Behavioral health leaders met at the 2023 Tennessee State of Reform Conference last month to discuss strategies for strengthening the state’s behavioral health system and ensuring adequate access to these critical services.
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Wendy Farmer, regional vice president of the National Crisis Center of Excellence at Carelon Behavioral Health, opened the panel with a story about the time she had a heart attack. She discussed the clear steps she was able to take in order to receive help, and said she wants the same for behavioral health.
“What if I had been suicidal? What if I had been having an episode of psychosis? What if I had had a drug overdose?” Farmer said. “I don’t believe it would have gone nearly as smoothly as it did for me that day. So, I have really been dedicating the last 10 years of my life to helping states develop crisis systems so that they can respond to behavioral health emergencies in a much better way.”
Alysia Smith Knight, executive director of the Tennessee Association of Mental Health Organizations, discussed the workforce crisis and how different entities are addressing the issue.
“We are just so pleased to see that the [Tennessee Department of Mental Health and Substance Abuse Services (MHSAS)] and TennCare co-chaired a group in 2021 to really look at the public behavioral health workforce and to develop both long-term and short-term strategies to address that,” Knight said.
Some of MHSAS’s proposed strategies include strengthening the workforce pipeline, expanding internship opportunities, and offering benefits and incentives.
Knight emphasized the importance of taking a multi-faceted approach to the workforce crisis. While compensation is a factor in hiring, she said the practice of behavioral healthcare must also be appealing to the potential workforce in order to attract and retain providers.
Farmer also highlighted Tennessee’s Certified Peer Recovery Specialists (CPRSs). These are people who have had their own struggles with mental health or addiction who go through training and certification so they can help their peers who are in need.
“Who better to take care of someone in crisis than someone who has actually been there?”— Farmer
Jessica Youngblom, director of Strategic Initiatives at MHSAS, said there are certification programs for them, as well as certification programs for young adult and family CPRSs.
“A lot of times we will see individuals who get into treatment, a couple years go by, and we get a call that someone has had a hiccup and they’ve relapsed,” Youngblom said. “And who are they calling? Their navigator that they met in the [emergency department] two years ago because that was the first person they really felt heard from.”
She said it is important that CPRSs are compensated properly for the work they do, and that this continues to be improved in the future.
Lee Dilworth, chief executive officer of ReVIDA Recovery Centers, said his clinics use CPRSs. “They share lived experiences,” he said.
Youngblom said collaboration is vital for improving outcomes in the field. Solutions, she said, cannot come from the department alone. As an example, she spoke about successful partnerships MHSAS has made to bring services to the community.
One program involves collaboration with local congregations to become part of the support system for people struggling with mental illness, called the Faith Based Initiatives. Tennessee is a highly religious state, and many people look to their church when struggling in times of need. The initiative aims to connect people to resources and educate communities to help those who need it.
Another program Youngblom discussed is Project Rural Recovery, which now has four mobile health integrative care units to go out and serve rural communities.
Dilworth spoke about his clinics and the work they do for Tennessee communities.
“We believe in visibility. It’s one of our core values, so we’re happy to go out there and integrate and collaborate with members of the recovery ecosystem and the communities that we’re in… We try to foster those relationships because the challenge is too large. We can’t just stay in our little silo.”— Dilworth
One way they collaborate is with hospitals in the community. Hospitals bring mobile health teams to ReVIDA recovery centers, and the organization publicizes the date to the community at large. These health teams are not just for behavioral or substance use care teams, but also primary care and other basic services.
The mobile health teams are not only for patients at ReVIDA’s recovery centers, but also for anyone in the community who may need it.
“Really this is about population health,” Dilworth said. “I mean, this is not just about our patients, it’s about these communities at large.”
Knight discussed the government’s role in providing fiscal resources to bolster the field’s workforce. The state has been increasing funding for provider rate improvements in recent years, “recognizing that for the past 20 years, rates for the behavioral health safety net have been stagnant,” Knight said.
Furthermore, “there has been over $15 million in provider rate improvements in the past few years through TennCare,” Knight said. “We are just so grateful for that. That’s just something we have never seen in our system”
She also discussed $12.1 million the legislature recently approved for provider sign-on and retention bonuses, upcoming behavioral health scholarship funds, and a $50 million fund for behavioral health provider bonuses.
“One of the great things, I think, about Tennessee and about this topic [is that] it doesn’t matter what side you’re on. Everybody understands that people need help.”— Knight
To close the discussion, Farmer asked the panelists where they see the most room for innovation in the behavioral health field.
Dilworth noted the importance of improving transportation, cost of medication, and lowering the stigma against behavioral health issues.
Knight said there is room for improvement in terms of youth preventative care, infant and early childhood mental health, and the provider intake process. Intake should be updated in coordination with the changing times, she said. For example, Knight said providers should ask about technology usage and content watched by children because it could impact their mental health. There is also room for technological innovation in the behavioral health field, she said.
Youngblom agreed with the other panelists, and added that the state should focus on improving the rural behavioral healthcare workforce.