Closing the Gap: Reimagining Equity and Continuum of Care in Behavioral Health

Denise is an accomplished senior healthcare executive with over 25 years of senior leadership experience in for-profit and not-for-profit integrated healthcare organizations, academic health systems, and freestanding behavioral health facilities. She has demonstrated expertise in strategic planning, business development, hospital operations, and leadership mentorship across the healthcare continuum delivery system with a primary concentration in behavioral health.

Denise is currently the senior director of Behavioral Health Services at the University Medical Center in New Orleans, Louisiana (UMCNO). As a senior leader, she is a dyad partner with the psychiatric medical director. She is responsible for executive oversight of a 60-bed inpatient unit, a 26-bed emergency psychiatric unit, ECT services, TMS services, outpatient services, consultative services, and a psychiatric GME program comprised of the LSU and Tulane Schools of Medicine.

Through her years as a behavioral health executive and advocate, Denise has served on various government, community, and healthcare association boards, councils, and committees. Although advances in behavioral health have made positive strides through the years, she feels there is still a long way to go.

Behavioral Health’s Ongoing Neglect in Healthcare

Despite decades of advocacy and reform, behavioral health remains the neglected sibling of medical care in our healthcare system. Patients facing mental health or substance use challenges continue to encounter barriers that their counterparts with physical illnesses rarely face. As we grapple with increasing rates of mental illness and addiction, it’s time to confront the inequities in how we design, fund, and deliver care.

Two Systems, Unequal Paths

In the realm of medical health, patients benefit from an extensive continuum of care: primary care, specialist referrals, urgent care, surgery, rehabilitation, skilled nursing, and home health services. Transitions are often coordinated and systems are generally well-integrated.

“Behavioral health remains the neglected sibling of medical care, with fragmented services, parity enforcement gaps, and barriers leading to homelessness and incarceration. To achieve equity, we must invest in infrastructure, enforce parity laws, strengthen the workforce, integrate care, and combat stigma”

By contrast, the behavioral health continuum is riddled with gaps. Crisis services are fragmented, acute psychiatric units are at capacity, causing beds to be scarce and outpatient follow-up is unreliable due to long wait times for an appointment or a lack of outpatient providers overall. Many communities lack essential services like step-down care, partial hospitalization programs (PHPs), or Assertive Community Treatment (ACT) teams. When people in crisis are discharged without follow-up or care coordination, the cycle of hospitalization, homelessness, and incarceration continues. No one would imagine discharging a ventilator-dependent person without adequate housing and follow-up care. Yet, it is okay to discharge someone with chronic to severe mental illness without proper housing and support. For those providers that do hold these people in an inpatient bed while working diligently to provide a safe discharge, the payer denies the claim for continued stay. Their reason is, “The patient is at baseline and no longer needs acute psychiatric care. Custodial care is not a covered service.”

Insurance Inequities and Fragmented Coverage

Mental health parity laws were intended to ensure equal behavioral and medical health coverage, but enforcement remains weak. Many insurance plans outsource behavioral health to third-party vendors, leading to confusion, reduced access, and out-of-pocket costs that deter care. Meanwhile, reimbursement rates for mental health providers remain lower than those for other specialties, contributing to workforce shortages and provider burnout.

The Human Toll

One in five U.S. adults experiences a mental illness annually, yet more than half receive no treatment. For those with serious mental illness (SMI), life expectancy is 10 to 25 years shorter, due not to their psychiatric condition but to untreated or poorly managed physical health issues. Emergency departments and jails are increasingly becoming our front lines of access to mental health care—a public health failure with profound human and economic costs.

Reimagining the Future

To build an equitable continuum of care, we must:

• Invest in infrastructure: Fund community-based crisis stabilization units, transitional housing, mobile crisis teams, and outpatient programs. Address the social determinants of health that influence poor health outcomes. Without safe housing, treatment adherence declines. Without income or food security, stress and instability can exacerbate mental health symptoms. Addressing behavioral health without attending to these social factors is like building a house without a foundation.

• Enforce parity laws: Hold insurers accountable for coverage equivalence, claim payment, and network adequacy.

• Strengthen the workforce: Expand loan repayment, boost reimbursement, and support multidisciplinary care teams.

• Integrate care: Scale collaborative care models in primary care and invest in Certified Community Behavioral Health Clinics (CCBHCs).

• Combat stigma: Support anti-stigma campaigns and train healthcare providers and law enforcement in trauma-informed practices.

Conclusion

Behavioral health is essential health. Equity in care isn’t just a moral imperative—it’s a necessary step toward a healthier, more just society. It’s time to stop treating behavioral health as an afterthought and build a system where care is equitable, continuous, connected, and compassionate for all.