When Bob Dylan wrote this iconic song, many felt that it captured
the spirit of social and political upheaval of the 1960s, much in the same way
that we view mental health as “a-changin'.” And these changes require
mental/behavioral health providers to change the manner in which they deliver
Reports over the past
decade have brought attention to the current mental health crisis:
In addition, over the
past few years far too many catastrophic events have brought attention to this
mental health crisis, resulting in a public outcry, demanding that changes are
made to prevent future tragedies.
But change isn't easy.
The relatively brief
history of community mental health services has been a challenging one. Just a
few months ago, as we celebrated the 50th anniversary of President John F. Kennedy's signing the
Community Mental Health Bill into law, the
conversations quickly progressed to the subject that is on the minds of
virtually all behavioral health providers—and an unusually large number of the
general public and policy makers, given the historical lackluster interest in
the topic—mental health is in dire need of change.
The economic downturn in
the US in 2008 resulted in massive budget cuts in all but a few states.
The March 2011 NAMI report, State Mental Health Cuts: A National Crisis, demonstrated the cumulative cut to mental health services
in the U.S. during that time was nearly $1.6 billion. Community mental health
services plummeted from being barely adequate to the critical point in many
states. Safety-net providers were forced to close programs due to the slashed
budgets. Many of those affected ended up on the streets or in jail.
The recent announcement
on the anniversary of the Sandy Hook tragedy, of
the planned infusion of dollars into help repair our broken mental health
system, is encouraging. However, the entire mental health system is in dire
need of an overhaul. One that looks at the broader healthcare picture and
strategically plans for mental health and substance use disorder treatment to
be included. A person-centered, whole health approach to treatment is necessary
for improving the patient experience of care; improving the health
of populations; and reducing the per capita cost of health
care: the Triple Aim.
Dr. Dale Klatzker knows that,
although it isn't easy, change is vital for community behavioral health
It’s exciting to be able to offer a look at integrated care from the perspective of a provider, particularly a provider who has demonstrated leadership excellence in integrating behavioral health and primary care services. Dr. Klatzker currently serves as the Chief Executive Officer of The Providence Center in Providence, Rhode Island. He has been a leader in behavioral healthcare for more than 35 years. Since becoming president/CEO of The Providence Center in 2004, Dr. Klatzker, a visionary, has transformeWe need to be proud of what we do, but also to expand it and extend itd the system of care, quality of service delivery, and social policy decision making at The Providence Center and the state of Rhode Island. Click here for Dr. Dale Klatzker's bio.
a good thing. Most CMHCs haven’t changed a lot. They haven’t prepared
themselves to change a lot and have marginalized themselves and the people that
they serve by not being more a part of the mainstream. We have sets of skills
that are integral to wellness and to health across a wide spectrum. We need to
be proud of what we do, but also to expand it and extend it because this is the
perfect time for this. We have a lot of things to offer that others are trying
don’t stay static. You have to look though the windshield but also through the
rear-view mirror. You have to know where you are but you also have to know
where you’re going.
executive director/CEO of a behavioral health organization, you have the
obligation to push yourself, and that will push your organization, to do what
is necessary so that your mission is reinforced but also to serve the needs of
the community. It’s hard to do that if you’re doing the same thing you did 20
years ago. We do our consumers a disservice if we do that.
We need to be proud of what we do, but also to expand it and extend it
approach to care
Klatzker: What we’ve embraced here
– what’s part of the DNA of the organization at The Providence Center –
we believe in a person-centered approach to care. No two people are
exactly the same. The people that we work for deserve as much access to a wide
array of both health and social supports as anyone. That’s how you have to
guide yourself. When you’re thinking of those things, primary care integration,
working much more toward the mainstream of traditional healthcare is imperative
we’ve found is, if you can build those relationships and find the right
connections, then others will embrace you and value you for what you bring to
the table. In fact, we bring a lot. Partnership is always the first choice, the
We don’t chase dollars, we don’t create programs because it’s the idea du jour from some funder somewhere, we consciously look on our mission as our touchstone and build upon that to provide as much choice to the people we serve. We can be very person-centered because there aren’t many gaps in what we’re providing. (They provide a wider array of services than the average CMHC) We’ve consciously built out a wide array because we think it’s the right thing to do. Rather than to take a “no,” if we can’t partner, we build.
Example of a successful integrated care partnership Dr.
Klatzker: The Providence Center is
closely connected to one the largest federally qualified health center in the
state of Rhode Island, the Providence Community Health Center. We have
become the largest community mental health center. Neither had a desire to
replicate the services that the other provided. Over the years we’ve built this
into a “no wrong door” integrated collaborative effort so that in the mental
health center, the FQHC runs a full-service practice with 1100-1200 patients.
In the FQHC, we are integrated in their physician practices building and we
also have a separate section of their building where we provide longer term
care and some other types of specialty care. We’ve integrated our records with
each other. We meet frequently to process and to try to figure out how to make
our care efficient and effective. We are working closely with them now on
adopting our health home model to integrate a modified health home into the
Yes, the times they are a-changin'. And so are healthcare providers. (At least the forward-thinking providers like The Providence Center.) They are heeding the findings from the numerous expert reports and research. They are thinking outside the box, adopting a person-centered approach that enables better outcomes for the many who place their trust in them—trusting them to take care of their whole-health needs.
Cheryl Holt, MA, CEO of Behavioral Health Integration Consulting, LLC, is an advocate for the integration of behavioral and primary healthcare for whole-person health and assists organizations in adopting a whole-health focus. She is active in social media promoting integrated care, behavioral health policy, and global mental health. She blogs regularly via the Behavioral Health Integration blog and manages LinkedIn's Behavioral Health Integration group and the Behavioral Health Integration page on Facebook. You can follow her on Twitter: @cherylholt, @BHPCIntegration, and @WorldMentalHlth
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CFHA is a member-based organization dedicated to making integrated behavioral and physical health the standard of care nationally. CFHA achieves this mission through organizing the integrated care community, providing expert technical assistance and producing educational content.