October 16, 2023
By now we’re aware that virtually every American city is aflame with a homelessness crisis that is mostly the product of mental illness and drug addiction, with some outrageous housing costs thrown in to keep the fire burning bright. Sure, the crisis is a lot more obvious if you’re in Portland or San Francisco, but it hasn’t really been effectively dealt with in any sizeable metro area.
In part, mental illness and addiction remain vexing issues in the United States because treatment is mostly still available only to those with significant financial resources. The bottom line is that effective treatment is so lengthy and expensive that health insurers do all they can to avoid providing coverage so as to protect their profit margins.
In essence, then, the private insurance industry has made the treatment of addiction and mental illness the tragic burden of individual families or the Sisyphean task of government at every level.
But it would be both unfair and inaccurate to paint the addiction and homelessness challenge as both unwon and unwinnable, at least in terms of making sure that care is available.
I’m talking about the Certified Community Behavioral Health Centers (CCBHC) model that has seen steady growth since the first facility opened in 2017. Currently, there are more than 500 CCBHCs across 46 states and the Biden administration has provided incentives for more clinics to adopt CCBHC status.
In some ways, this is a surprising development, as CCBHCs exist under bookend pressures: stringent requirements and challenging clinical issues. Sure, it can be hard to deal with patients when they’re only marginally cooperative and don’t take clinical recommendations seriously or medications regularly. It’s another thing entirely to try and heal a patient in the grip of unceasing delusion or ravenous addiction.
To meet the CCBHC requirements established by the Substance Abuse and Mental Health Services Administration (SAMHSA), organizations must provide crisis services 24/7, a broad enough range of additional clinical services to support the full range of patient needs, care coordination, and comprehensive reporting.
They must also take all patients regardless of ability to pay (CCBHCs are funded by Medicaid at a higher reimbursement rate), which suggests the seriousness of the nationwide addiction, mental illness, and homelessness problem.
Support for the CCBHC model is only one aspect of the current administration’s efforts to combat the addiction and homelessness epidemic. The president recently proposed new rules that would make it easier to enforce the Mental Health Parity and Addiction Equity act originally passed in 2008, arguing that any distinction between types of care misses the point.
“You know, we can all agree, mental health care is health care,” Biden said. “It is health care, it’s essential to people’s well-being and their ability to lead a full and productive life, to find joy, to find purpose, to take care of themselves and their loved ones. It’s about dignity.”
The American system of health coverage, however, does not see things quite the same way. In some ways, this is understandable when viewed from a business viability perspective. The addictive power of modern drugs and the complexity of treatment—the process usually has to include a host of socioeconomic and other factors, as well as unceasing commitment and resilience—make it different in terms of both quality and quantity from treating, say, high blood pressure. For some people, treatment could go on forever.
But the magnitude of the challenge now evident in American society makes leaving it to private insurance an unacceptable option, especially since the overwhelming majority of people suffering from mental illness and addiction receive no treatment at all. Those on the front lines of addiction and mental illness treatment go so far as to suggest that effective treatment requires substantial changes in terms of healthcare policy, how the police respond to drugs and mental illness, and management of social determinants of health.
Is it realistic to suggest that American society should engage in an overhaul in order to confront addiction, mental illness, and homelessness? One might say no, but then American society has been slowly transformed in recent decades by more powerful drugs, the offshoring of jobs, migration to urban areas, and increases in costs for healthcare, education, and other essentials. Why is it fantasy to suggest that coordinated, proactive efforts to deal with societal decay are doomed or unreasonable?
Which is why we should recognize CCBHCs for both their success and the initiative required to respond to daunting challenges.
On the success front, Syracuse, NY’s Helio Health went from serving 3,802 clients before moving to CCHBC status to caring for 8,054 patients in 2021. In Oklahoma, Grand Mental Health has reduced local inpatient psychiatric hospitalizations by 93 percent. Nationwide, 82 percent of CCBHCs offer more than one form of medication assisted treatment for addiction when only 56 percent of substance use clinics do the same.
When grouped with the roll out of the national 988 mental health crisis line and the impact of non-profit groups like Solari Crisis and Human Services, it’s possible to see a future in which American healthcare steps into the breach between care and crisis and American society understands fully the requirements of taking that step.
Of course, CCBHCs are not the answer to every challenge created by addiction, mental illness, and homelessness, but they are indicative of a certain ethic and recognition of reality when it comes to where America stands right now. May the spirit and ingenuity of CCBHCs inspire countless similar and similarly effective approaches to dealing with this modern plague.