This is one section of Modernizing Behavioral Health Systems: A Resource for States. See the full resource guide.
The graphic below provides a high-level framework for a modernized behavioral health system. The conceptual frame synthesizes key components of a behavioral health continuum of care and cross-cutting principles from expert input and best practice approaches.
Experts identified the organizing principle for a modern behavioral health system as one in which people get “what they need, when and where they need it.” This moves away from a disconnected and under-resourced system with limited access to high-quality interventions.
The principle harkens to the core vision of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) “Description of a Good and Modern Addictions and Mental Health Service System” that outlines the essential services needed for a “transformed and integrated system” and provides clarity, guidance, and support to federal and state agencies involved in regulating, purchasing, expanding, and financing services. This resource rests on that vision and reflects the evolving behavioral health landscape. The framework is organized into general areas of intervention across the continuum of care (or “buckets”). The high-level buckets and cross-cutting principles reflect both child- and adult-serving systems for people at risk of or with identified behavioral health needs.
Strategic Considerations for State Officials Undertaking Behavioral Health Modernization
The following are key elements of a state government approach to systems modernization that were gleaned from the state examples provided herein. As state policymakers prepare for or update their modernization efforts, they may consider lessons provided by national and state leaders offered below.
- Align programs and investments. Cross-agency alignment drives a holistic approach to changing the trajectory of the behavioral health crisis. State Medicaid programs, behavioral health authorities, public health, departments of insurance, human and social service agencies, departments of education, departments of corrections, housing, and employment can collaborate to align overlapping efforts, align policies, and braid funding and accountability mechanisms.
- Pursue a comprehensive data strategy. A comprehensive data strategy underpins effective targeting of need, resources, and implementation and accountability approaches. Data collection, sharing, and integration across state agencies moves siloed efforts to whole person/whole of government data-informed policy approaches. Further, data exchange among agencies, providers, and community-based organizations (CBOs) is instrumental to successful program and policy implementation and evaluation. Quality improvement and evaluation approaches can capitalize on outcome metrics associated with improved access to high quality care.
- Foster intergovernmental and external partnerships. Routine transparent information exchange and collaborative policy design with key partners facilitates improvements. Key partners include consumers of services, as well as providers, payers, CBOs, employers, and academic institutions.
- Leverage payment and delivery approaches. Payment and delivery approaches that incentivize evidence-based interventions and equitable access to care reshape system investments and drive change. Value-based approaches for behavioral health that mirror progress made in other parts of health care, such as primary care, are needed for long-term system change.
Acknowledgement
NASHP expresses its gratitude to the Commonwealth Fund for generously supporting this resource and to the Behavioral Health Modernization Learning Collaborative for their active involvement.
Special appreciation goes to state leaders and experts including Suzanne Fields and Rebecca Boss who contributed valuable input and feedback to this resource. The strategies and examples within were identified through rigorous research, informational interviews with leaders in state public health, mental health, substance use, Medicaid, and related agencies. This collaborative effort involved a state leader workgroup, expert-informed multi-state convenings, and focused technical assistance with five states. NASHP also thanks Josh Rohrer for his contribution to this resource while on staff at NASHP.
