Sally Satel This Program Is a Lifeline for the Severely Mentally Ill Certified Community Behavioral Health Clinics serve as a one-stop shop for people with psychotic conditions.
The Department of Justice is brainstorming ways to clear homeless encampments and increase involuntary hospitalization, focusing on people with serious mental illness. Fortunately, the federal government already has a resource for people with such conditions: Certified Community Behavioral Health Clinics. CCBHCs serve as one-stop shops for people with serious mental illness, providing coordinated physical and specialty behavioral health services. As part of their congressional mandate, the clinics turn no one away, regardless of ability to pay.
But according to an April 10 document leaked to the media, the White House was considering defunding grants for the CCBHC program. This would have eliminated a crucial lifeline for the seriously mentally ill.
CCBHCs have been a bipartisan effort. In 2014, Congress and President Obama established the clinics under an eight-state Medicaid demonstration project that launched three years later. In 2020, Congress and President Trump adopted the CARES Act, which expanded the demonstration and provided grant funding for additional CCBHCs. Today, nearly 500 CCBHCs serve 3 million patients across 46 states.
Congress requires that the clinics provide services essential to people with psychotic conditions like schizophrenia and bipolar disorder. These include 24-hour mobile crisis teams of clinicians and social workers that respond immediately to people whose symptoms are making them an acute danger to themselves or others, and emergency stabilization, including medication adjustment or use of short-stay beds.
People with psychotic illnesses also require intensive case management: daily in-person visits or telehealth check-ins to ensure that they take medications and engage in treatment. This helps them stay out of prisons, county jails, emergency rooms, and homeless shelters. CCBHCs provide these services, as well as primary-care screening and monitoring. For example, clinic staff conduct diabetes screenings for patients who take antipsychotic medications, which is critical, since these drugs often disrupt glucose metabolism.
In the end, the White House opted not to cut a program that serves its mental-health goals. The budget proposal released by the administration on May 30 calls for CCBHCs to be preserved. Under the administration’s plan, the program, which would be moved from the Substance Abuse and Mental Health Services Administration to a new agency called the Administration for a Healthy America, would receive $385 million in funding for fiscal year 2026, which begins on October 1. Now it is up to Congress to maintain the funding or even expand it.
The administration’s support for continued CCBHC funding is welcome. “This is not the time to reduce comprehensive mental health services provided by CCBHCs,” says Chuck Ingoglia, president of the National Council on Mental Wellbeing. “CCBHCs have garnered so much bipartisan support. Let’s continue to invest in them.”
Centerstone, a CCBHC program with locations in Clarksville and Tullahoma, Tennessee, has had considerable success. “After implementing the CCBHC model, unemployed patients increased their participation in the workforce by nearly 70 percent,” Centerstone’s chief executive officer, David C. Guth, Jr. said. Centerstone also operates CCBHCs in Bradenton and Fort Myers, Florida, where nearly 80 percent of patients improved school and work attendance after receiving the clinics’ services.
At Arisa Health, which serves rural Boone County in Arkansas, the clinic’s peer support, targeted case management and care coordination, and traditional mental-health services contributed to a 46 percent reduction in patients’ hospital use.
“Among those with the most severe conditions, 9 of 10 patients with a history of hospitalization have not had a single hospital visit since enrolling in Arisa’s extensive outreach program,” the group’s project director, Blaine Hubbard, said.
States with these programs have seen cost savings and fewer psychiatric hospitalizations. Kansas, for example, projects that CCBHCs will save the state $47 million in 2025, primarily through lowering emergency-room usage and inpatient stays as demonstrated in prior years. Missouri’s Behavioral Health Council reports that the number of patients served by CCBHCs has increased by 94 percent since 2017, while hospitalizations and ER visits have been cut nearly in half.
Lisa Dailey, executive director of the Treatment Advocacy Center, a nonprofit based in Arlington, Virginia, sees the funding cuts as uniquely harmful to people with the most serious mental illnesses. “It will lead to congestion in emergency departments,” Dailey said, “in large part because [the clinics] are ideal locations for Assisted Outpatient Treatment [AOT] programs.”
AOT, a form of civil-court-ordered community treatment for patients known to be self-destructive or dangerous when not taking their medication, is an effective program for some people with serious mental illness. A 2024 evaluation by Duke University and others found AOT to be extraordinarily effective in preventing homelessness, violent behavior, and drug abuse while improving medication adherence.
CCBHCs represent the implementation, at long last, of the intensive community-based psychiatric services envisioned by Health and Human Services secretary Robert F. Kennedy Jr.’s uncle. In 1963, President John F. Kennedy signed the Community Mental Health Act to accommodate newly deinstitutionalized patients who were streaming into communities. With the law, Kennedy said, “reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability.”
Tragically, the network of smaller clinics planned for the sickest individuals never fully materialized. For decades, people with the most devastating mental illnesses have struggled to find respite and care, languishing in jails and on the streets.
The first Trump administration championed CCBHCs as successful communities of warmth, concern, and capability. Now the second has, in the end, proposed continued funding. Congress should heed the White House’s recommendation.
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