Behavioral healthcare access in community health centers up 40%

The number of behavioral health visits to community health centers soared by nearly 40 percent between 2018 and 2022, but if these care sites are to continue to meet patient demand, they’ll need more federal funding, according to a new report from The Commonwealth Fund.

The report, completed in partnership with the African American Research Collaborative, showed an overall increase in behavioral health visits—meaning mental health and substance use disorder visits—of 38 percent between 2018 and 2022. This increase is largely driven by an influx of mental healthcare encounters in community health centers, the data showed.

This trend comes as healthcare policymakers continue to observe increased mental and behavioral healthcare needs among low-income adult and Medicaid populations.

A 2021 Substance Abuse and Mental Health Services Administration (SAMHSA) report showed that 8 percent of adults with incomes below 100 percent of the Federal Poverty Level reported serious mental illness; for those with higher incomes, that number was 4.8 percent.

Meanwhile, KFF data showed that Medicaid enrollees carry a disproportionate mental health burden. Despite representing 18 percent of the non-elderly adult population, Medicaid covers 23 percent of those with any mental illness.

The Commonwealth Fund and AARC report said higher rates of behavioral health needs among the low-income and Medicaid-insured population indicate growing demand for community health centers, which mostly serve those populations.

“CHCs offer comprehensive primary care to all, regardless of the ability to pay, and serve many people with low income, people who live in rural areas, or those who are racial or ethnic minorities,” the report authors said.

And in response to increasing demand, community health centers have stepped up the mental and behavioral healthcare services they provide.

In 2018, there were 29.4 million SUD and mental health visits to community health centers; by 2022, that figure soared to 40.7 million visits. That upswing was largely driven by an increase in mental health visits (23.1 million visits in 2018 versus 33.1 million visits in 2022). Access to SUD treatment at community health centers remained more stable during the four-year period, jumping from 6.3 million visits in 2019 to 7.6 million visits in 2022.

Community health center leaders interviewed for the report noted that centers anticipated increased demand in 2018, and that’s largely reflected in their staffing models.

“I think we were already sort of in a ramp-up mode for behavioral health services,” one leader said in qualitative interviews. “And we were already really trying to recruit behavioral health providers and expand the access to services we already provide.”

In 2018, behavioral health specialists comprised 5.7 percent of the CHC workforce; by 2020, they comprised 6.6 percent of the CHC workforce.

CHCs have also been leveraging health IT to expand patient access to care, the report added. In 2022, a third of all virtual visits at CHCs were for behavioral health, compared to just 9 percent of all in-office visits.

“[W]hen we see patients in person for their medical care, we like to do warm handoffs for behavioral health,” according to one CHC chief medical officer. “And so behavioral health can see them on the spot on that day. But when they can’t, when the patient has to leave, being able to say, ‘Oh, we can set you up a telehealth appointment so that you can still see them from home’ has been a blessing.”

Part in parcel with increasing mental and behavioral health offerings is CHC work confronting the youth mental health crisis. In 2023, the CDC reported that mental health diagnoses in youth are increasing, with girls and LGBTQ kids and teens being most at risk for experiencing poor mental health and suicidal thoughts and behaviors.

CHCs are meeting the moment by sponsoring school-based health centers, which help kids get the healthcare they need in a setting where they spend most of their time. School-based healthcare has been shown to improve health outcomes and patient access to care, The Commonwealth Fund report authors said.

In 2022 alone, CHCs served more than 950,000 patients in school-based settings, but CHC leaders say they’ll need more staff to continue to meet demand.

“I think we can say with an astounding yes that there has been an increased need for behavioral health mental and health services… in our school-based health centers,” said one CHC CEO. “We have an overwhelming need for practitioners to provide services...”

In fact, most CHCs will need greater resources to keep meeting increasing mental and behavioral health demand, the report authors asserted. Expanded scope of practice for certain providers, now allowed under Medicare, will help CHCs expand their mental health services, but an uphill funding battle for the Community Health Center Fund needs to be won to truly support necessary services, the authors noted.

“While there is a bipartisan effort to sustain the fund, without substantial increases, center leaders are unsure how they’ll continue to provide comprehensive care to underserved communities, let alone build capacity,” they concluded. “Further, policymakers can permanently remove the requirement for community health centers to have an initial in-person visit before beginning behavioral telehealth care, which can limit access for rural and homebound patients.”