A medical assistant with COPE Community Services discusses treatment with a patient. The Tucson facility is part of Arizona’s Certified Community Behavioral Health Clinics program.
Photo courtesy COPE Community Services
Behavioral health services have been in short supply for years in the U.S., something that became even more apparent during the high-stress early years of the COVID-19 pandemic.
But even as the pandemic has ebbed, the need for mental health and substance use services, particularly during crisis situations, has remained. Fortunately, across the U.S., Certified Community Behavioral Health Clinics are increasingly helping to meet the demand.
The clinics were created in 2014 through the Protecting Access to Medical Care Act, with 10 states chosen for pilot demonstrations of a new strategy offering a continuum of care for mental and behavioral health patients.
The CCBHC model provides crisis services that are available 24/7, comprehensive behavioral services in a single location, and care navigation among health and social services so that patients do not fall through the cracks. The clinics serve a vital role for people experiencing mental health crises, steering them away from emergency rooms and from interaction with law enforcement.
In 2022, the program was re-imagined by offering selected states CCBHC one-year planning grants or expansion grants from the Substance Abuse and Mental Health Services Administration. In June this year, the U.S. Department of Health and Human Services announced authorization of 10 more demonstration states, among them Alabama, Illinois, Indiana, Maine, New Mexico and Vermont. Demonstration states receive enhanced Medicaid funding for public health programs.
Today, over 500 CCBHCs have been established in 46 states, Puerto Rico and the District of Columbia, with more opening regularly.
To finance their operations, the clinics operate under a SAMHSA grant, are part of a state demonstration program or are funded independently by state Medicaid fee-for-service reimbursement.
Arizona received a four-year SAMHSA expansion grant in 2023. The state had already received accolades from federal health officials for its continuum of care in behavioral and mental health.
Arizona has a 24-hour call line for people in mental health crisis, infrastructure for crisis response and outpatient receiving facilities, said Richard Frank, PhD, senior fellow in economic studies and director of the Center for Health Policy at the Brookings Institution.
“They are kind of a model for how you do this,” said Frank, a former assistant secretary for HHS planning and evaluation during the Obama administration, when Congress passed the law creating CCBHCs.
Bringing health services together
COPE Community Services in Tucson is part of Arizona’s CCBHC program. COPE oversees 15 licensed outpatient facilities for behavioral and mental health in Pima County.
The nonprofit receives patients from area crisis response centers. Among COPE’s offerings are individual and group therapy, peer support, substance use and recovery services, HIV and sexual health services, housing and homelessness services, and job training and employment services.
COPE, which stands for Community Opportunity for Personal Enrichment, also operates a mobile unit called Wellness on Wheels in a converted RV. On any given day, the unit might visit a low-resource community to offer HIV and sexual health services, or offer medical aid and preventive health services to people experiencing homelessness.
Celebrating its fifth decade of operation this year, COPE has 370 employees, an annual budget of $45 million and is funded through Arizona Medicaid and grants.
The SAMHSA expansion grant has enabled facilities to extend office hours, expand services for adult, children and veteran outreach, and make key hires in positions requiring advanced degrees, such as for a child psychiatrist and medical and counseling staff, said Laura Santa Cruz, MBA, CCBHC project director for COPE.
“We try to arrange so patients can receive all the services under one roof,” Santa Cruz told The Nation’s Health.
Pima County, population 340,000, has a disproportionate number of people on Medicaid, who may struggle to find access to care, particularly for behavioral health services.
“Lots of folks in the county have serious mental illness and chronic substance use,” said Siobhan O’Boyle, MBA, COPE’s chief compliance and operations officer.
Despite grant funding, COPE struggles with staff recruitment and retention, as do many other CCBHCs across the country. About 20% of COPE positions are vacant, O’Boyle said.
Counselors and case managers are finding work in other fields that pay more and are not as stressful as a grant-dependent job, she said. Also, many areas of Pima County have no broadband internet access, so telehealth is not an option. That is a deal-breaker for some behavioral health professionals used to providing remote care.
“We do employ psychiatric providers and therapists via telehealth, but usually the patient is in the clinic and the provider is remote,” O’Boyle said.
COPE uses tuition reimbursement incentives and other strategies to recruit and retain workers. It also works with local university public health departments to fill positions.
“We have this whole incentive-based program to try to entice people and try to keep them in their current roles,” Santa Cruz said. “But it just continues to be a challenge.”
Besides problems with funding, recruitment and retention, CCBHCs struggle to serve people in rural areas, Frank said.
“In their impulse to increase the quality and the capacity of these centers, it also means that it’s more costly to stand one up,” he told The Nation’s Health. “CCBHCs require a larger population base, and so small cities and rural areas with a lot of poverty and a lot of mental illness are less likely to get one of these places and be able to support one.
“The challenge is going to be figuring out how to build that capacity in smaller communities and lower income communities,” he said.
COPE’s federal grant has enabled services to reach farther into rural Pima County, but bringing people into the behavioral care system has been hard, Santa Cruz said.
“We are working on developing partnerships with providers in rural communities, so that we can then refer patients and connect them to those resources,” she said.
Meanwhile, COPE leaders are grappling with how to fund its services when the SAMHSA grant runs out. State and health officials are meeting to decide if Arizona should apply as a demonstration state, as federal officials will choose 10 more in 2026.
Visit www.samhsa.gov for more on CCBHCs. Learn more about COPE at www.copecommunityservices.org.
- Copyright The Nation’s Health, American Public Health Association
