The Changing Health Policy Environment and Behavioral Health Services Delivery

• Published in: The Psychiatric clinics of North America Vol. 40; no. 3; pp. 533 - 540
• Main Authors: Medford-Davis, Laura N., MD, MS, Beall, Rakel C., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2017
• Subjects: Affordable Care Act (ACA); Criminal Law; Deinstitutionalization; Deinstitutionalization - statistics & numerical data; Drug abuse; Emergency Services, Psychiatric - trends; Health policy; Health Policy - trends; Humans; Insurance Coverage; Mental Health Parity and Addiction Equity Act (MHPAEA); Mental Health Services - legislation & jurisprudence; Opioid addiction; Patient Protection and Affordable Care Act; Psychiatric crisis; Psychiatric/Mental Health; Substance-Related Disorders; United States; Affordable Care Act (ACA); Drug abuse; Opioid addiction; Health policy; Mental Health Parity and Addiction Equity Act (MHPAEA); Insurance coverage; Psychiatric crisis; Deinstitutionalization
• ISSN: 0193-953X; 1558-3147
• DOI: 10.1016/j.psc.2017.05.013

Deinstitutionalization has left an inadequate supply of inpatient psychiatric beds. Simultaneous cuts to public funding and insurance coverage for outpatient mental health treatment have increased the frequency of acute psychiatric crises. The resulting lack of available options has shifted the burden of treatment to emergency departments and the criminal justice system. Recent legislation has improved insurance access, but rules are not always enforced and there are still few options for care. Discussion of mental health care delivery must acknowledge that many emergent behavioral health crises arise in the context of acute substance intoxication, withdrawal, or dependence.