State level integrated behavioral health care requires coordinated, collaborative partnership across multiple agencies and systems. Public health entities, behavioral health authorities, hospitals, community organizations, advocacy entities, and primary care providers all must take part in building a system of care that optimizes its resources and assets towards providing quality services. Successful integration efforts acknowledge that client outcomes in behavioral health are not just tethered to medical needs but also non-medical drivers of health such as housing stability, familial support, vocational opportunity, transportation, education, and other community support services.

States are revisioning how behavioral health systems deliver services by moving towards bridging behavioral health models by focusing on greater integration. Instead of delivering siloed care for mental health, substance use disorders, and physical health practitioners are focusing more on coordinating a holistic array of care inclusive of the patient’s full needs. This more person-centered shift is becoming more important as states are confronted with rising patient needs, workforce shortages, growing insurance costs, and persistent disparities in access to care.

Access to services and how to effectuate change that prioritizes patient need as first are at the center of this discussion. Best practices and models such as Certified Community Behavioral Health Clinics (CCBHCs) are helping states expand coordinated treatment and improve continuity of care. Texas Local Mental Health and Behavioral Health Authorities are certified as CCBHCs signaling the prioritization of integrated care for the state. While the model of CCBHC has been prioritized at the policy level further steps towards full integration of care may to be in order to enhance outcomes for persons served in the Texas safety net system with comorbid health issues.

Should policy makers determine that full integration at the state level is an appropriate priority, existing state level assets/resources as well as the provider community would need to be activated. This type of activation would likely require legislative direction specifying the scope. Establishment of a project management plan that is inclusive of stakeholders both internal and external would be essential for the responsible state agency. Potential considerations and topics to address include data usage/sharing/interoperability, clinical standards alignment, fiscal integration and financing, and quality outcomes. Technology and data sharing are central to statewide integration efforts. A balance between innovation and practicality acknowledging needs for strong privacy protections are imperative when considering federal standards such as HIPAA. As important to privacy protections are financing and funding opportunities that support the sustainability of long-term system transformation.

Healthcare reform initiatives like state level integrated care are transformative and require methodical planning that consider stakeholder impact with none being more important than the clients who are being served. Such a transformative investment must also be inclusive of persons with lived experience to better position these efforts to improve health outcomes and strengthen communities for the future.