The federal parity law of 2008 was an outstanding achievement that brought many complex changes to behavioral healthcare. Fights will continue for many years over its implementation. As the most noteworthy effort by our field in generations to improve our standing in the world, it was quite limited.
Parity legislation was designed to bring coverage for behavioral healthcare up to the level set for medical/surgical care. This was necessary and right, but essentially an elaborate effort at playing catch-up. I would argue that the behavioral healthcare industry should aspire to more than catching up.
The industry is represented by the various segments that comprise it. There are consumer advocacy groups, professional associations and an array of specialized groups representing the interests of each sector of the industry.
Our industry needs a common voice, not for industrywide lobbying or sales promotion, even though these activities will be well served by better general marketing. A collective viewpoint can elucidate our industry’s tremendous value since people have fragmented, distorted and jaundiced views today.
The recitation of statistics on the prevalence and burden for behavioral health conditions is a common point of orientation. These numbers tell an impressive story. Unfortunately, numbers propel few people with competing interests into action. We all face statistical fatigue in healthcare.
A compelling case can be made to do more for every major disease state. Statistics are used to boost everything from public understanding to private sales to new legislation. Everyone’s numbers call out for more action, but a new message must be found to compete in a world of worthy causes.
There are several messages and slogans put forward by segments of the behavioral healthcare industry that must be respectfully set aside. For example, messages around stigma and coordinated care are important, but messages for internal stakeholders do not necessarily advance the industry externally.
What is extraordinary about behavioral health must be our focus. Our goal is to tip the scales so that any discussion of priorities about healthcare starts with behavioral health in a position of primacy. Integrating into the larger healthcare system should not be our top priority.
Integration into the delivery of primary care is positive, but it is more important to recognize that behavioral health issues drive most PCP visits. Accordingly, behavioral health issues must be the top priority for identification and triage in the primary care setting.
Physical health is important for many reasons, one being its contribution to a sense of wellbeing. Our field provides expertise in calculating how any healthcare service contributes to wellbeing, and this critical metric is a measure of the psychological wealth of individuals and societies.
We need to get out of behavioral healthcare silos, and this means connecting overall industry messaging with subsidiary messages. For example, recovery and resiliency is important for those with serious mental illness, and this population needs a unique health home. What is critical for health homes?
The first principle for a health home should be recognizing that behavioral health issues are the most prevalent, representing everything from chronic stress to psychosis, and the fundamental goal is to increase wellbeing by addressing the physical, emotional, and practical components of wellbeing.
When communicating about the primacy of behavioral healthcare, it quickly becomes apparent that no single patient population, delivery system, funding stream, or advocacy group takes priority. We should always strive to position our societal marketing messages to address the common interests of all people.
Everyone cares about behavioral health in a way that they don’t care about other conditions. It is personal for all of us. Diabetes is important, but not everyone cares about it or is impacted by it. We all know what it is like to be sad or worried, and we all want the strongest sense of wellbeing possible.
Behavioral healthcare owns the primary, preventable source of health problems – health behaviors – and it is the driver of most doctor visits. Its primary goal – an increase in wellbeing – is the ultimate reason we pursue all health goals. Eating and moving for a healthy body enhances our wellbeing.
We need to offer people a view of our field from 30,000 feet – it is vital, misunderstood, and underfunded, with untapped capacity to impact the health, wellbeing and economic prosperity of the country. Let’s get out of our silos and show that we can help meet the overall needs of society.
Arguments for the primacy of behavioral healthcare are persuasive, and they should be used to increase funding from all sources. Increased funding is critical. Funding discussions should not get sidetracked by debates about how to deliver and organize services. Those questions are important, but secondary.
Marketing the value of behavioral healthcare at a societal level will only be successful by owning the terms of the debate. Physical healthcare leaders typically divert discussion to how we might better integrate with their services. Our field has long accepted that challenge to its detriment.
Top priorities get funded first and we are not a top priority today. Behavioral healthcare is by turns a compliant or resentful stepchild. Successful marketing on a societal level starts by repairing old narcissistic injuries. Once grounded in a strong sense of our worth, we can begin a conversation.
In the spirit of needing to spend money to make money, I propose an industry marketing campaign that gets funded by each industry segment. It has credibility to the extent that it is not owned by any one segment. A model for this is lobbying for parity. Industry segments collaborated well to pass this law.
Let me close with an example. Medication-assisted treatment (MAT) is a critically needed component in confronting the opioid crisis. That message is often muffled and misrepresented today, but the problem is as much ignorance about SUD treatment as MAT. We must confront ignorance about SUD, SMI, and all our acronyms together, rather than from within each behavioral healthcare solo.
We will have more success advancing our policies, programs and products if done within the context of how we meet the needs of society overall. The behavioral healthcare industry has a powerful societal message that needs refinement and promotion. Let’s collectively develop and spread that message.
Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.