As behavioral health systems move beyond the immediate post-pandemic push to expand care access, leaders across the industry are increasingly asking a more complex question: What does high-quality behavioral healthcare look like?
For Omar Fattal, MD, system chief of behavioral health at NYC Health + Hospitals in New York City, the answer goes beyond simply increasing capacity. It includes strengthening workforce training, improving continuity of care, expanding measurement-based treatment and ensuring patients remain engaged throughout their care journey.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: NYC Health + Hospitals is often the front door for patients across emergency, inpatient, outpatient and community settings. How are you ensuring those access points connect patients to consistent, high-quality longitudinal care?
Dr. Omar Fattal: One of the things we’re focused on is continuity of care. People are not able to navigate the healthcare system on their own, especially when you have severe mental illness or complex needs. So we’ve been thinking a lot about that, and one of the things that we’ve done is invest in our treatment infrastructure.
To create these programs that are innovative and are tailored for people who really need them, such as having extended care units where people can stay inpatient for up to 120 days, having our Bridge to Home program, which is a program that’s based in the community where people can live for up to one year in their own private room in a home-like environment and receive services and have us work with them on their permanent housing application and connect them with permanent housing.
So this is the idea of creating a pathway instead of siloed care.
And what that could look like for someone coming to our system — you can be homeless, you can be living in the subway and having severe mental illness. You can come to our common entry point. If you meet criteria for inpatient, then you can move on to an inpatient unit for acute care.
We can start you on medications, begin your stabilization and then we can move you to an extended care unit, where you can stay for up to 120 days, continue that stabilization, but more importantly, we can work with you to help you rehabilitate and be able to integrate back into the community.
The last part of that continuum is the Bridge to Home, where you can live in the community for up to one year and work with you on your housing application. So this is how a care journey can happen in a seamless way.
Obviously, this is not going to apply to every single person, but we want to create these pathways for those patients who can benefit from them.
Another way that we’ve been leveraging our system is working on our infrastructure for both inpatient and outpatient to be able to create more equitable access to care.
We have 11 acute care facilities, so we have Comprehensive Psychiatric Emergency Programs and psychiatric EDs in all these facilities, and we have inpatient beds in all these facilities. What we’re doing is using our centralized transfer center to move people from any one of our CPEPs to any one of our inpatient units, so we can make sure people who need inpatient care are receiving it regardless of which facility they arrive at.
The other thing that we’ve done recently is leverage our outpatient contact center by having one number that anyone can call to access an appointment in outpatient at any one of our facilities.
Traditionally, in the past, people had to call each individual clinic. We don’t want to put the burden on the patients to have to call around to see where they can get an appointment.
This way, we’re making it so much easier for them to call one number, and then we can determine, depending on their location and chief complaint and circumstances, to connect them with the best outpatient appointment that’s appropriate for them.
Q: There is often tension between lowering barriers to care and delivering standardized, high-quality treatment. How do you think about balancing these priorities, and what will distinguish the systems that truly get quality access right over the next few years?
OF: It’s definitely a very tricky balance.
To me, access and quality are not interchangeable. It’s not either-or. We have to be able to walk and chew gum at the same time.
But access is always going to be foundational. We do need access. In behavioral health, access could mean the difference between life and death.
So access is always going to be a foundation, and it’s always going to be important. In my view, getting care is always going to be better than not getting any care. But it’s not enough in and of itself.
We don’t really have a lot of tools in behavioral health, but we do have tools that we can use. And the key is not just to use those tools and make sure that we are tracking them, but also to make sure that that tracking and that information is making it back to the providers and the clinicians who are on the front lines.
In many cases, I see a little bit of a disconnect between the people who are providing the care and the people who are monitoring quality. What we want to do is bring those together very closely, so the people who are providing the care are also able to get that information about the quality of the care that they’re delivering in real time, so that informs their practice.
The other one is to increase the quality of services by bringing the services to the patients and modifying our services to meet the needs of the patients.
In our case, we have a few examples, but I want to highlight B-HEARD as one of the programs that we partner with the New York Fire Department on. It’s a 911 mental health response.
If you’re someone with a mental health crisis and you call 911, now you get B-HEARD in many areas in New York, and that allows you to interact with a social worker and an EMS worker instead of a traditional response, which is New York City Police Department and EMS.
And what that results in is you getting services in the community almost 50% of the time and eliminates the need to go to an emergency room. This is a way that we can bring services to patients and do it in a setting that’s more appropriate for them.
Another example of something we’re working on along those lines is our domestic violence mental health shelter work. We have embedded mental health workers in more than 50 domestic violence shelters across the city.
Survivors of domestic violence face a lot of barriers to receiving care, including the need for anonymity and higher layers of confidentiality. So by going to them, we’re actually removing a lot of these barriers.
And the last one is patient engagement. I think that one is very closely connected to quality because, again, you can provide excellent care, you can have the best team, you can have the best-trained staff, the nicest facilities and the most high-quality care, but if the patients are not engaged in that care — if they come to one appointment and then they don’t come back for follow-up — then obviously you’re not providing quality care.
In our case, one of the things that we’ve been doing is embedding community health workers in our different care settings so that they can work closely with our patients to make sure that they’re staying in treatment.
We’ve deployed five critical time intervention teams. These are teams of up to 10 workers who work with patients after discharge for up to nine months to make sure that they are connected with care and that they stay with care, to also minimize coming back to the facilities and the ER.
We’ve also implemented the Peer Bridger program in our CPEPs. These are certified peers that meet with our patients while they’re in the CPEP to try to engage with them and then follow up with them after discharge to make sure that they are successful in their treatment in the community.
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.
