Objective 1.4: Drive the integration of behavioral health into the healthcare system to strengthen and expand access to mental health and substance use disorder treatment and recovery services for individuals and families

HHS supports strategies to drive the integration of behavioral health into the healthcare system to strengthen and expand access to mental health and substance use disorder treatment and recovery services for individuals and families across all settings.  HHS is enhancing the ability to serve those in need of behavioral health services by exchanging data, information, and resources while expanding evidence-based integrated systems of behavioral and physical healthcare to improve equitable access to quality care.  HHS is also engaging and educating healthcare providers, healthcare professionals, paraprofessionals, other health workforce professionals, and students in these professions to build their practice competence and capacity to address the behavioral and physical health needs of individuals, families, caregivers, and communities. 

Objectives represent the changes, outcomes and impact the HHS Strategic Plan is trying to achieve.  This objective is informed by data and evidence, including the information below. 

• In 2019, suicide was the 10th leading cause of death for individuals of all ages in the United States.  Broken down by age, suicide is the second leading cause of death for individuals ages 10–34 and the fourth leading cause for those ages 35–54.  (Source: Suicide Mortality in the United States, 1999–2019)  Rates of depression, suicidal thoughts, and suicidal behaviors are high among all college students, rates are higher among teens and young adults identifying as a sexual minority (referring to sexual orientation) or gender minority (referring to gender identity).  (Source: Differences in Suicide Risk Among Subgroups of Sexual and Gender Minority College Students)  Similarly, treatment for depression among adolescents ages 12–17 increased from 37.8 percent in 2005 to 43.3 percent in 2019.  (Source: 2019 NSDUH Annual National Report)  Suicide and drug overdose are also two of three leading causes of pregnancy-associated deaths.  (Source: Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence)
• The overdose crisis has continually evolved and escalated, including during the COVID-19 pandemic.  (Source: U.S. Department of Health and Human Services Overdose Prevention Strategy)  In 2020, 91,799 drug overdose deaths occurred in the United States, which is a rate increase of 31 percent over the previous year.  (Source: Drug Overdose Deaths in the United States, 1999–2020)  Provisional data from CDC’s National Center for Health Statistics indicate that this upward trend has continued into 2021, as estimates of drug overdose deaths in the United States first topped over 100,000 during the 12-month period ending in April 2021.  (Source: Drug Overdose Deaths in the U.S. Top 100,000 Annually)
• Concerning trends have been noted among racial and ethnic minority populations.  From 2018 to 2019, opioid overdose deaths rose sharply among African Americans.  (Source: Opioid overdose deaths rise among Black Americans)  Methamphetamine use and use disorder increased between 2015 and 2019 for American Indians/Alaska Natives and African Americans.  (Source: Methamphetamine-involved overdose deaths nearly tripled between 2015 to 2019, NIH study finds)
• There are substantial differences in mental health service utilization between non-Hispanic White adults and other racial/ethnic groups.  These differences may result from structural barriers, such as lack of transportation, low availability of care providers, cost, and insurance barriers.  (Source: Racial/Ethnic Differences in Mental Health Service Use among Adults)

Contributing OpDivs and StaffDivs

ACL, ASPE, AHRQ, CDC, CMS, FDA, HRSA, IHS, NIH, OASH, OCR, OGA, and SAMHSA work to achieve this objective.

HHS OpDivs and StaffDivs engage and work with a broad range of partners and stakeholders to implement the strategies and achieve this Objective.  They include: the Duke Margolis Center for Health Policy, National Drug Control Strategy Recovery Chapter, Opioid Rapid Response Program (ORRP) Interagency Collaboration, Reagan-Udall Foundation, and Substance Abuse and Mental Health Service Administration Technical Advisory Committee.

Strategies

Strengthen a fragmented behavioral and physical health system to reduce costs, enhance quality care and patient and consumer experience, and improve mental health and substance use disorder outcomes for individuals, families, and caregivers

• Use existing policy levers to encourage clinically-effective integrated care models (e.g., financial incentives to support multidisciplinary team care or co-location of services.).
• Increase equitable access to care, including bi-directional integration, where physical and behavioral health providers coordinate and deliver care, wrap-around services, and expand telehealth options.
• Examine how science, data, and evidence support and inform programs and policies across HHS that prioritize behavioral and physical health integration.

Expand evidence-based integrated systems of behavioral and physical healthcare to improve equitable access to quality care

• Assist states and communities with the development and implementation of effective  365/24/7 crisis services and systems, including quick, easy, and reliable access to emotional support and crisis counselling, community-based mobile crisis intervention services, and community-based crisis stabilization services outside of emergency care settings.
• Expand payment models to support integration of behavioral health and physical healthcare to include other qualified provider types and modalities, including telehealth, across HHS healthcare programs and public payers.
• Support states, tribal, local, territorial, and rural communities to access and develop resources and processes to facilitate wider use of effective evidence-based integrated care models.
• Promote the development of effective educational resources and dissemination approaches to improve public understanding of mental and substance use disorders and when to seek treatment, with a focus on efforts to effectively address overdose death, death by suicide, and non-fatal self-harm.

