Upstream solutions for mental health crisis

Claudia D’Allegri
Claudia D’Allegri

Most of the attention on our state’s mental health crisis has been focused on the downstream end of the mental health system. Focusing upstream as well is critical, because all pieces of the system work together. Prevention and early intervention give you the most for your money, and the Legislature can’t ignore them this session.

There are two investments the Legislature must make to shore up the early side of the mental health system. The first is to accelerate behavioral health integration in primary care for Medicaid patients, ensuring mental health and substance use issues are identified and treated when and where patients come in for medical health care.

The second is to make sure there are enough mental health providers in primary care settings to meet the demand for this care.

An immediate solution is to expand the Health Professional Loan Repayment program to include social workers, marriage and family therapists and psychologists, who typically provide behavioral health services in a primary care environment, but are now excluded.

These are targeted, modest investments that can’t wait. Washington state adopted a mandate to achieve behavioral health integration for Medicaid patients by 2020. To deliver on that goal, we need to get ahead of the curve and have the appropriate workforce in place. If we don’t start preparing now, this could become the next mental health crisis.

A common scenario in our clinics is a patient coming in because of diabetes or high blood pressure, and physicians identify symptoms of depression or heavy alcohol consumption. We can literally walk them down the hall during the same visit and connect them to help for their mental health or substance problem. It enables us to treat the whole person. If “non-medical” needs aren’t addressed, it’s difficult to manage their health, and their behavioral health conditions can spiral, resulting in expensive crisis intervention.

Community health centers have a hard time attracting providers to serve rural areas and underserved populations. Sea Mar Community Health Centers has 15 unfilled positions for behavioral health providers who don’t prescribe medication, such as social workers and psychologists. Statewide, there are more than 40 such vacancies at health centers. Including these professionals in the Health Care Professional Loan Repayment Program, which the Legislature wisely funded last year to address primary care workforce shortages, is a smart, immediate fix.

Prevention and early intervention don’t generate headlines, but we must pay attention to them. The mental health of our state is at stake.

Claudia D’Allegri is a licensed mental health therapist and vice president of behavioral health for Sea Mar Community Health Centers. Sea Mar’s network of services includes more than 50 medical, dental, and behavioral health clinics in 12 counties, including Thurston County.