Navigating the mental health system to obtain appropriate care for mental illness and addictions often seems akin to trying to pilot a small airplane through a turbulent thunderstorm in the dark. It’s challenging, uncomfortable, scary and hard to safely reach your destination.
In an effort to provide better guidance to find mental health and substance use services, SAMHSA (the US Substance Abuse and Mental Health Services Administration) and CMS (the US Centers for Medicare and Medicaid Services) have developed “A Roadmap to Behavioral Health.“ This “guide to using mental health and substance use disorder services” was designed to help you understand and use your health insurance benefits to find the care you need.
The “Roadmap” is clear and concise, and offers several practical tips and resources. It’s organized in 8 sections:
1. Understand your behavioral health
This section provides basic definitions of common terms such as “mental disorders” (changes in thinking, mood and/or behavior), “substance use disorders” (when the use of alcohol and/or drugs causes health problems or disability), and “co-occurring disorders” (having both a mental and substance use disorder). It defines “behavioral health care” as often including key services such as screenings, assessment, treatment, recovery services, and support, including peer support. Each of these services is described briefly. Finally, this section includes a list of common feelings and behaviors which could be warning signs if they worsen and persist.
2. Learn about health insurance
This part of the Roadmap covers the basics of health insurance and describes basic benefits related to behavioral health care, which may include access to specialized health care professionals, psychotherapy and medication, hospital and emergency care, and services focused on prevention, such as screenings for mental and substance disorders.
3. Where to go for help and treatment
Various types of providers and locations for behavioral health treatment are described, including seeing your primary care medical provider (such as a family physician or nurse practitioner) versus a specialized behavioral health provider, and the option of seeking emergency care in a hospital emergency department. Some of the pros and cons of each of these options, such as ease of access and cost are briefly covered.
4. Find a behavioral health provider
This section provides further details on the specific steps involved to locate a behavioral health provider in your area. In addition, descriptions are given of specific specialists, (psychiatrists, psychologists, substance counselors, etc.) Using online directories and other resources from your health insurance plan can steer you to lower cost providers in your coverage network, and you can also seek recommendations for providers from friends, family, and health care professionals. (I’ve covered more details about the specific issue of how to find a good psychotherapist in a previous post.)
5. Make an appointment with a behavioral health provider
Important practical points to consider and questions to ask when calling to arrange a first appointment are detailed. These include finding out if your insurance is accepted, determining which conditions are treated by the provider, appointment availability, special needs (language interpreter, disability accommodations), and location.
6. Prepare for your appointment
This section talks about things to take to your appointment, such as your insurance card, photo ID, payment, health history and other pertinent records, and a list of medications and allergies. You should also outline questions you want to ask and consider bringing a family member or friend along for support.
7. Decide if the behavioral health provider is right for you
This very important step takes you through several questions to evaluate the provider and see if they seem to be a good fit for you. These considerations include whether you felt listened to and respected and checking to see if the provider communicated clearly in providing explanations of proposed treatment options.
8. Next steps to stay healthy on the road to recovery
This final section discusses the importance of staying engaged in your treatment by following your treatment plan, attending appointments, reviewing your insurance statements, and by keeping a clear and consistent channel of communication open with your providers about issues or concerns.
The Roadmap also includes a helpful Glossary of clear and simple definitions for several common insurance and treatment-related terms. Also provided are several additional online resources about locating treatment, understanding health insurance and who to contact if in a crisis or emergency. Finally, the Roadmap makes several references to a larger companion document called the “Roadmap to Better Care and a Healthier You,” which includes expanded information (in 8 parallel sections) on general health care coverage and how to access care.
The Roadmap to Behavioral Health is helpful as it is easy to understand and it offers a structured step-by-step process to walk you through the often complex health care and insurance system. What it was not designed to address is how to navigate the still far too common barriers (cost, lack of insurance, lack of available/effective providers and treatments) that can easily arise along the way while attempting to access affordable and effective behavioral health care.
Here’s a question: What steps do you need to take next on your “roadmap” to obtaining mental health care? Please leave a comment. Also, please subscribe to my blog and feel free to follow me on X (formerly Twitter), “like” my Facebook page, or connect on LinkedIn. Finally, if you enjoyed this article, please share it with a friend. Thanks!