Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis.
NBBJ: What is the most impactful change that could be made to how behavioral health is handled in the United States?
Dr. Gregory Miller: The development of a truly integrated system of care — not between behavioral health and physical health, but within behavioral health itself — is one change. Care for episodes of illness has become spread out between disparate providers, such as inpatient, partial hospitalization programs, outpatient, case management, etc. Often one team knows nothing about the real handoff information necessary to change the level of care smoothly. Delivering care from truly integrated systems would make a huge difference. In addition, community services need to be built out and invested in.
What is an innovative approach/treatment you — or another institution, city, state, country, etc. — are working on when it comes to behavioral health treatments?
The concept of Psychiatric Emergency Services, i.e. specialty mental health care that is immediately accessible, is an innovation that mostly benefits the severely mentally ill (SMI), a poorly-resourced population. It helps to rebalance the needs of the SMI population when community services are inadequate or poorly accessible. It should be seen as a temporary approach, providing access during a period of transition to more richly-resourced community services. When the community is adequately resourced, the need for such higher-end services will decrease.
Traditional behavioral health facilities are sometimes seen as socially isolating or unpleasant to the senses. How should the design of behavioral health facilities transform to better serve patients (and their families and visitors) and staff?
I like the design of progressively expanding “spheres of community.” For example, in an inpatient unit or subacute unit, the most intimate sphere of community is where one sleeps and tends to personal hygiene. Units where patient rooms are clustered internally with progressively expanding bands — such as an area for dining and group treatment, with activities that emerge into a larger sphere for consultation with providers, school service and family and visitation — tend to mimic life in the communities that we live in.
What makes you hopeful when it comes to combating the behavioral health crisis?
I am hopeful regarding the progression of knowledge and treatments. However, I am disappointed that care has become, over the course of my career, progressively more disintegrated and confusing. Systems do not converge to provide cohesive treatment. Patients are confused by the systems they are involved in. Providers, likewise, are confused. Hopefully this will be the next wave of progress.
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