Behavioral health is widely recognized as a core component of comprehensive patient care. However, for underserved communities, access to quality care and treatment is limited by a variety of factors. Federally Qualified Health Centers (FQHCs) are at the heart of this effort, providing millions of patients with accessible, comprehensive, and coordinated primary care, regardless of their ability to pay. While FQHCs are required to offer behavioral health services, many face ongoing operational challenges that impede program capacity and effectiveness. This presents a significant opportunity for health centers to re-evaluate the way they work and build a program model that sets them up for success.

According to the National Association of Community Health Centers’ (NACHC) 2010 Assessment, over 70% of FQHCs provide virtual mental health services, 55% offer substance use services, and 65% have some form of integrated care. However, behavioral health represents just 7% of all visits at FQHCs—a number that is both substantial and still not reflective of the true need in these communities.

The reality is that behavioral health is becoming a growing priority for FQHCs, and for good reason. Many of the patients they serve face not only mental health and substance use challenges but also barriers like poverty, unstable housing, and limited access to healthcare. These intersecting issues highlight the critical need for integrated, comprehensive behavioral health programs.

The Current Landscape: Navigating Complex Challenges in Behavioral Health Care

FQHCs are already making strides in providing behavioral health services, but the journey is far from simple. There are several complexities and challenges that must be addressed to build effective programs:

• Referral Systems Aren't Enough: Some FQHCs manage behavioral health requirements by referring patients to external providers. While this helps meet regulatory requirements, it often leads to fragmented care and can delay patients from receiving the services or treatment they need in a timely manner. For patients already facing barriers to care, these delays can be detrimental.
• Primary Care Providers (PCPs) are Overloaded: Many FQHCs rely on their PCPs to manage both physical and behavioral health needs. The challenge? PCPs are not always trained to handle the nuances of mental health and substance use disorders, making it difficult for them to provide the proper level of care. This is particularly evident in medication management, a key aspect of behavioral health care that requires specialized knowledge of psychiatric medications and their impacts.
• Variation in Program Development: While some FQHCs have built robust behavioral health programs with integrated care models, many are still struggling to create a cohesive system. Those who have figured it out are reaping the benefits: improved patient outcomes, efficient care coordination, and better overall clinic performance. But there’s a long way to go to ensure that all FQHCs can provide this level of care.

The Opportunity: Building Integrated Behavioral Health Programs

There is a tremendous opportunity to transform how behavioral health care is delivered at FQHCs. By investing in integrated, comprehensive behavioral health programs, FQHCs can move beyond simply meeting a mandate—they can create lasting, impactful change in their communities. Here’s what that looks like:

1. Building Shared Care Plans: Instead of relying on referrals, FQHCs can benefit from an integrated care model that brings together mental health professionals, substance use specialists, and primary care providers. Shared treatment plans enable a more holistic approach to patient care and reduce the risk of patients falling through the cracks.
2. Empowering the Right Teams: To truly make an impact, FQHCs need dedicated clinical support from professionals who are specifically trained in behavioral health care. This includes Licensed Clinical Social Workers (LCSWs), Psychiatric Mental Health Nurse Practitioners (PMHNPs), and psychiatrists who can work alongside PCPs, providing the level of expertise needed to deliver quality care.
3. Streamlining Medication Management: Managing psychiatric medications is a complex and essential part of behavioral health care. For many FQHCs, it’s a significant pain point. By bringing in behavioral health specialists who understand the intricacies of medication management, FQHCs can improve patient outcomes and alleviate the burden on PCPs.

Leveraging Technology for Better Care Coordination: Modern behavioral health programs require robust technology to support their workflows. Virtual patient rooms, EMR integration, telehealth capabilities, and analytics tools are all essential to creating seamless care for patients. With the right technology in place, FQHCs can provide more accessible, efficient, and patient-centered behavioral health services.

Funding the Transformation: Where FQHCs Can Find Support

One of the biggest hurdles for FQHCs is funding the development of comprehensive behavioral health programs. Fortunately, there are resources available to help.

• HRSA Grants for Behavioral Health Services: The Health Resources & Services Administration (HRSA) offers grants specifically aimed at expanding behavioral health services in FQHCs. These grants are a critical resource for clinics looking to invest in staff, technology, and program development. More information can be found in the HRSA Compliance Manual: Chapter 10.
• Federal and State Funding Opportunities: Beyond HRSA, federal programs like the Substance Abuse and Mental Health Services Administration (SAMHSA) provide funding for mental health and substance use services. Many states also have initiatives to support FQHCs in developing their behavioral health programs. For a comprehensive overview, the National Council's Guide to Financing Behavioral Health Services is a great resource.
• Medicaid and Reimbursement Models: Integrated care models, such as Behavioral Health Integration (BHI) and Collaborative Care Models (CoCM), can open up additional opportunities for Medicaid reimbursement. By properly billing for behavioral health services, FQHCs can create a sustainable revenue stream that supports their programs.

While funding options can provide a quick infusion of capital allowing FQHCs to invest in new resources, developing long-term, revenue-generating programs is the key to creating sustainable clinics. Implementing a comprehensive behavioral health program opens up new opportunities that can contribute to the lasting success of the organization. 

The Role of Partnerships: Transforming Care Together

While the opportunity to transform behavioral health care in FQHCs is clear, the path forward isn’t always easy. That’s where partnerships come into play. At Peregrine Health, we’re committed to helping FQHCs build integrated behavioral health programs that serve their communities and improve patient outcomes. From providing specialized staffing and clinical support to integrating technology and care coordination, we support FQHCs in delivering quality care without overwhelming their teams.

By building the right behavioral health programs, FQHCs can truly become leaders in the communities they serve, offering not just care but a clear pathway to better mental health outcomes.

If you’re interested in learning more about how Peregrine Health is working to transform behavioral health care in FQHCs, let’s connect. Together, we can create lasting change in how care is delivered to those who need it most.