Behavioral Health

Behavioral health is not a separate issue from the health of the community.

Mental health, substance use, trauma, family circumstances, housing, employment, social relationships, and other conditions can affect whether people are able to remain healthy and obtain the care they need.

For a Tribal health program, behavioral health should therefore be understood as part of the health system rather than as a service operating on the side of it.

Behavioral health is part of primary care

Patients do not necessarily separate their physical health from their behavioral health.

A patient may come to the clinic because of diabetes, chronic pain, hypertension, or another physical condition while also experiencing depression, anxiety, substance use, family stress, or other concerns.

The health program needs ways to recognize those needs and connect patients with appropriate services.

This does not mean every clinician becomes a behavioral health specialist.

It means the organization recognizes that behavioral health is part of providing comprehensive care.

Workforce is a major challenge

Behavioral health professionals can be difficult to recruit and retain, particularly in smaller and rural communities.

A Tribal health program may need to use several approaches, including:

Behavioral health professionals working within the health program.
Integrated behavioral health services.
Telehealth when appropriate.
Partnerships with other Tribal or community organizations.
Referral relationships with outside providers.
Prevention and community-based programs.

There is no single staffing model that works for every Tribe.

The important management question is whether the community can obtain appropriate behavioral health services when they are needed.

Prevention matters

Behavioral health is not only about responding to a crisis.

Prevention and early intervention can be equally important.

Programs may address:

Youth mental health.
Suicide prevention.
Substance use prevention.
Family and community wellness.
Trauma.
Parenting and family support.
Healthy coping and resilience.

Some of these activities may not look like traditional clinical services, but they can be important parts of a community health strategy.

Crisis care

Behavioral health crises can place enormous pressure on a Tribal health program.

A program needs to know what happens when a patient requires services beyond what can safely be provided locally.

That means having clear relationships with emergency departments, hospitals, behavioral health facilities, crisis services, law enforcement when appropriate, and other community resources.

The Health Director should not wait for a crisis to discover that those relationships do not exist.

Substance use services

Substance use is another area where health care, behavioral health, public health, and community conditions intersect.

The appropriate response may include prevention, screening, treatment, medication-assisted treatment, recovery support, harm reduction, family services, and community partnerships.

The specific mix will vary by community.

What matters from a management perspective is that the Tribe has a coherent approach rather than a collection of unrelated programs.

Behavioral health and the rest of the health program

Behavioral health should connect with:

Primary care.
Public health.
PRC.
Pharmacy.
Dental services.
Community health representatives.
Youth and family programs.
Social services.
Emergency and hospital services.

Patients should not have to navigate an organizational maze simply because their needs cross program boundaries.

The Health Director’s job is to make sure those boundaries do not become barriers to care.

Community partnerships

A Tribal health program cannot address every behavioral health need by itself.

Schools, social services, courts, housing programs, cultural programs, community organizations, and other Tribal departments may all have important roles.

The Health Director should understand which services are available in the community and how the health program connects with them.

A referral is only useful if the receiving service is available and the patient can actually reach it.

Questions for Tribal leadership

Does the community have adequate access to behavioral health services?
Are behavioral health services integrated with the broader health program?
Can the program recruit and retain qualified behavioral health staff?
What happens when a patient is experiencing a behavioral health crisis?
Are substance use services available?
Are prevention and early-intervention programs adequately supported?
Are youth and families being addressed?
Are relationships with outside behavioral health and crisis services working?
Are Tribal programs coordinating with one another?

A practical management principle

Behavioral health should not be treated as a separate program that receives attention only when there is a crisis.

It is part of the health of the community and part of the health program.

The management challenge is to build a system in which behavioral health, primary care, public health, and community services work together rather than operating in isolation.

That requires coordination, appropriate staffing, clear responsibilities, and recognition that many behavioral health problems extend beyond the walls of the clinic.