Last month, Governor Charlie Baker announced a bold omnibus health care proposal that could significantly enhance the lives of the underserved in our community. The proposal would place much greater emphasis on wellness and mental health, requiring health care providers and insurers to increase their spending on addiction services, behavioral health, primary care, and geriatric services by 30 percent over the next three years.
As primary care providers who have been working on the front lines of health care for a combined 60 years, we find this bill to be, in many ways, music to our ears. Experience and research show that in communities that have access to primary care, populations are healthier and the cost of spending is lowered. In states like Rhode Island, for example, bold increases in primary care have been instituted and in just a few years, the early outcomes have been highly promising — including improved health outcomes and lowered total cost of care.
Nationwide, an increased focus on behavioral health has also had irrefutable benefits. Behavioral health, a relatively new field that addresses both psychiatric and addiction disorders, seeks to address the needs of the 1 in 5 American adults suffering from a behavioral health disorder, including nearly 20 million suffering from substance use disorders and nearly 11 million suffering from a serious mental illness.
A recent study calculated that Massachusetts spends a great deal on serious mental health conditions — $2.8 billion a year. The state also has the highest number of behavioral health practitioners per capita in the country. Even so, over a quarter of individuals with a behavioral health disorder report not receiving the care they need. Over 40 percent cited cost as the primary barrier. One reason: More than half of behavioral health practitioners in the state do not accept insurance. The bill Governor Baker proposes specifically tries to bridge this gap in access by, among other things, working to have more behavioral health care providers take insurance, including Medicaid.
Our psychiatry department at Boston Medical Center, as well as others around the state, has made enormous and important strides in addressing the mental health needs of patients. However, as primary care clinicians and educators working with teams integrating behavioral health into community health centers that accept all insurance, we would argue — and statistics would support — that insurance coverage access is only the beginning.
In communities where trauma, depression, violence, poverty, and substance use disorders run deep, there are other, continuing barriers to access. To put it bluntly, our behavioral health system is broken.
Barriers that need to be fixed include improving the availability of behavioral health services in racially and ethnically diverse neighborhoods, addressing the cultural competency of providers, reimbursing for telephone engagement, integrating more behavioral health services into other community agencies such as housing, prison systems, and education, and training and hiring nonprofessional staff from the community.
While reimbursement is important, good evidence is available to truly start to address these other barriers. We need to invest outside the walls of the clinics and hospitals and focus on training behavioral health providers and community leaders in culturally competent care, embed behavioral health services in social services, and have telephone or e-consultation for behavioral health become universally practiced.
As the Legislature considers Governor Baker’s proposals, we hope that they turn to the communities in need and ask for their wisdom and guidance on how best to invest any increased behavioral health spending so that we may continue to decrease health disparities in our state.
Dr. Katherine Gergen Barnett is residency director and vice chair of Primary Care Innovation and Transformation, Department of Family Medicine, at Boston Medical Center. Dr. Barry Zuckerman is professor and chair emeritus, Department of Pediatrics, at Boston Medical Center.