By Marko Mijic, Managing Director, Consulting, Sellers Dorsey
LinkedIn: Marko Mijic
LinkedIn: Sellers Dorsey
Across the country, a growing movement is calling for a stronger, more connected behavioral health system—one that meets people’s needs with compassion, timeliness, and dignity. For individuals living with mental illness and/or substance use disorders, especially those from communities of color, those living in poverty, older adults, and young people, the pathways to care are often confusing, slow, and ineffective. Yet we are amid a societal shift.
The historic stigma surrounding behavioral health is changing. More people are stepping forward to seek help, and conversations that were once hidden are now taking place in the open—in families, schools, workplaces, and communities. Behavioral health is no longer confined to the margins; it’s becoming a central part of our public dialogue.
But while the demand for services has grown, our systems have not kept up. We simply are not equipped to meet this moment. We face a critical shortage of clinicians, a lack of culturally and linguistically responsive care, and outdated delivery models that do not reflect the needs and realities of diverse communities. And for those with the most acute needs—people living with serious mental illness—the community infrastructure to support their stability and recovery is almost nonexistent.
A Fragmented System That Fails to Catch People Before They Fall
Too often, people only receive behavioral health services once they’ve reached a point of crisis. And once in crisis, they still must navigate a complex web of services and supports that results in multiple delays, handoffs, or complete disconnection. The system is fragmented and often disconnected from physical health, especially in states where mild-to-moderate behavioral health care is handled by one entity while those with more severe needs are provided care by another. This bifurcated structure leads to gaps in care and people often fall through the cracks.
We have to ask ourselves: Are we solving the right problem?
Shifting the Paradigm
What if housing stability depends just as much on timely and high-quality behavioral health care as it does on a roof over one’s head? What if prevention and community-based supports were the norm, not the exception?
Imagine a care system designed around people’s lives, not programs delivered in siloes. A system that reduces friction points, supports individuals in their communities, and focuses on long-term stability, not just acute care. A system that prioritizes early intervention for people with behavioral health needs—preventing decompensation that too often leads to homelessness and repeated cycles of inpatient care.
We can’t focus solely on the non-medical drivers of behavioral health; we must also, and perhaps more urgently, build the capacity to improve the accessibility and quality of behavioral health services in the community. Solely building up the capacity to house individuals with behavioral health needs—without simultaneously developing the tools to address those needs—will only perpetuate a cycle that leads to homelessness and, in many cases, involvement with the justice system.
Reimaging Care for People with Serious Mental Illness
There is a subset of individuals whose behavioral health conditions are chronic, disabling, and cyclical. These are people living with serious mental illness who often experience repeated episodes that make it difficult to maintain employment or housing without continuous support. Their disability may be invisible, but it is no less real.
We need to stop pretending that they can navigate these challenges alone. What they need is a village.
People living with serious mental illness don’t need more referrals or more fragmentation. They need intentional and culturally appropriate supports that are easily accessible and timely; real support like community-oriented housing models with onsite care and peer connection. Not institutional settings, but intentional communities built to foster dignity and recovery alongside peers.
An Overlooked Population: Older Adults
We are seeing an alarming rise in the number of unhoused older adults. This is partially because behavioral healthcare for older adults is too often overlooked. Many struggle with depression, anxiety, or substance use in silence. Cognitive decline and physical health issues make access even more difficult. Older adults are increasingly isolated, a trend that worsened during the pandemic and continues today.
The simple truth is that our systems were not built with older adults in mind, and that needs to change. We need behavioral health services that are age-friendly, culturally competent, and connected to intergenerational community support.
Rethinking the Behavioral Healthcare Workforce
We don’t have enough licensed clinicians to meet the growing demand for behavioral health services, and won’t any time soon. So why not expand the care team?
Community health workers, peer support specialists, and behavioral health coaches are trusted, effective, and rooted in community. California has begun to pilot innovative workforce models that offer a glimpse of what’s possible. Community health workers and behavioral health coaches are emerging as trusted, culturally grounded providers who can support individuals earlier, more frequently, and in community-based settings. But we’ve only just scratched the surface. When paired with clinical oversight, they can dramatically expand access and offer more personalized care.
Imagine a model where individuals are empaneled not to a licensed therapist, but to a behavioral health coach or community health worker embedded in their community. That worker becomes their anchor—someone they know and trust. The licensed clinician remains a key part of the care team, offering technical support, oversight, and intervention, when necessary, but they are no longer the only doorway to care.
Aligning Around People, Not Programs
If we are to make this vision real, we must also confront one of the most persistent barriers to progress: the lack of aligned goals and data across our systems. Too many systems track performance in isolation. What if we aligned our goals around person-level outcomes?
- Are people getting the care they need when they need it?
- Are they staying housed, connected, and stable?
- Are disparities in access shrinking over time?
These are the metrics that matter and the metrics by which we should hold ourselves accountable. Without data, we are flying blind. Without shared accountability, we risk continuing to invest in well-intended programs that do not lead to meaningful change.
Culture Change Is the Hardest, and Most Necessary, Step
Real reform goes beyond policy or programs. It’s about shifting mindsets within government, providers, payers, and communities.
Behavioral health must move from the margins to the core of our thinking about health and well-being. That means funding prevention, rethinking how care is delivered, rewarding outcomes, not volume, and leading with connection, not control.
Looking Ahead
We know what’s broken. But we also know what works. This is our chance to build something better—together.
Let us dare to build something better—something rooted in humanity, connection, and care. Let us create a behavioral health system that doesn’t just catch people when they fall but lifts them before they do. A system that honors every individual’s dignity and affirms that help will always be there—not just in crisis, but in community, every day.
Let’s meet this moment together.
This article was originally published on the Sellers Dorsey blog and is republished here with permission.