathering resources, we must broaden the lens so that we are more deeply inquiring about social determinants of health and access to them. This part of the work must be seen as just as important as the clinical work. Second, we need to broaden who we see as our community partners. Food banks, housing organizations, social service agencies, health/behavioral health/substance use provider systems at large and other community partners can and should play a role in suicide prevention and efforts to improve the overall health of the individuals of their community.
Wayne Young. CEO of The Harris Center for Mental Health (Houston): A commonly held assumption in behavioral health that needs to be challenged is the idea that simply adding more funding to existing models will meaningfully solve our challenges. While investment is important, more of the same will not produce different outcomes — especially when too many individuals still struggle to access care, disengage early or never enter the system at all.
We have to fundamentally rethink how care is delivered. That means designing services around how people actually live, not how systems are traditionally structured. It requires meeting individuals where they are and addressing the real-world intersections that shape behavioral health, including homelessness, involvement with law enforcement and unmet social needs.
In short, we must prioritize innovation alongside investment.
Advancing innovation and new clinical approaches
John Driscoll. President and CEO, Caron Treatment Centers (Wernersville, Pa.): Addiction is a brain disease and treating it effectively requires a precise, objective approach. Today, we have the science to better understand how the brain functions, yet it has not been consistently applied across behavioral health. At Caron, we are working to change that — treating the brain as the target organ and incorporating advanced tools such as comprehensive neurocognitive assessment, brain mapping and imaging to better understand what is driving a patient’s condition.
Too often, behavioral health relies primarily on symptoms, self-report and observation. While valuable, this approach can be incomplete — it is akin to trying to repair a high-performance engine without ever opening the hood. By directly assessing the brain, we gain a clearer and more accurate understanding of the underlying issues.
We have seen this firsthand. One patient presented with what appeared to be severe depression and cognitive decline. Based on symptoms alone, treatment would have focused on psychiatric care. However, brain-based assessment revealed a hypoxic brain injury caused by undiagnosed sleep apnea — fundamentally changing the course of care.
At the same time, as we advance the science of treatment, we must not lose what has long been foundational to recovery: spirituality, connection and personal accountability. These elements provide structure and resilience, supporting long-term healing.
Equally important is recognizing the brain’s capacity for change. Through neuroplasticity, the brain can heal and adapt when treatment is properly aligned. With ongoing monitoring, we can track that progress, refine care in real time and better support-sustained recovery.
For years, the field has focused heavily on trauma, triggers and behavior. These insights are important, but they do not tell the full story. When we integrate brain-based diagnostics with whole-person care, we create a more complete and effective path forward — improving not only how we treat, but how people recover.
At the Becker's Fall Behavioral Health Summit, taking place November 4–5 in Chicago, behavioral health leaders and executives will explore strategies for expanding access to care, integrating services, addressing workforce challenges and leveraging innovation to improve outcomes across the behavioral health continuum. Apply for complimentary registration now.
