Central Oregon Health Council :: Measures for Behavioral Health: Increase Access and Coordination

Why are these measures important?

Please see the information below, describing the measures being tracked for this priority area, and why they are important.

Learn more about this topic and others through funded pilots and projects on the "What We're Learning" page.

Behavioral Health Access

While the prevalence of mental illness is similar between rural and urban residents, the services available are very different.
Accessibility – Rural residents often travel long distances to receive services, are less likely to be insured for mental health services, and are less likely to recognize an illness.
Availability – Chronic shortages of mental health professionals exist and mental health providers are more likely to practice in urban centers.
Acceptability – The stigma of needing or receiving mental healthcare and fewer choices of trained professionals who work in rural areas create barriers to care (https://www.ruralhealthinfo.org/topics/mental-health).
Central Oregon is experiencing a behavioral health workforce shortage. This makes it difficult for patients to get the behavioral health care they need. This barrier in care is a growing public health issue.
The Journal of the American Medical Association reports that the “disease burden” (as defined by cost and outcomes) of mental health and substance use disorders was higher than for any other condition in 2015 (Kamal et al, 2017).
Of all the 50 states plus the District of Columbia, Oregon ranks 49^th in the nation for access to mental health care. Oregon has less than one mental health professional for every 1,000 people (SAMHSA, 2014).
Additionally, there is a shortage of specialty behavioral health providers who are accepting new clients, providing timely access and currently accepting certain types of insurance plans such as Medicaid and Medicare.
There is also a lack of behavioral health providers that specialize in serving certain subpopulations such as young children, seniors, and linguistic and cultural groups such as Native Americans and Latinx (Advancing Integrated Care in Central Oregon Needs Assessment, 2019).

In Central Oregon, we are seeing the following:

In La Pine, there are currently 0.24 behavioral health providers per 1,000 people, and the target in the 2020-2024 RHIP is increasing this number to 0.62 behavioral health providers per 1,000 people.

In Warm Springs, there are currently 0.34 behavioral health providers per 1,000 people, and the target in the 2020-2024 RHIP is increasing this number to 0.62 behavioral health providers per 1,000 people.

In Prineville, there are currently 0.46 behavioral health providers per 1,000 people, and the target in the 2020-2024 RHIP is increasing this number to 0.62 behavioral health providers per 1,000 people.

In Redmond, there are currently 0.66 behavioral health providers per 1,000 people, and the target in the 2020-2024 RHIP has currently been met at 0.62 behavioral health providers per 1,000 people.

In Madras, there are currently 0.68 behavioral health providers per 1,000 people, and the target in the 2020-2024 RHIP has currently been met at 0.62 behavioral health providers per 1,000 people.

In Sisters, there are currently 0.77 behavioral health providers per 1,000 people, and the target in the 2020-2024 RHIP has currently been met at 0.62 behavioral health providers per 1,000 people.

Access and Engagement with Specialty Behavioral Health

Specialty behavioral health providers are often separate from the rest of the health care community.
Many smaller providers do not have electronic health records (EHRs) and are often part of “unmanaged” insurance networks that lack quality oversight.
Behavioral health reimbursement rates are typically lower than physical health reimbursement rates, which can make it financially challenging to develop infrastructure and quality improvement mechanisms.
The result of this is that lower-risk individuals have greater ease of access to services. This, therefore, leaves little capacity in the system for those with moderate and serious needs.
Creating an environment where individuals in our communities can have access to specialty behavioral health care when care with their primary care provider is not enough, is vital.

In Central Oregon:

There is currently no way to measure timeliness and engagement with specialty behavioral health for people who are referred from primary care.
By December 2024, the goal is to develop a measure around the timeliness and engagement with specialty behavioral health for people who are referred from primary care.

Standardize Screening Processes

Primary care and specialty behavioral health are interdependent; however, the promise of integrated behavioral health in primary care settings will not be fully realized without an adequate specialty behavioral health system for patients who need a higher level of care.
In order to meet the behavioral health care needs in Central Oregon, the primary care and specialty behavioral health care systems must work together.
Further complicating this situation are the differences that exist in coordination between primary care and specialty behavioral health, creating fragmentation and safety concerns.
Primary care clinics in Central Oregon are struggling to meet the needs of their patients without adequate access to and coordination with specialty behavioral health care.

In Central Oregon:

Currently, there is not a standardized screening process to assure people receive the appropriate level of care and follow-up across the various types and intensities of services offered.
By December 2024, a method will be developed to standardize screening processes to assure people receive appropriate levels of care and follow-up across various services.