Most efforts to address the behavioral health crisis focus on finding ways to succeed within the confines of the care delivery system we have in place today — which is valuable work! But to correct for flaws baked into the system’s foundation, we also need structural change.

Hopefully you’ve seen our research that boils down the dysfunction and inequity in our behavioral healthcare system to five root causes. (If you haven’t, I highly recommend you check it out — here’s a good starting place.) We’ve even come up with subsector — specific playbooks to help different stakeholders understand their roles in tackling these root causes. But in the spirit of being as action oriented as possible, our team has taken things one step further: we identified the three “rate limiting steps” needed to restructure our behavioral healthcare system. These are three goals that, if left unrealized, will hamstring all other efforts to strengthen our systems and address the crisis. In other words, they are mission — critical to achieving structural change in behavioral health.

To create structural change in behavioral health, we must:

1. Establish universal definitions of quality and recovery in behavioral healthcare.
   Because we don’t have universally accepted (and enforced) care standards and metrics for behavioral health conditions, patient care journeys vary drastically based on where a patient seeks care, which provider they see, and which insurance they have (or don’t have). This has meaningful ripple effects beyond the individual patient journey. Such inconsistency in treatment plans — including which services individuals can access, how, and when — makes it difficult to empirically evaluate treatment efficacy, which in turn makes it difficult to design evidence — based care and coverage plans. We need to get on the same page when it comes to the definitions driving care and coverage, including what is “necessary,” what represents “quality,” and what constitutes “recovery.”
2. Determine viable reimbursement rates for behavioral healthcare services and providers.
   There is a reason that most outpatient behavioral health providers choose to operate outside the insurance system — accepting insurance for behavioral health services often means providers operate at a financial loss. It’s tempting for other stakeholders to place blame squarely on payers — but the reality is far more nuanced. We need to improve our evidence base and data sharing practices and ultimately re-examine what constitutes “fair” reimbursement.
3. Reduce demographic disparities in behavioral healthcare access and outcomes.
   Despite the spotlight on both behavioral health and health equity in recent years, disparities in behavioral healthcare access and outcomes have persisted — and in some cases gotten worse. I think we can all agree level that your race, ethnicity, income, or ZIP code should not determine your access to high — quality behavioral healthcare. On top of the moral imperative to reduce disparities, the economic reality is also straightforward: if we don’t improve behavioral health for those experiencing disproportionate burden, we won’t improve outcomes — or lower total cost — overall. An effective behavioral healthcare system is an equitable one.

In February, we brought together 38 behavioral health leaders from across the industry to talk about why these goals are important, articulate what’s standing in the way of progress, and identify next steps we can take — independently and in partnership — to move the industry forward on each. Keep an eye out for an upcoming post where I’ll share what we learned from those discussions.