Expanding Mental Health Access Through Integration

It is easier to follow tradition than to embrace innovation, but doing so risks progress. This is no different from change, and change is inevitable. So we can either idly stand by as the foundation of our legacy erodes or recognize our past while raising pillars to progress. The Substance Abuse and Mental Health Services Administration defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” This process starts with hope for a future in which integrated care is not only safe and effective but also dignified.

Over 40 million people 12 years of age and older live with substance use disorders. Almost 52 million adults, or about 30% more overall, have mental health problems. Around 17 million people live with both. These are not just arbitrary estimates. They are an impetus for the national suicide hotline anticipated to go live later this year. In a press release by the Department of Health and Human Services last month, Secretary Xavier Becerra noted that strengthening these initiatives is a priority of the current administration. At the same time, they have likely increased exponentially during the pandemic.

While our understanding of treating substance use disorders and mental health problems has improved over the past two decades, our approach to treatment has not changed. The Minnesota Model was created in the 1950s and – at the time – revolutionized treatment of substance use disorders. Services were delivered collaboratively by professionals and peers in recovery themselves. This was a shift from the sterile medical approach in which the provider administered interventions or treatments to a largely uninvolved patient. Moreover, treatment became individualized and incorporated family involvement.

In the 1980s, patients hospitalized for chronic conditions were de-institutionalized. Providers and policymakers alike advocated for expansion of community programming. Their argument was well-founded as social isolation only worsened functioning. Yet, patients encountered countless challenges accessing care. They could receive treatment for either substance use disorders or mental health problems, not both. The expansion never occurred. The private payer mechanism administered by health insurance companies did little to alleviate this bottleneck. Substance use counselors remained distrustful of the medical model broadly and treating addiction with medications specifically. A large subset also believed that mental health problems were nothing more than a symptom of alcohol and drugs. Mental health professionals, on the other hand, contended that substance use was a failed attempt at self-medicating mental health problems. This arbitrary dichotomy would persist for decades to come despite mounting evidence that integrated treatment is the most effective approach to treating both.

Treatment integration using a collaborative approach is defined by a shared understanding that neither substance use disorders nor mental health problems take precedence (i.e., this is notwithstanding withdrawal management, however). Burdens must be distributed equitably across disciplines and providers. Communication must be streamlined so patients do not receive conflicting messages that otherwise leave them more confused.

A study using claims data in Ohio, for example, found that dual disorders treatment saved around $1.4 million in service costs for a group of 160 people. This has two important implications. First, the return on investment is relatively quick. People who received dual disorders treatment reported improved outcomes in 12 months or less. Total savings per person were over $1,000 across levels of care (e.g., individual, group, medical, housing, residential, crisis, and inpatient. Second, we can use data to develop person-centered eligibility criteria that predicts recovery with considerable accuracy.

We have to move beyond antiquated beliefs that adding mental health programming to substance use treatment, or vice-versa for that matter, makes interventions “integrated.” It did not in the late 1980s, and it certainly doesn’t now with only around 18% of addiction and 9% of mental health treatment programs nationwide being capable of delivering both effectively. So what do we do? We have to leverage data to making informed decisions. Integrated treatment can improve not only outcomes and the quality of life for people but also yield significant cost-savings. The answer to this question does not rest on more money but better utilization.

AssuredPartners is proud to hold a strong relationship with Hazelden Betty Ford Foundation (HBFF) through our AssuredExcellence program. The program adopts a bundled payment plan versus a fee for service program. 

The professionals at HBFF focus on employee mental health from the very beginning of the process. HBFF takes the employee from the initial stage (i.e., detoxification) through educational private and group classes, counseling, and providing the appropriate tools for each person to maintain positive mental health for a bright future. Employers that take advantage of our program are able to offer their employees access to this and other specialty facilities with no cost-sharing, while also saving on average 1/3 of the cost under a self-insured arrangement with a traditional group insurance program. This is a win-win! Contact the AssuredExcellence team for more information today.