Identifying Problems in Behavioral Health Systems

Last week, the National Council for Behavioral Health held their annual conference, coming to our industry virtually for the first time.

In a pre-pandemic world, the Sigmund team looked forward to attending NatCon’s conference every year. It is always a great opportunity to learn from and connect with the behavioral health community.

Unfortunately, we all missed out on the business trip and camaraderie this year. However, that didn’t stop the National Council from providing an excellent virtual experience.

There were a number of fantastic speakers who gave powerful and informative presentations, but Scott Lloyd’s stood out to our staff in particular. Lloyd is the President of MTM Services, LLC, and spoke about the shortcomings of the current care delivery systems in behavioral health.

We loved Lloyd’s passion for care delivery and his willingness to call out our industry’s problems, using over twenty years of data and experience to back up his claims.

At Sigmund, we strive to consistently reimagine our software and how it can best improve care systems for both providers and patients. Much of what Lloyd spoke about are problems that we have been reckoning with on the vendor side for years.

We wanted to highlight and explore Mr. Lloyd’s thoughts here, as they will be relevant and resonant for many of our readers.

Our Behavioral Health Systems Require Change

Lloyd’s main point is that the care delivery systems in behavioral health are faulty. They’re inefficient, full of gaps, and overall make it more difficult to provide the treatment patients deserve.

Many people in behavioral health agree that our systems need to improve. There isn’t so much a lack of support for changes as there is a lack of confidence in how to make changes.

Have you ever worked for an agency that seems to talk about change but never acts on it? That is common all across the industry.

If we just keep talking about it, our patients and their families will continue to suffer in a system that does not optimally serve them.

This article will explore the following issues that Lloyd claims are keeping behavioral health organizations from committing to really changing (improving) how they deliver treatment:

• Financial Pressures
• Access Data
• Staff Burnout
• Organizational Dysfunction

Financial Pressures

As you probably know, money is a big factor in virtually any decision behavioral health agencies make. Organizations are often limited, or altogether restricted, by funding issues. Unfortunately, this then dictates the quality of their systems.

Lloyd has found that leaders at agencies and around the industry have become paralyzed by financial pressures.

At the end of the day, behavioral health agencies have to make money to stay open. This business necessity commonly yields systems that are designed to keep organizations financially viable. If you notice, though, the patient’s interests are not exactly present in this equation.

Access Data

Lloyd defines access data as a measurement of when a patient calls for care vs. how long it takes them to receive that care.

This is another big problem he has found in behavioral health systems, which is due in large part to an overwhelming amount of assessments. The assessment market is booming in our industry. And not in a good way, at least for patients.

Lloyd has seen a lot of excessive documentation in his travels.

For example, some organizations have many thousands of active assessments (which are often fragmented and repetitive). Others have extremely long assessments that can take a patient an entire day to fill out.

These excessive systems contribute to a labyrinth of assessments that obstruct and convolute the path to treatment. As a result, patients can become disenfranchised by the cumbersome process. They feel like they will never get the care they reached out for.

Lloyd made a very good point in that when a patient finally calls for treatment, they are ready for that treatment. Our systems fail them by making it such a chore to actually get into treatment. We owe them that compassion upfront.

Instead, the industry is currently exhibiting an alarmingly high dropout rate before the patient even receives treatment.

Staff Burnout

Our industry’s systems are also causing widespread burnout amongst staff.

Lloyd states that there is a lot of system noise in behavioral health, or forces that keep staff from doing the job they want to do – helping patients in need.

Common examples of these noisy forces are:

• Counterintuitive/inadequate EHR software
• Overly burdensome paperwork
• A lack of resources
• Doing more than they should/are asked to keep the system working

Lloyd notes that he rarely sees lazy staff. The vast majority are passionate and hardworking. The system simply fails them.

That failure eventually takes a toll. In his experience and collaboration with hundreds of organizations, Lloyd has found a 40% staff turnover rate.

In other words, the average organization will turn over nearly half of their staff each year. This runs the risk of introducing inconsistency into processes and treatment. Furthermore, the task of training and retraining employees can become a nearly constant deterrent to efficiency and consistency.

Organizational Dysfunction

Organizational dysfunction can be a major factor in preventing agencies from making necessary system improvements. Lloyd defines the term as a point when an organization becomes so frustrated and/or stagnant in their change process that they cannot move forward with any changes.

Any organization is going to deal with some dysfunction. However, Lloyd has identified specific staff behaviors that most contribute to organizational dysfunction.

We can break these red flags down into 4 personas:

• The “We’ve Tried This Before” Persona – This staff is not interested in making changes because they’ve personally witnessed how a similar change has failed. Or, oftentimes, they’ve heard about a similar system failing somewhere else.
• The “I Think, I Feel, I Don’t Like..”  Persona – This staff reacts emotionally to changes and decisions that really can’t afford to be based in emotion.
• The “I’m Angry” Persona – This staff reacts in anger. Whether they lash out or yell, it is never productive and always disruptive.
• The “We Can’t Afford That, Maybe Next Budget Cycle” Persona – This staff allows the budget to dictate their expectations of what kind of changes are possible. They are commonly resistant to change because they do not think it is financially viable. However, many positive changes typically generate more revenue once they’ve been made in earnest.

If left unchecked, these behaviors become ingrained in a staff’s behavior, and therefore in the agency’s systems as well.

Where Do We Go From Here?

“We are addicted to paperwork. We are addicted to regulations. We are addicted to our processes so much so that, ultimately, we allow our systems to take precedence over our consumers.”

In a presentation full of resonant and powerful statements, this quote really stood out.

When you put it in those stark terms, it’s difficult to argue or ignore the need to transform our behavioral health systems.

Why are we so attached to doing things inefficiently? Why are we so complacent in a system that is not just failing patients, but actively causing them to disengage?

Asking (and hearing) those kinds of questions can be a bit demoralizing.

However, one silver lining is that more and more behavioral health professionals are asking the same things. During Lloyd’s presentation, there was a steady flow of comments from the audience that applauded and shared his views.

Lloyd and others like him have done some tremendous groundwork to bring our industry’s shortcomings to light. And now, after two decades, Lloyd has the data to back up his findings.

Now that these problems with our systems have been illuminated, we hope that more behavioral health professionals continue to take up the cause, both philosophically and professionally.  Lloyd has an idea for how the industry can succeed in solving these issues, which you can read about in this blog post that explores his vision for how to transform behavioral health systems.

Lloyd’s presentation also further validated the importance of our efforts on the vendor side. The providers can’t be the only ones making changes.

At Sigmund, we strive to constantly improve AURA, our enterprise software solution, to fill the gaps in systems we see all over behavioral health.

The lines of communication and collaboration are always open between us and our customers. We’ve found this is the only way to continually refine and innovate our software in ways that best facilitate their care delivery.

As a result, we can provide organizations with a tailor-made solution that optimally serves their systems and, most importantly, improves patient outcomes and the care they receive.

If you are interested in how AURA can help patch up your organization’s flawed systems, we’d be happy to speak with you directly. Click this link to reach out to one of our knowledgeable experts today!