Community Behavioral Health Centers: Better Help Than BetterHelp

It was inevitable. COVID was going to irreversibly change the landscape of

mental health around the world. Mass isolation and the constant threat of a terrible

death, combined with the boiling over of rage from civil injustice and political turmoil,

created the perfect breeding ground for profound and long-lasting post-traumatic

effects. As depression and SI rates rose, and sentiments on both sides of the political

divide reached a fever pitch, mental healthcare facilities found themselves stretched

further beyond their capacities than ever before. This was felt most strongly in

community clinics, where waitlists began to top 100 people or more and intake

departments had to regrettably turn away new clients because of capacity.

And then came the rise of therapy apps. BetterHelp, Headway, Talkspace. From

the depths of capitalism rose an answer to the growing need for therapy that could be

conducted in a COVID-safe and nearly on-demand manner. These platforms contracted

with largely private practice therapists who were already being forced to work through

telehealth only, and turned their services into an easy access commodity. This has not

been a perfect process, as criticism1,2 over relationship quality, session effectiveness,

appropriate clinical boundaries, and a vast overburdening of clinicians have all led to

resistance to engage in this Psychology as a Service model. It has left some clients

disillusioned and laboring under misconceptions of therapy, and is contributing to

clinician burnout on a larger scale, especially since pay rates are often dependent on

1
https://www.thecut.com/article/mental-health-therapy-apps.html
2
https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2009.09071012
maintaining massive caseloads and productivity requirements. The tradeoff between

ease of access and quality has been well worth it for some, but for many vulnerable

populations, the benefits have been minimal or nonexistent.

There is a silver lining, however. These apps, and the visibility they have

garnered (thanks largely to great advertising and celebrity endorsements) have done

wonders to shed light on the necessity of treating mental wellness with the focus and

seriousness it deserves. We are a capitalist society, and there are few better ways to

destigmatize and publicize a cause than to turn it into a trendy business model. The

national crisis and the prevalence of these platforms has brought the need for increased

mental health resources to light, and many states are listening. In Massachusetts, new

legislation and funding efforts have explicitly targeted community mental health centers,

as the breadth of resources they provide in mental health, substance use, and social

services have become recognized as vital to maintaining a functioning society.

To that end, a recent granting program has established a system of Community

Behavioral Health Centers (CBHC) throughout the state. The centers who have been

chosen as CBHC centers will provide communities throughout Massachusetts with

comprehensive, integrated, accessible care on an urgent and long-term basis. Medicaid

and MassHealth users are the main demographic for these services, which tends to

include a much more economically and racially diverse population. Additionally, this

funding seeks to mitigate the financial strain on these clinics and their practitioners,

increasing salaries, removing fee-for-service, and providing funded support for

administrative and wraparound services. The hope is that this takes the extra burden of

free labor off of clinicians, attracting more into the community health workforce.

At Riverside Community Care, CBHC is currently being implemented at two of

our clinics. The image below is from a recent presentation on the new program, and

details the key goals and features of the program.

These services clearly demonstrate an improved recognition for the importance

of integrating mental health services with other social programs, such as crisis

response, law enforcement, and public transportation. Additionally, CBHC provisions for

integration with medical care, family services, and emergency/hospital partnerships

within their catchment areas. Clinicians will be supported by peer mentors, social

workers, nurses, youth specialists, translation services, and other supplementary

resources for health related social needs. Because of this increased visibility and

access to the community at large, it is going to be easier and more efficient to refer both

children and adults to ongoing services. The program will be advertised widely, with

official support by the office of the governor and state departments.

I sincerely hope that this is the future of community care. Using this momentum, I

would like to see enhanced funding for CBHC models spread to other states. Currently,

40 states have at least one Certified CBHC3, and bringing more robust services with

better pay to larger catchment areas is only going to improve outcomes for the

populations served. For example, officially integrating mental wellbeing into the cycle of

care for, say, substance use or domestic disturbance situations helps improve the odds

that people in crisis will receive help and not abuse at the hands of law enforcement

(though of course that is only one piece of a very complex issue). With these and other

improvements, I am optimistic about the way we as a state, and hopefully country,

approach the idea of mental health as part of the larger societal organizations. Efficacy

will be seen as we go through implementation, but this is a long-awaited step in a

desperately needed direction.

3
https://www.samhsa.gov/certified-community-behavioral-health-clinics