Behavioral health experts discuss the need for medical and behavioral reintegration and how to fill access gaps in Utah


Patrick Jones


Behavioral health experts in Utah highlighted the need to “carve in” behavioral health care accountable care organizations (ACOs) and fill gaps in the access to behavioral health care for rural and mild-to-moderate risk patients. 

At our 2022 Utah State of Reform Health Policy Conference panel, “An honest conversation about behavioral health,” three behavioral health experts discussed the biggest needs for Utahns in the behavioral health space and how Utah is attempting to address these needs. 


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The panelists were Mark Rapaport, Chief Executive Officer of the Huntsman Mental Health Institute, Scott Whittle, M.D., Medical Director at SelectHealth, and Patrick Fleming, Former Director of the Salt Lake County Division of Behavioral Health Services. 

Rapaport outlined the behavioral health struggles in Utah and around the country in numbers, saying suicide is the number one killer of all Uthans between the ages of 10 and 24 and the number two killer nationwide for the same age group. 

He noted that 75% of all mental disorders appear between the ages of 10 and 24. The early onset of these disorders makes preventative care and access to care for the mild-to-moderate risk demographic so important, said Rapaport. 

He is also concerned about the effect stigma has on expanding and receiving quality access to behavioral health care. The University of Utah (UofU) is kicking off a 10-year initiative to attempt to eradicate stigma around behavioral health and substance use disorders. 

“If we don’t do that, we are never going to handle the issues of parity,” said Rapaport. 

Though these issues have been prevalent in Utah for some time, seven years ago, Utah was more concerned about the continual increase in the cost of health care and coverage. To help curb these costs, the legislature created accountable care organizations (ACOs), in which a group of providers are held accountable for the quality of care they provide by having their payments tied to quality metrics. This payment structure aims to lower costs and improve health outcomes.

However, Medicaid behavioral health is not managed by ACOs and is a “carve out” run on a capitation model by the counties in Utah. The panelists said Medicaid medical and behavioral health need to be integrated and that behavioral health needs to be “carved in” due to the “intertwined” nature of medical and behavioral health. 

Whittle said that the capitation model currently used by Medicaid when providing behavioral health is nearly “impossible” to navigate due to the amount of intertwined comorbidities many behavioral health patients have when seeking care. Whittle said Utah needs to merge these two payment models and reintegrate medical and behavioral health.

“It is not my responsibility in being in charge of the medical risk, but it is my problem,” said Whittle. 

Fleming expressed some of the challenges that he thinks will be faced before this reintegration. “We will make a change and we will come out really well on this. Is it going to be easy? No, there are some people who are going to want to resist this,” said Fleming.

Next, the panelists discussed the many gaps to access to behavioral health care found throughout the state. With the ACO model, counties typically pay and care for those who are in most need. This ends up leaving out many Utahns with mild-to-moderate behavioral health concerns, which causes more Utahns to slip through the cracks of the system. 

Rapaport described the need for spaces to deal with crisis management that are not emergency departments (EDs), where most people in crisis end up going to now. He said folks in behavioral health crises suffer the longest wait times and release times in EDs.

That is why UofU is creating a new crisis care center in a place near the university where people who need the most help are. This center will take anyone, regardless of their ability to pay, and has in-patient beds and staff to assist those in crisis. The center will be partnering with law enforcement to reduce the number of those in crisis ending up in jail. 

“We need to create a place of dignity where we can deliver appropriate care for individuals,” said Rapaport. 

He said the UofU will continue to create legal clinics for those having trouble with the law, dental clinics, and family medicine clinics to best meet those in need where they are at.