In recent years, the health care landscape has undergone significant transformation, with behavioral health and addiction treatment moving to the forefront of conversations among medical leaders. A 2019 survey conducted by the American College of Healthcare Executives (ACHE) confirmed this shift, revealing that hospital CEOs across the country see behavioral health as one of their most pressing challenges.
The findings highlight both the growing awareness of mental health and addiction issues and the urgent need for systemic changes in how communities provide care.
Behavioral Health Ranks High Among CEO Concerns
The ACHE survey asked 1,481 community hospital CEOs to rank 11 critical issues impacting their organizations. Nearly 400 CEOs responded, and behavioral health and addiction issues ranked as the third most significant concern, following only financial challenges and personnel shortages.
This ranking underscores a dramatic shift in priorities. For decades, behavioral health was often considered separate from “traditional” hospital care, with limited integration into mainstream medical systems. Today, however, hospital leaders recognize that untreated mental health and addiction conditions place an enormous burden not only on patients and families, but also on hospitals and health systems as a whole.
The Biggest Pain Point: Lack of Facilities and Programs
The survey drilled down into specific concerns related to behavioral health and addiction. The most frequently cited issue was the lack of appropriate facilities and programs in communities, with 81% of CEOs identifying this as a major barrier.
Many hospitals simply do not have the inpatient psychiatric units, detox beds, or outpatient programs necessary to meet demand. This gap often results in emergency departments becoming default entry points for patients experiencing behavioral health crises. Not only is this approach costly, but it also fails to provide individuals with the comprehensive treatment they need.
Hospital leaders recognize that without adequate facilities, patients fall through the cracks, cycling between ER visits, short inpatient stays, and repeat relapses. This pattern fuels higher health care costs and perpetuates the stigma around mental illness and addiction.
Other Challenges CEOs Identified
In addition to the lack of treatment facilities, hospital CEOs highlighted several other major obstacles:
- Funding shortages (73%) – Behavioral health programs are chronically underfunded, leaving hospitals struggling to provide comprehensive services.
- Low reimbursement rates (67%) – Even when hospitals invest in behavioral health, insufficient insurance reimbursement makes it difficult to sustain services.
- Opioid addiction and related conditions (56%) – The opioid crisis remains a nationwide public health emergency, driving high volumes of patients to hospitals.
- Regulatory barriers (35%) – Legal and regulatory frameworks often limit hospitals’ flexibility in delivering behavioral health and addiction care.
Together, these challenges create a perfect storm that hinders hospitals’ ability to meet community needs.
Why Behavioral Health Matters to Hospitals
Hospital CEOs’ concern about behavioral health is not simply about compassion—it is also about system-wide impact. When behavioral health is not adequately addressed, it strains every part of a hospital’s operations.
For example:
- Patients with untreated mental illness often present with chronic physical health conditions, driving up costs.
- Emergency rooms see high numbers of patients in psychiatric crisis, leading to overcrowding and longer wait times for all patients.
- Hospitals face challenges with care coordination when patients lack access to community-based follow-up programs.
By prioritizing behavioral health, hospitals aim to reduce avoidable hospitalizations, improve patient outcomes, and create more sustainable care systems.
The Workforce Shortage Problem
One of the key findings of the ACHE survey was that personnel shortages were the second-highest concern overall for hospital CEOs. Within behavioral health, this problem is particularly acute.
The United States faces a well-documented shortage of psychiatrists, psychiatric nurse practitioners, licensed clinical social workers, and other behavioral health professionals. Rural areas are especially affected, leaving many communities with limited or no access to specialized providers.
Without adequate staffing, even well-funded facilities struggle to deliver consistent, high-quality behavioral health care. Hospital CEOs are increasingly calling for expanded workforce development initiatives, loan forgiveness programs, and training pipelines to address this gap.
Financial Strains on Hospitals
While financial challenges were the number one overall concern for CEOs, behavioral health services magnify this issue. Historically, reimbursement for mental health and addiction services has lagged behind physical health services, despite federal parity laws intended to equalize coverage.
Low reimbursement rates make it difficult for hospitals to expand programs, especially in areas such as inpatient psychiatry, intensive outpatient programs, and substance use disorder treatment. The result is a mismatch between community need and available resources.
Hospital leaders argue that addressing reimbursement inequities is critical for long-term sustainability. Without financial viability, behavioral health programs risk closure—even when they are desperately needed.
The Opioid Epidemic: A Continuing Crisis
Another factor driving CEOs’ concern is the ongoing opioid crisis. Although awareness has grown and some progress has been made, the epidemic continues to overwhelm health systems.
Patients with opioid use disorder frequently require emergency care for overdoses, infections, or complications related to intravenous drug use. Treating these conditions is both medically complex and costly.
Hospital CEOs understand that expanding access to evidence-based treatments—such as medication-assisted treatment (MAT) and recovery support programs—is essential to breaking the cycle of addiction.
Regulatory and Policy Barriers
Finally, regulatory frameworks often make it difficult for hospitals to innovate in behavioral health care delivery. Rules around licensing, reimbursement, and privacy can restrict hospitals’ ability to implement integrated care models or expand telehealth services.
During the COVID-19 pandemic, temporary policy changes allowed greater use of telehealth for mental health and addiction treatment. Many hospital leaders now advocate for making these changes permanent, arguing that flexible policies are key to expanding access.
Looking Ahead: What CEOs Want to See
Hospital CEOs’ recognition of behavioral health as a top concern reflects a broader cultural shift in health care. Leaders are no longer treating mental health and addiction as secondary issues—they are acknowledging them as central to overall health.
Moving forward, CEOs are calling for:
- Increased funding for behavioral health infrastructure.
- Fair reimbursement rates for mental health and addiction services.
- Expanded workforce development programs.
- Community-based partnerships to build comprehensive care networks.
- Policy reforms that remove barriers to innovative care delivery.
Conclusion
The ACHE survey results from 2019 were a wake-up call for the health care industry: behavioral health and addiction issues are no longer peripheral—they are central to hospital operations and patient outcomes.
While financial challenges and workforce shortages remain pressing concerns, hospital CEOs clearly recognize that addressing behavioral health is integral to solving these broader issues. By investing in facilities, funding, workforce development, and policy reform, hospitals can move closer to meeting the growing demand for behavioral health and addiction treatment.
As communities continue to face rising rates of mental illness and substance use disorders, hospital leaders’ prioritization of behavioral health may be one of the most significant steps toward a more responsive and compassionate health care system.
