The Role of Certified Community Behavioral Health Centers in Expanding Access to Comprehensive Services for Individuals with Serious Mental Illness

Background: Access to comprehensive psychiatric, medical, and social support programs is critical to improving the health and wellness of individuals with serious mental illness (SMI), however, the siloed nature of our health system has long functioned as a barrier to accessing needed care. Community mental health centers (CMHCs) have traditionally acted as the de-facto service setting for individuals with SMI and recently there have been efforts to enhance the availability of comprehensive services in these settings. Over a billion dollars has been invested in creating Certified Community Behavioral Health Clinics, a new type of enhanced behavioral health setting with the primary goal of integrating behavioral health, health, and social support services. While these efforts represent the largest investment in community mental health since its inception, research evaluating the CCBHC’s impact on increasing access to comprehensive services for individuals with SMI has been limited. The present study utilized national data comparing the availability of comprehensive services for SMI in CCBHCs compared to other community settings that provide behavioral health, including traditional CMHCs, Federally Qualified Health centers (FQHCs), and Hybrid FQHCs with certified behavioral health centers.

Methods: This study drew from the 2022 National Substance Use and Mental Health Services Survey, an annual survey that collects information on services offered by all behavioral health facilities in the United States. The study sample (n=1,896) included all CMHCs (n=1,019), CCBHCs (n=310), FQHCs (278) and FQHCs with certified behavioral health centers (ie: Hybrid-FQHCs; n=217) that offered specialized services to individuals with an SMI. Within these clinics, we explored service availability across four domains: health (integrated primary care and diet and exercise counseling), community-based support (ACT, and intensive case management), psychiatric rehabilitation (peer support, supported employment and illness self-management), and specialized programs (co-occurring disorders, first episode psychosis, and crisis management). Univariate statistics described the proportion of each setting that offered these services. Logistic regression was used to compare the odds of service availability between settings, controlling for the effects of nonprofit ownership, clinic size, receipt of community mental health grants, and Medicaid expansion.

Results: Results indicate that CMCHC’s were less likely than CCBHC’s to offer integrated primary care (OR=.29, p<001), and diet counseling (OR=.37, p<.001) but there were no significant differences in the availability of health services between CCBHCs and FQHCs or Hybrid FQHCs. CCBHC clinics were significantly more likely than all other settings to offer all types of community based programs, psychiatric rehabilitation services, and programs for co-occurring disorders. FQHC and FQHC-hybrid clinics, but not CMHCs, were significantly less likely to have crisis teams than CCBHCs.

Discussion: Findings indicate that CCBHC clinics offer more comprehensive services for individuals with SMI than other service settings. In addition to providing more behavioral health and social support programs, CCBHCs offered health services at similar rates to FQHCs. This suggests that CCBHCs have the potential to improve the health and wellness of people with SMI, but research is needed to examine the impact of CCBHCs on clinical outcomes.