Integrating Mental Health and Substance Use Treatment With Emergency and Primary Care: The Case of Opioid Use Disorder and Suicide

Tags:
Early View Perspective
Topics:
Mental health Opioids

Policy Points:

  • There have been significant advancements in expanding care for opioid use disorder and suicide in general medical settings in the first quarter of the 21st century.
  • Incessant barriers in the US health system continue to hinder progress in sufficiently scaling up evidence-based behavioral health interventions and getting them to those at highest risk.
  • State policymakers have multiple levers available to make significant improvements to address ongoing challenges and improve access to evidence-based behavioral health services in emergency and primary care settings.

The United States is facing an ongoing mental health and substance use crisis. In 2023, 58.7 million US adults had a past-year mental illness, 46.3 million had a substance use disorder (SUD), and 20.4 million had both.1 Overdose and suicide deaths have risen substantially over the past decades,2-6 contributing to declining life expectancy that is unevenly distributed across sociodemographic subgroups.7 In addition to their impact on premature mortality, mental illness and SUD are primary contributors to acute and chronic morbidity and disability.8 Still, only half of people with a mental illness and a quarter with SUD in the United States received any treatment for these conditions in 2023.1

Despite gaps in access to behavioral health treatment, people with mental illness and SUD interact with general health care settings for a range of needs. Two critical points of care are primary and emergency care settings. Primary care is often the first or sole point of contact for most of the population, playing an increasingly significant role in identification, treatment, and referral to other specialties or levels of care for behavioral health conditions.9, 10 Indeed, over a third of visits for any mental illness in the United States occur in primary care settings.11 At the other end of the spectrum, emergency departments (EDs) and hospitals bear the charge of addressing severe behavioral health needs, particularly in the aftermath of the COVID-19 pandemic.12-16 Of all ED encounters between 2018 and 2020, 12% were for behavioral health conditions.15

References

1

Substance Abuse and Mental Health Services AdministrationKey substance use and mental health indicators in the United States: results from the 2023 National Survey on Drug Use and Health. SAMHSA. July 2024. Accessed December 30, 2024. samhsa.gov/data/report/2023-nsduh-annual-national-report

2

Garnett MFCurtin SCStone DMSuicide mortality in the United States, 2000–2020: NCHS data brief 433. Centers for Disease Control and Prevention. March 2022. Accessed May 15, 2022. cdc.gov/nchs/products/databriefs/db433.htm

3

Garnett MFCurtin SCSuicide mortality in the United States, 2001–2021: NCHS data brief 464. Centers for Disease Control and Prevention. April 13, 2023. Accessed December 28, 2024. doi:10.15620/cdc:125705

4

Garnett MFCurtin SCSuicide mortality in the United States, 2002–2022: NCHS data brief 509. Centers for Disease Control and Prevention. September 2024. Accessed December 28, 2024. www.cdc.gov/nchs/products/databriefs/db509.htm

5

Hedegaard HMiniño AMSpencer MRWarner MDrug overdose deaths in the United States, 1999–2020: NCHS data brief 428Centers for Disease Control and Prevention. December 30, 2021. Accessed December 8, 2024. doi:10.15620/cdc:112340

6

Spencer MRMiniño AMWarner MDrug overdose deaths in the United States, 2001–2021: NCHS data brief 457. Centers for Disease Control and Prevention. December 2022. Accessed February 14, 2023. cdc.gov/nchs/products/databriefs/db457.htm

7

Harper SRiddell CAKing NBDeclining life expectancy in the United States: missing the trees for the forestAnnu Rev Public Health202142381403.

8

Vigo DJones LThornicroft GAtun RBurden of mental, neurological, substance use disorders and self-harm in North America: a comparative epidemiology of Canada, Mexico, and the United StatesCan J Psychiatry202065(2): 9798.

9

Burke SPFrank RGKennedy PJ, et al. Tackling America’s mental health and addiction crisis through primary care integration. Bipartisan Policy Center. March 2021. Accessed December 31, 2024. bipartisanpolicy.org/download/?file=/wp-content/uploads/2021/03/BPC_Behavioral-Health-Integration-report_R03.pdf

10

Kates NArroll BCurrie E, et al. Improving collaboration between primary care and mental health servicesWorld J Biol Psychiatry201920(10): 748765.

11

Jetty APetterson SWestfall JMJabbarpour YAssessing primary care contributions to behavioral health: a cross-sectional study using medical expenditure panel surveyJ Prim Care Community Health202112.

12

Bommersbach TJMcKean AJOlfson MRhee TGNational trends in mental health-related emergency department visits among youth, 2011–2020JAMA2023329(17): 14691477.

13

Holland KMJones CVivolo-Kantor AM, et al. Trends in US emergency department visits for mental health, overdose, and violence outcomes before and during the COVID-19 pandemicJAMA Psychiatry202178(4): 372379.

14

Gutiérrez-Sacristán ASerret-Larmande AHutch MR, et al. Hospitalizations associated with mental health conditions among adolescents in the US and France during the COVID-19 pandemicJAMA Netw Open20225(12):e2246548.

15

Peters ZJSanto LDavis DDeFrances CJEmergency department visits related to mental health disorders among adults, by race and Hispanic ethnicity: United States, 2018–2020: NCHS report 181. Centers for Disease Control and Prevention. March 1, 2018. Accessed December 30, 2024. doi:10.15620/cdc:123507

16

Santillanes GAxeen SLam CNMenchine MNational trends in mental health-related emergency department visits by children and adults, 2009–2015Am J Emerg Med202038(12): 25362544.


Citation:
Krawczyk N, Samples H. Integrating Mental Health and Substance Use Treatment With Emergency and Primary Care: The Case of Opioid Use Disorder and Suicide. Milbank Q. 2025;103(SI):0618. https://doi.org/10.1111/1468-0009.70028.