Behavioural Health Services

Behavioural Health Services


In United States, one out of four persons are likely to experience different forms of mental ailments and also suffering from comorbid physical fitness disorder. On a day-to-day basis, one of the patients may need behavioural health care assistance from a health facility. According to Oss (2005), managed health care is considered as a risk valuation and health care management clinically and money-wise. This is done with an aim of expediting pertinence and cost efficiency of health-care services within the restraints of whatever is reasonable.

This can be achieved by utilizing rule-based and medical management-based plans. In the recent years, medical insurance providers such as Medicaid, has continuously headed in the appropriate path on a successful mode of behavioural health care services.  The Psychiatric Prospective payment, initiated by the National Association of psychiatric systems, was developed with an aim of enhancing the overall experiences of the behavioural health patients. The Psychiatric Prospective is a mandatory for the health care facilities to enhance validity and reliability in guaranteeing that every patient is treated effectively. Considering managed care programmes, both patients and management have an agreement to offer the programmes at an affordable rate. Managed care establishments may also generally assist in the management of utilization services offered.

Managed care is often regarded not only as a healthcare system, but also more of a routine and cost suppression technique.  It also focuses on other components such as the prevention and general quality of care service offered. For this research assignment, the focus will be on the behavioural health care services business model and the impacts of managed care on behavioural health industry.  The key objective of this research is to have an in-depth understanding the several impacts on the delivery of behavioural health services.

Behavioural Health Services as a Profession

In recent years, a raging debate continues to ensue in regards to whether behavioural services may be considered as a career. Behavioural health services can be viewed as a profession. One of the aspects that makes it a career is emphasis on handling persons with psychological ailments. Nevertheless, it is comprehended by a range of other vocations. The careers are composed of; professional counsellors, psychiatric nurses, psychoanalysts, sociologist, and social personnel. Each professional plays a critical role in administering behavioural health services.  A majority of American citizens acquire psychological health care from specialized psychotherapists.

These counsellors have attained high qualifications such as having a masters degrees and engage families, persons and groups. They lay emphasis on the treatment of mental, behavioural and emotional ailments and complications. General, they use mental and human advancements to deal with personal development, career progress, and wellness challenges. Expert in behavioural treatment, psychiatric health personnel can nurse patients and offer modes of helping the patients and families handle the psychological ailments.  Psychiatrists are qualified as physicians. They identify and also treat and assist in the inhibiting patients with psychological fitness and emotive difficulties.  Since they acquire training in mental health management, they comprehend the relations between medicinal and emotional disorder.

Reimbursement of Behavioural Health Services

While comparing the behavioural health services and other services in the industry; behavioural health service are varied. One aspect that differentiates the service from the elements is founded on the form of service offered.  For instance, the healthcare sector offers treatment to patients in health institutions while behavioural health services can be delivered in a salutary settings. Considering that several patients that pursue behavioural health services also agonize from prolonged ailments, it may turn out to be a daunting task for doctors to treat patients. This is as a result of the fact that most of the doctors have no expertise and preparation to handle both challenges. Another aspect is every service offered contains a customized code which is delivered by the Healthcare Common Procedure Coding System. The trials for the method of reimbursements under Medicare and Medicaid have remained a constant challenge.

Numerous elements decide how the process of reimbursement is conducted under Medicaid. This means that the patients and insurance providers are reimbursed reliant upon the case by case basis. This generally guarantee that there are no excess payments and also ensuring that every party is covered equally, in terms of finances. According to Zuvekas (2020), nations have the ability of establishing their own Medicaid insurance payment rates in accordance with the federal requirements. Governments normally pay for provisions through programmes such as the fee-for-service or managed care provisions.  Some of the factors that may be considered are founded on the rates for delivery of services as well as reviewing what commercial financiers pay in the private sector. Generally, the providers ought to have the readiness to assent to the rates of reimbursement integrated under the Medicaid programme. Consequently, a majority of the patients will retreat from the medical sector devoid of obtaining care for their health conditions.

Challenges Faced By Behavioural Healthcare Providers

While dispensing their duties, Behavioural Healthcare providers are known to experience a wide range of challenges. Foremost, the healthcare face the challenge of having to work devoid of any form of clinical security. It is demanding for health providers and practices when EHRs do not back discretion. Individuals suffering from mental ailments are faced with unique patient security challenges when acquiring health care.  Regrettably, there is still a non-existence of cognizance regarding the unique concerns amongst healthcare providers and patients. In addition, there is an absence of proof linked to these concerns. Patient discretion necessitates protection through the incorporation of clinical accounts and billing structures. On the other hand, the split up of structures may make the organization of care more demanding.

