The mental health care system in the United States needs reform. Despite substantial government investment, mental illness continues to pose many social challenges. The high prevalence of suicide, overdoses, mass shootings, homelessness, and mental illness among incarcerated people are just a few examples. In some surveys, the American public views the mentally ill less favorably than it did decades ago.

The public mental health system has been failing to address serious mental illness, so other public programs and agencies are being forced to assume some of the responsibility. This leaves them less able to focus on their core missions. Untreated serious mental illnesses would require a more responsible mental health system.

A continuum of care is a system designed to assist people with serious mental illness before, during, and after episodes of crisis. A continuum of care is anchored in residential programs and staffed by trained professionals who help patients in their communities.

To provide better care for mentally ill people in crisis, it is necessary to create a Continuum of Care system that coordinates the efforts of multiple programs to provide services to people with different kinds of psychiatric disorders and at different stages in the recovery process.

The Continuum of Care model can aid policymakers and advocates in discussions of accountability in mental health policy. In recent years, mental health has been a leading focus of news coverage, with policymakers at all levels of government regularly questioned as to their plans for reform; however, the direction of mental health policy reform is often vague, if defined at all.

In order to function as a tool for accountability, the Continuum of Care must be a term of distinction. Not all public mental health programs serve those suffering from serious mental illnesses, and not all programs that provide some benefit to those with serious mental illnesses should be considered part of the Continuum of Care.

Two general challenges must be addressed to develop more robust Continuum of Care programs: Financing: insurance is the primary payer of most mental health care, as it is for mainstream health care. Thus, reforming public insurance needs to be a near-term focus of mental health reform. Most notably, that reform must include removing the so-called IMD Exclusion. Longer-term, however, policymakers should explore the development of more targeted, non-third-party-payer programs to address the lack of system capacity in some communities.

A Continuum of Care must be able to share data in order to function as a system. This will require cross-agency and cross-stakeholder collaboration, as well as legal agreements for data sharing with defined purposes and uses. Mentally ill beneficiaries of multiple social programs often face incompatible program requirements, which can make it difficult for them to navigate the complex systems. The most effective types and duration of programs may vary depending on the range of mental illnesses and an individual’s given point in time. 

A Continuum of Care model will enable ownership and accountability for meaningful outcomes and will enable the coordination of services while also defining and tracking those outcomes across programs.

A Continuum of Care model is a local system for providing mental health care. Local leadership is imperative for its development. In many respects, our ongoing crisis in mental health is also local. State and local leaders are often pressed for reforms in response to other crises related to mental illness, such as mass shootings and homelessness. Mayors and other local officials should commission studies of their existing networks of residential mental service providers who care for seriously mentally ill individuals. They should also simply talk up the concept of a Continuum of Care system to promote more focus and coherence in the mental health reform debate.

In some cases, local communities may need to rely on state or federal resources to develop these systems. This concept will help ensure better targeting of any future mental health resources.