A Dual Epidemic: Mental Health And Substance Use Disorders Are Escalating
The United States is facing a mounting behavioral health crisis. Mental health issues and substance use disorders (SUDs) are reaching critical levels nationwide. From rising suicide rates to record-breaking overdose deaths, the situation is dire—and the traditional health care system is struggling to keep up. During a recent U.S. Senate hearing, leading experts—including Dr. Mitch Prinstein, chief science officer of the American Psychological Association—called on lawmakers to take swift action. Their recommendation? Invest in integrated behavioral health care models that combine primary medical care with behavioral health services. These models, they argue, offer one of the most promising paths forward in reversing the nation’s troubling mental health trends.
The Disconnect Between Need And Treatment
Statistics tell a troubling story. Up to 75% of individuals with behavioral health needs initially seek help from their primary care provider. Yet, despite reaching out, 55% of adults with mental health concerns remain untreated.
One of the primary reasons for this disconnect is the lack of mental health services within primary care settings. Most medical practices are not structured to provide behavioral health services in-house, and many patients face long waits, referrals, or high costs when trying to access help outside the system.
“Integrated care is in fact an excellent way to go,” Dr. Prinstein stated at the hearing. “But it’s very hard for people to find a health care provider and a mental health care provider.”
This is why integrated behavioral health care models are gaining traction. They aim to eliminate silos, bring behavioral health into the same setting as physical health, and make help more accessible to those in need.
Stigma Still Stands In The Way
In addition to structural issues, stigma remains a pervasive barrier. Many people hesitate to seek mental health or addiction support due to fear of judgment or societal bias—particularly for conditions like alcohol use disorder or schizophrenia.
“But walking into your physician’s office is not attached to stigma,” Prinstein explained. That’s the power of integration. When behavioral health services are offered within familiar, non-stigmatized environments like primary care clinics, people are far more likely to accept help.
Integrated behavioral health care models normalize mental health conversations and increase the chances that patients will follow through with treatment.
Systemic Challenges And Workforce Gaps
Even with rising demand, access remains limited. Many communities—especially rural areas—lack sufficient behavioral health professionals. And even where providers exist, they’re often disconnected from the medical system, creating logistical barriers and delays in care.
Senator Bob Casey of Pennsylvania acknowledged this limitation during the hearing. “Many physicians still don’t have the ability to seamlessly connect patients to a mental health provider,” he said.
While integrated behavioral health care models are growing in recognition, adoption remains low, in part due to reimbursement complexities, insufficient training, and rigid regulations.
What The Data Tells Us
Dr. Prinstein highlighted concerning data from the Centers for Medicare & Medicaid Services (CMS):
- Medicare behavioral integration billing codes, introduced in 2017, saw usage nearly double between 2018 and 2019.
- Over 70% of providers using the Primary Care Behavioral Health model billed with these codes.
- However, fewer than 25% of collaborative psychiatrist-based care providers used the codes.
- And critically, less than 1% of Medicare beneficiaries received services through any integrated model.
This gap between availability and utilization underscores the need for structural changes. Integrated behavioral health care models work—but only when providers are supported and incentivized to implement them.
The Path Forward: Three Key Solutions
To scale integrated care across the country, Dr. Prinstein recommends a three-part strategy:
- Simplify billing: Make reimbursement processes easy to understand and apply for both behavioral and physical health providers.
- Cross-train providers: Equip clinicians with shared language and workflows that foster collaboration and continuity of care.
- Encourage flexibility: Offer diverse implementation options, recognizing that integrated behavioral health care models should be tailored to the needs of different communities, patient populations, and clinical teams.
“A one-size-fits-all approach is just not going to work,” Prinstein warned. “We have evidence that all approaches can be very effective.”
Private Sector Momentum And Innovation
While public policy is still catching up, private companies are making strides. Organizations like Concert Health, Oak Street Health, and Crossover Health have emerged as leaders in the push for integration. These companies are proving that integrated behavioral health care models can be both scalable and sustainable.
They embed behavioral health professionals directly into primary care teams, streamline communication, and produce better outcomes—fewer emergency room visits, improved chronic disease management, and higher patient satisfaction.
Their success sends a clear message: the integration of behavioral and physical health care is not only possible—it’s already happening. Now it’s time to take these models mainstream.
Why Congress Must Act Now
The mental health and addiction crisis is not slowing down. Without decisive action, more Americans will continue to suffer in silence, without access to the care they need. But by expanding and funding integrated behavioral health care models, Congress has the power to create a transformative shift in how care is delivered.
This includes:
- Funding workforce training and provider education
- Simplifying billing and expanding code utilization
- Offering flexible grants to implement diverse integration strategies
- Reducing administrative barriers and regulatory red tape
- Increasing research into outcomes from integrated care models
Behavioral health doesn’t exist in a vacuum—it intersects with chronic illness, socioeconomic challenges, and everyday stress. Integrated behavioral health care models represent a whole-person approach to wellness, one that is long overdue.
