Case Study

Improving Behavioral Health For All

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One in five United States adults experiences mental illness,1 and 17% of youth experience a mental health disorder.2 Over 32% of adults with mental illness also experience a substance use disorder.1 In Massachusetts, almost 32% of adults reported symptoms of anxiety and depression, and of those individuals, up to 55% of those did not receive mental health treatment, said the Kaiser Family Foundation.3

In addition to substance use disorder, mental health disorders can be tied to cardiovascular and metabolic diseases, unemployment, emergency department visits, homelessness, and domestic violence.4 Access to mental health services is also a significant challenge for many. A 2018 National Council for Mental Wellbeing study revealed that American mental health services are insufficient, and despite high demand, the root of the problem is lack of access – or the ability to find care. Ninety-six million Americans, or 38%, have had to wait longer than one week for mental health treatments.5

To address these complex issues, Massachusetts embarked on a major initiative to change how behavioral health services are delivered in the Commonwealth. Part of that work involved speaking with more than 700 individuals, families, and others to understand the gaps and flaws in the state’s behavioral health services. The information gleaned advised actions on how to address access to and the delivery of behavioral health services in the state.

The Challenge: Helping to Improve Behavioral Health Services for All6

  • Residents cannot find the mental health services they need or how to connect to them.
  • There are not enough behavioral health providers who accept insurance (public or private), and those that do may have long waiting lists.
  • People often turn to the emergency department during a behavioral health crisis because there is no effective system for immediate urgent care in the community.
  • Individuals often cannot get mental health and addiction treatment at the same location, even though mental health conditions and substance use disorder often co-occur.
  • Culturally competent behavioral health care for racially, ethnically, and linguistically diverse communities can be difficult to find.
  • The onset of the COVID-19 pandemic increased the need for both mental health and addiction services.

The Strategic Planning, Process Improvement & Project Management team worked in collaboration with our policy experts to support the Department of Mental Health and the Massachusetts Medicaid (MassHealth) Office of Behavioral Health to restructure the crisis system in Massachusetts.

Our Approach: Getting People Connected to the Right Treatment in Real Time

We work with our clients to generate practicable plans while providing coaching and mentoring so that strategic planning and process improvement become standardized activities the organization can improve upon over time.

For this initiative, we collaborated with the client to create the Roadmap for Behavioral Health Reform (Behavioral Health Roadmap), which consists of a three-year strategic plan to address issues related to access to care and services, stigma, discrimination, absence of parity, age-specific issues, condition-specific issues, financing, payments, coverage, workforce, regulatory constraints, and other challenges. The Behavioral Health Roadmap will make it easier for residents to find and access behavioral health services, reduce reliance on hospital emergency rooms, and improve and streamline the availability of behavioral health clinical services for adults and youth.


With our support and many other community agencies and partners, our client created the Behavioral Health Roadmap, which produced over 30 cross-agency policy initiatives that have been or are currently being implemented. This includes establishing community-based health centers, the behavioral health helpline, and improvements to behavioral health urgent care, which our team helped design, implement, and manage with employees and agency stakeholders.

Some key measures consist of a “front door” for people to get connected to the right treatment in real-time, such as a centralized service for people or their loved ones to call or text to get connected to mental health and addiction treatment before urgent help is needed. Community-based health centers provide better and more convenient community-based alternatives to the emergency department for urgent and crisis intervention services, which operate 24/7.

Perhaps most importantly, the Behavioral Health Roadmap advances health equity to meet the diverse needs of individuals and families, particularly from historically marginalized communities, encourages more providers to accept insurance by reducing administrative and payment barriers, and implements targeted interventions to strengthen workforce diversity and competency.