With demand for behavioral health services growing and legislation to expand access advancing in Congress, and with the move to value-based care and population health, hospitals are in a position to play a larger role in coordinating mental healthcare.
In 2014, nearly 44 million adults 18 and older in the U.S. suffered from some form of mental illness, according to the National Institute of Mental Health. Many of those people wind up in hospital emergency rooms, with physical or other manifestations of their disorder.
Several hospitals have developed roles for behavioral health specialists, but most of them are at the director level, says James “Jim” King, III, senior partner and chief quality officer and leader of the children’s hospital practice at executive search firm Witt/Kieffer.
As behavioral health evolves into an integral part of overall health and well-being, King sees the potential for a new C-suite role at hospitals and health systems — that of chief behavioral health officer (CBHO).
“Going forward, behavioral health will become an essential aspect of population health,” he says. To successfully integrate behavioral health into new delivery models and bring other leaders on board, the CBHO will need a unique set of attributes.
“A premium will be placed on soft skills,” says King. ”Collaboration will be one. The CBHO must bring together different forces and service lines in order to treat the whole patient.”
In addition, the CBHO will need to have influence and business savvy. “The new executive will need to think strategically and make behavioral health an engine of new successful care models,” he says.
To do their job well, the CBHO will also need psychiatric and related training and experience with the different areas his or her will touch — emergency medicine, mental health, and community outreach. And they will need to understand Medicare and Medicaid regulations and new healthcare models, such as accountable care organizations, King says. “Payments, especially for this demographic, will be central to the success of any behavioral health integration program.”
The CBHO must also be a fan of technology and its ability to bridge gaps in care to the benefit of patients. “When working with at-risk communities, providers should take advantage of ever opportunity to make it easier for community members to be in contact with a mental health professional,” King says. “At the very least, the CBHO should work closely with the CIO to ensure the technological infrastructure for integrating mental health outreach is in place.”
Marlene Maheu, executive director of the TeleMental Health Institute, says, “Most hospital physicians only think about referring a behavioral patient to a psychiatrist, and that’s a problem because we’re running out of psychiatrists. Patients can wait for days in hospital emergency rooms for a psychiatrist to release them or triage them to another hospital unit."
In fact, roughly 4,000 areas in the U.S. have been designated as having such a shortage — areas with more than 30,000 people per psychiatrist. Moreover, psychiatrists make up only about 2% to 5% of the behavioral care workforce, leaving 95% to 98% of that workforce being underutilized in the hospital environment, Maheu says.
With telehealth, consumers are connected with the people they need to talk to like substance abuse counselors, behavior analysts, or psychologists but not necessarily at the suggestion of a hospital, she adds. “There are lots of people who are available and yet … that full range of services is not made available to people going to the hospital, which is sad if the goal is to keep people out of the hospital.”
Hospitals that are considering adding a CBHO will need to have buy-in from other executives that the role is necessary and essential to the organization’s success, King says. He recommends that they consult with other health systems to learn how they dealt with similar changes.
Once the decision has been made to hire a CBHO, hospitals should approach this search as they would any other executive recruitment, according to King. Is there a strong mental health program already in place, or will the CBHO be designing and implementing the program from scratch? “Asking these questions will guide the search process for the new leader,” he says.