Integrating Clinical and Mental Health: Challenges and Opportunities

Nearly 45 million American adults suffered from some form of mental illness in 2016. Although there is little change in the estimates of those with mental illness over the last few years, rates of death due to drugs, alcohol, and suicide are increasing. In 2016, about 45,000 Americans age 10 and over died by suicide. Twenty-five states experienced at least a 30 percent increase in suicide rates between 2014 and 2016.

The national opioid crisis has resulted in significant attention to federal policy associated with substance use disorder (SUD). Mental illness along with SUD comprise a broad category of illness commonly referred to as “behavioral health.” In 2016, 44.7 million American adults experienced a mental illness, 20.1 million experienced a SUD, and 8.2 million experienced both—and these numbers are likely underestimated due to lack of identification and issues of stigma. Collectively, more than 1 million people have died from drugs, alcohol, and suicide over the past decade. If these trends continue, the death rate could grow to claim 2 million more lives by 2025.

The purpose of this paper is to examine the barriers to the integration of clinical health care and mental health services, and to identify policy options for consideration in advancing integration of services. In 2018, the Bipartisan Policy Center hosted a series of public and private discussions on this topic. As part of this research, BPC consulted patient advocates; clinical and behavioral health care providers; federal, state, and county agency officials and staff; insurers; academics; and other experts. The goal was to identify barriers to integration caused by federal policy, to identify policy options to mitigate or remove those barriers, and, through policy changes, to advance evidence-based treatment for mental health in the United States.

The full paper can be downloaded below.