The National Association for Behavioral Healthcare (NABH) is entering a new decade with fresh leadership and a bold agenda. On January 1, Shawn Coughlin officially stepped into the role of president and CEO, succeeding Mark Covall, who led the organization for 24 years. With decades of experience advocating for behavioral healthcare, Coughlin brings both continuity and an ambitious new energy to the trade association that represents nearly 1,800 organizations across the country.
In his new position, Coughlin is leading the charge on some of the most critical and persistent issues in behavioral healthcare—ranging from workforce shortages and outdated Medicare regulations to enforcement of mental health parity laws and breaking down systemic silos. His message is clear: the industry cannot afford to keep operating under the same fragmented, inefficient conditions. The coming years, under his leadership, will be about transformation.
Who is Shawn Coughlin?
Coughlin is no stranger to NABH. Prior to becoming CEO, he served as executive vice president for government relations and public policy and worked as a lobbyist for the organization on Capitol Hill. His long-standing relationship with NABH positions him to understand the deep complexities of behavioral healthcare policy and regulation.
His experience and vision make him uniquely suited to lead NABH into the future. In interviews, Coughlin has emphasized a need for disruptive change—stating that NABH’s goals for the new decade include breaking down not only legislative barriers but also long-standing stereotypes, systemic inefficiencies, and restrictive silos that limit access to care.
Taking Aim at Parity Violations and Managed Care Challenges
A key focus for Coughlin and NABH in 2020 and beyond is enforcing mental health parity laws. Despite federal regulations mandating equal treatment for mental and physical health conditions, insurance companies often impose restrictive limitations on behavioral health services. Coughlin calls out these “blatant parity violations,” particularly within managed care organizations (MCOs), as one of the biggest challenges the industry faces.
He describes a system where patients are often denied necessary care based on unclear or opaque definitions of “medical necessity,” while behavioral health providers are burdened by administrative micromanagement. This imbalance diverts time and resources away from patient care and limits access to life-saving services.
Another barrier is network adequacy—or lack thereof. While insurers claim their provider networks are full, patients still struggle to find in-network behavioral health providers. Coughlin argues that insurance companies are not being held accountable to the parity standards they’re supposed to meet. He’s calling for more transparent policies and enforcement to ensure that behavioral health patients receive the same level of care and access as those seeking medical treatment.
Outdated Medicare Regulations
In addition to parity, outdated Medicare regulations are a top concern for NABH. Many of the current standards were established in 1966, with only minor updates in the 1980s. These outdated rules no longer reflect best practices and often force providers to spend more time on paperwork than with patients.
NABH is actively advocating for updates to the Medicare “conditions of participation” and addressing structural issues such as the 190-day lifetime cap on inpatient psychiatric services. According to Coughlin, these limitations are not only unfair—they’re clear violations of parity.
Equally concerning is the Medicaid Institution for Mental Diseases (IMD) exclusion, which prohibits Medicaid from covering inpatient care in psychiatric facilities for adults aged 21 to 64. NABH sees this exclusion as an unjust and discriminatory cap on access to care and continues to push for its repeal.
Tackling the Behavioral Health Workforce Crisis
One of the most pressing problems Coughlin hopes to solve is the severe workforce shortage in behavioral health. The U.S. simply does not have enough trained professionals to meet the growing demand for mental health and substance use disorder treatment.
Addressing this issue requires a multi-faceted approach. NABH is advocating for expanded training programs, increased federal funding, and reform of federal regulations that restrict providers from practicing at the top of their license. Coughlin also points out that behavioral health providers are often reimbursed at rates lower than even Medicare rates—a disparity that discourages people from entering the field and perpetuates provider shortages.
The solution, he believes, lies in aligning financial incentives with workforce development. Insurance companies must pay providers fairly, and the federal government must make behavioral health workforce development a policy priority.
Integration Over Silos
Another recurring theme in Coughlin’s agenda is the need to break down silos in healthcare delivery. Historically, behavioral health has been treated as separate from the rest of the medical system, often divided further into separate categories for mental health, substance use disorders, and various disease-specific treatments.
Coughlin argues that this fragmented approach undermines care quality and access. Many individuals with substance use disorders also have co-occurring mental health issues—and vice versa. Treating these conditions in isolation fails to address the full scope of a patient’s needs.
Instead, NABH is pushing for integrated care models that bring together medical, psychiatric, and addiction services in a single continuum of care. The goal is to ensure that patients can access the right treatment, in the right setting, at the right time—regardless of diagnosis or funding source.
Opportunities on the Horizon
Despite the challenges, Coughlin remains optimistic about the future of behavioral healthcare. He points to a growing public awareness of mental health issues and a cultural shift that’s making it more acceptable for people to ask for help. High-profile figures like Olympic champion Michael Phelps have helped normalize mental health conversations, opening the door for increased advocacy and investment.
Policy-wise, there are reasons for hope. In 2019, CMS expanded Medicare coverage for opioid use disorder (OUD) treatment—a major win that Coughlin believes could set a precedent for private insurers. NABH worked closely with CMS to ensure the new coverage policies reflected the realities on the ground and served the needs of patients and providers alike.
Looking Ahead: Building the Full Continuum of Care
Looking forward, Coughlin envisions a behavioral health system that includes a full continuum of care—from outpatient services and peer support programs to residential treatment and inpatient hospitalization. The pendulum, he notes, has swung too far in favor of community-based care at the expense of more intensive options. As a result, many patients lack access to the levels of care they truly need.
By building out this continuum, NABH hopes to create a system that is both accessible and responsive. One where care decisions are guided by clinical needs rather than reimbursement limitations or outdated laws.
Final Thoughts: A Call for Unity
Coughlin’s message to behavioral health providers is simple but powerful: We are stronger together. Achieving meaningful change will require coordinated advocacy, shared goals, and a united voice.
“Anybody who’s engaged in legislation knows that the squeaky wheel gets the grease,” he says. “The more we can align our interests, speak up, and move together collaboratively, the better off we all will be.”
Under Coughlin’s leadership, NABH is poised to make behavioral health a bigger, bolder, and more integrated part of the American healthcare system. The decade ahead may be challenging—but with the right leadership and shared vision, it also holds immense promise.