Another challenge experienced by behavioural healthcare providers is the absence of adequate evidence. As compared to the over-all healthcare, mental health has ailments that lack proof and also procedures to certain prescriptions that are unconvincing. Another challenge involves lack of integration.  In many instances, a Psychiatry electronic health record policy doesn’t assimilate appropriately with other healthcare services. For EHR data-sharing to work faultlessly, it is important for the health care system to connect efficiently, every time and wherever it is required. Detached structures bring about tons of disseminated information and incoherent reports.  This leads to difficulties in putting their EHR systems to optimum practice. Moreover, this also results to a momentous reduction in practicing efficiency, income, and patient treatment.

Areas of Conflict

There exists several regions of dispute between the behavioural health and managed care. The areas include health care quality, ethical evaluation and the patient-doctor relations. Ethical analysis strain is as a result of the frameworks in both managed care and behavioural management services; in which urgencies are viable.  Amongst the challenges at hand, the quality of care is the utmost vital and requires instant consideration. This conflict is unavoidable and results to unfortunate or prejudiced services to patients.  According to Reiter Dobmeyer and Hunter (2018) if the emphasis is on the magnitude as compared to the quality, patients will not be guaranteed of quality health care.  Quality ought to constantly important as compared to magnitude of the health care provided.

Managed care environment

Even though there is an upsurge in the demand for behavioural health services, I am certain that managed care surroundings have the capability of supporting the services needed to offer efficient residential treatment.  Residential treatment programmes are planned on offering an efficient mode of intensive therapy or assistance for persons experiencing serious mental ailment. Residential treatment programmes are favourable for persons that have a certain ailment and is considered as risky while dwelling in the community. This form of treatment is not accomplished in a patient’s place of residence, but they are accommodated in a facility. In this kind of facility, treatment is administered, overseen and also observed by specialized members of staff.

In my point of view, a residential treatment amenity may require a residential treatment program to continue offering efficient treatment procedures. A residential treatment programme assists in the provision of discrete and group rehabilitation along with offering encouragement and openings for family psychanalysis.  This is achieved through on-site breaks, home pass, phone calls and other forms of communicating.  Other means for a residential treatment processes include continuous effectiveness. This is meant to embolden positive behaviors that may lead to a drop in a patients’ occurrences of hostility. Additionally, it may also be favourable to guarantee that the programme presented includes strategies adequate for enhancing safe behaviours. According to Oss. (2005)in the case patients victimization, it is vital to outlaw any kind of castigation or deeds of bullying.  It is likewise extremely imperative to guarantee that treatment offered is founded on evidence based rehabilitations.

Incorporating Changes as a Manager

Based on the assignments research, managed care plays a critical role in the behavioural health industry. In regard to the behavioural healthcare business model, there ought to be constant effort to guarantee the provision of quality services by the providers.  This definitely helps in terms of legal matters between patients and health providers. To guarantee that behavioural healthcare providers are executing legitimate and reliable services, it is vital for these professionals to be experienced and well trained. In doing so, it promotes high quality of services and general upgrading of a person’s quality of life. Families that entrust the healthcare specialists want to guarantee that loved ones receive equal and fair treatment.

Being a manager of a behavioural healthcare facility, I may have integrate various changes to enhance efficiency. Foremost, this would entail the formation of a strategy that stabilizes the financial independence of the organization.  If a behavioural health organization fails to receive appropriate funding, it may lead to deteriorating of services received by a patient. Funding plays a pivotal role in guaranteeing the type of services offered by professionals. The next adjustments may involve the integration of technology in the overall treatment procedures of patients experiencing mental ailments. Lack of sufficient gear or the essential resources may delay a person’s treatment procedure.  Components such as electronic health accounts, are extremely significant in regard to patient data and how it is circulated. Locating other choices for healthcare analysis will also be one of the significant urgencies. Other changes that may be instigated include catering for the needs of the consumer.


The role played by managed care mechanism in the behavioural health care sector seem to be an imbalance in the quality of care and services offered. Most of the challenges are attributed to lack of funds and insufficient training of healthcare providers, resulting in ineffectiveness of managed care. Management of the costs is also a challenging aspect. Focusing on the cost and quality of the professionals and fundamental care may necessitate the involvement of more states. This allow insurance provides such as Medicare and Medicaid to assist in financing and allowing patients get access to services at affordable rates. Nevertheless, this does not enhance medical services but restricts the mental health services.




Zuvekas, S. H. (2020). Financing of Behavioral Health Services: Insurance, Managed Care, and Reimbursement. In Foundations of Behavioral Health (pp. 71-99). Springer, Cham.

Reiter, J. T., Dobmeyer, A. C., & Hunter, C. L. (2018). The primary care behavioral health (PCBH) model: An overview and operational definition. Journal of Clinical Psychology in Medical Settings25(2), 109-126.

Oss, M. E. (2005). What’s next for managed behavioral health. (Cover story). Behavioral Health Management, 25(6), 11-14






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