Connect physical health and behavioral health communities to enhance the ability to serve those in need of integrated health services by exchanging data, information, and resources

• Facilitate collaborations with health officials, behavioral health authorities, and national provider networks to develop sustainable activities and pathways to integration with common performance measures that help to achieve standards of excellence in integrated care.
• Identify opportunities to expand linkage and use of electronic health records and other related data to identify unmet needs and help improve access, equity, quality, and value.
• Promote research to build the evidence base and inform best practices, including implementation science research to support the scaling up of effective models to identify and treat behavioral and physical health issues of individuals in all healthcare settings, including primary care.
• Strengthen health equity research to highlight the diversity of populations, communities and researchers and to ensure that evidence-based treatments are available across race, ethnicity, national origin (including primary language), sex, sexual orientation, gender identity, pregnancy, geographic location, and other demographics.

Engage and educate healthcare providers, healthcare professionals, paraprofessionals, other health workforce professionals, and students in these professions to build their practice competence and capacity to address the mental health and substance use disorder needs of individuals, families, and communities

• Support a health workforce including community health workers and peer support specialists knowledgeable in behavioral and physical health interdisciplinary care.
• Enhance the capacity of physical health providers to assess, screen, and treat behavioral health conditions by increasing access to treatments for substance use disorders and other disorders and assisting behavioral health providers to coordinate with individuals, families, caregivers, and communities on physical health needs.

Performance Goals

The HHS Annual Performance Plan provides information on the Department’s measures of progress towards achieving the goals and objectives described in the HHS Strategic Plan for FY 2022–2026.  Below are the related performance measures for this Objective. 

• Number of people trained for the support of the recovery community organizations and peer support networks
• Increase the cumulative amount of publicly available data on 1) Opioid-Related Hospital Use and 2) Neonatal Abstinence Syndrome (NAS).
• Number of providers who have provided Medication-Assisted Treatment
• Number of outreach events to provide training and technical assistance to healthcare providers, healthcare professionals, and paraprofessionals on providing healthcare services free of disability discrimination against persons receiving medication assisted treatment (MAT) for substance abuse disorder and on protecting the confidentiality and care coordination of behavioral health through HIPAA

Learn More About HHS Work in this Objective

• Behavioral Health Coordinating Council: An HHS-wide collaboration with the primary goal to facilitate collaborative, innovative, transparent, equitable, and action oriented approaches to addressing the HHS behavioral health agenda.
• HHS Overdose Prevention Strategy: The strategy embodies HHS’s reinvigorated efforts to strengthen prevention and treatment, as well as its more recent commitment to robust harm reduction and recovery support services.  The strategy recognizes that addressing the overdose crisis requires a multifaceted and integrated approach spanning public health, healthcare, human services, and many other sectors.  The Overdose Prevention Strategy includes four priority areas: Primary prevention, Harm reduction, Evidence-based treatment, and Recovery support.
• Integrated Behavioral Health Resources Library: HRSA sponsored resource center on integrated health related topics.
• Information About Naloxone: Naloxone is a medication that rapidly reverses the effects of opioid overdose and is the standard treatment for overdose.  The FDA approved a higher dose of naloxone hydrochloride nasal spray product to treat opioid overdose which increases the previously sanctioned doses from 2 and 4 milligrams (mg) to 8 mg of naloxone that can be delivered into the nasal cavity.  If naloxone is administered quickly, it can counter the opioid overdose effects, usually within minutes.  A higher dose of naloxone provides an additional option in the treatment of opioid overdoses.
• Medicaid Guidance on the Scope of and Payments for Qualifying Community-Based Mobile Crisis Intervention Services authorized by section 9813 of the American Rescue Plan Act of 2021 (ARP) (Pub. L. 117-2): CMS is working with states to promote access to Medicaid services for people with mental health and substance use disorder (SUD) crises. Authorized under President Biden’s American Rescue Plan (ARP), states have a new option for supporting community-based mobile crisis intervention services for individuals with Medicaid. Mobile crisis intervention services are essential tools to meet people in crisis where they are and rapidly provide critical services to people experiencing mental health or substance use crises by connecting then to a behavioral health specialist 24 hours per day, 365 days a year. This new option will help states integrate these services into their Medicaid programs, a critical component in establishing a sustainable and public health-focused support network.
• SAMHSA Strategic Plan FY 2019–FY 2023: Provides the roadmap for SAMHSA to fulfill its vision and mission in five priority areas with goals and measurable objectives.