The COVID-19 Pandemic has forever changed the world of behavioral health.
Before the COVID-19 pandemic, behavioral health needs were on the rise, and these needs exploded during the pandemic.1 Of note, there was simultaneously a significant reduction in the utilization of behavioral health resources. For example, from April 2020 through October 2020, there was a 64% decrease in behavioral health service utilization, inclusive of all ages and demographic subgroups.2
At first glance, these figures seem contradictory. How can behavioral health needs be rising, but utilization is falling?
The answer is most likely due to a system that was antiquated and ailing prior to the pandemic and is now ready to collapse. Pre-pandemic, our behavioral health systems were facing workforce shortages, disconnected siloes of care, ineffective access points and financial models that failed to keep up with the changing world of behavioral health. All of this has led to a system where some cannot access care at all, others must wait unreasonable lengths of time for care, and everyone is confused about how to access appropriate care. This reality has led many individuals to throw up their hands in frustration and ultimately give up on help.
On the one hand, this seems likes a crisis of the greatest degree. On the other hand, however, there are some opportunities for positive and sustainable change. The weight of this reality has pushed behavioral health front and center and, as a result, there are a few initiatives that many believe will greatly improve our current systems of care. I will point out only a few of the initiatives.
The first initiative to watch closely is the California Medi-Cal reform initiative titled “CalAIM.”3 One interesting and hopeful aspect about CalAIM is the focus on payment reform. The major benefit here is that this reform may increase access to higher levels of care which previously were difficult to access due to administrative complexity and not necessarily a lack of funds, or purely financial resource issue. Another component is the “no wrong door” policy. This policy increases access to care. No longer will patients need additional diagnoses and additional assessments or appointments before they can access the behavioral health care they need. CalAIM also brings forward new services such as Enhanced Care Management teams. These interdisciplinary teams include community healthcare workers and focus on supporting individuals through the complex systems of physical, behavioral and social resources systems. Altogether, CalAIM seems promising for its potential to increase access and utilization of care for those that receive Medi-Cal.
Second key initiative is the California Department of Healthcare Services Behavioral Health Continuum Infrastructure Program (BHCIP).4 This $2.2 billion program is focused on building behavioral health infrastructure throughout the state. Currently, this program has paid out over $1 billion to nearly a hundred projects across the state. These projects range from new behavioral health wellness centers to new inpatient facilities, residential facilities, etc. An additional $480 million will be given out early this year. The 6th round of funding is planned but delayed due to the current California budget deficit.
Both of these two large projects are hopeful, but one additional problem exists. A problem that, if left unsolved, will make these other initiatives irrelevant: the ever-growing workforce shortage. To this end, the California Department of Health Care Access and Information (HCAI) is investing heavily in financial incentives intended to help retain our current behavioral health force professionals as well as encourage the future workforce. In this fiscal year, for example, HCAI will award multiple workforce grants targeting various professional subgroups and areas of behavioral health.5
These three major initiatives are only a part of the efforts out there. There are many more programs and activities, including other state level initiatives as well as federal and private programs. Whether these initiatives help rebuild an ailing system is yet to be seen, and, more realistically, the devil is likely in the details when it comes to how effective these program will be in the long and short term.
The bottom line is that a major behavioral health crisis is in full swing as the pandemic pushed our ailing systems to a breaking point. However, the silver lining is that this moment in time has been noticed. There are many efforts underway to not just revive our behavioral health system, but also to reinvent them. Healthcare, government, education systems as well as our communities will feel these effects soon and for a long time to come.
Brian Distelberg, PhD
Dr. Distelberg is the Director of Research at the Behavioral Medical Center and is also a Professor of Counseling and Family Sciences for the School of Behavioral Health. His research interests include behavioral health integration, chronic illness and mental health, housing, and healthcare systems.
- Coe, Erica. Insights on Utilization of Behavioral Health Services in the Context of COVID-19, June 15, 2021. https://www.mckinsey.com/industries/healthcare/our-insights/insights-on-utilization-of-behavioral-health-services-in-the-context-of-covid-19
- American Hospital Association. (2023). TrendWatch: The impacts of the COVID-19 pandemic on behavioral health. https://www.aha.org/system/files/media/file/2022/05/trendwatch-the-impacts-of-the-covid-19-pandemic-on-behavioral-health.pdf
- California Department of Health Ccare Services (2023) CalAIM Behavioral Health Initiative. https://www.dhcs.ca.gov/Pages/BH-CalAIM-Webpage.aspx
- California Department of Health Care Services (2023). Behavioral Health Continuum Infrastructure Program. https://www.dhcs.ca.gov/services/MH/Pages/BHCIP-Home.aspx
- California Department of Health Care Access and Information (2023). https://hcai.ca.gov/loans-scholarships-grants/grants/bhp/