Treatment of mental illness in the United States is woefully inadequate. One-third of adults report having a mental health condition or substance use disorder, but less than half receive treatment for their condition.Access is the problem. The U.S. is short on mental health professionals: more psychiatrists are needed and psychologists and social workers are overextended. Proposed solutions are to (1) increase reimbursement rates for psychiatrists and other mental health practitioners, and (2) use a wider range of providers, including nurses and family support specialists—all good ideas. My focus however is on two other forces that are moving into the behavioral health area, offering both financing and technologies to extend the reach of mental health services—private equity and telemental health.First, private equity firms see high demand in this market. Behavioral health is desperately needed but is highly fragmented and lacking in innovation. Private equity is attracted to outpatient programs that target specific conditions that have evidence-based clinical models—programs aimed at addiction, eating disorders, and autism; these areas require less capital. Federal and state reimbursement is available, some regulations have been relaxed to allow remote prescribing of medicine; and innovative telehealth tools can be used. The problem is that private equity has a poor track record in both nursing home care and behavioral care for teens. The private equity model and its financial incentives are at odds with good care.Second, telemental health tools, already in use because of the need during the pandemic, appear attractive. These tools require less capital to treat a higher volume of patients and promise much improved access to mental health treatment for populations that could not get such care because of travel distance, costs, and time limitations. The problem is that the telemental health tools have yet to be subjected to evidence-based testing.My goal in this article is to test whether these two developments – private equity and telemental health —can improve access for patients at an acceptable level of quality. I conclude that both have substantial problems and I offer a range of regulatory approaches to control patient abuses and poor quality.

中文翻译：

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行为健康的未来：私募股权和远程医疗能否改善可及性？

美国对精神疾病的治疗严重不足。三分之一的成年人报告患有精神健康问题或药物滥用障碍，但只有不到一半的人接受了治疗。获取是问题。美国缺乏心理健康专业人员：需要更多的精神科医生，而心理学家和社会工作者则不堪重负。提议的解决方案是（1）提高精神科医生和其他心理健康从业人员的报销率，以及（2）使用更广泛的提供者，包括护士和家庭支持专家——所有这些都是好主意。然而，我的重点是另外两股正在进入行为健康领域的力量，它们提供融资和技术来扩大心理健康服务的范围——私募股权和远程心理健康。首先，私募股权公司看到了这个市场的高需求。行为健康是迫切需要的，但其高度分散且缺乏创新。私募股权公司被针对特定病症、具有基于证据的临床模型的门诊项目所吸引——针对成瘾、饮食失调和自闭症的项目；这些领域需要的资金较少。可以获得联邦和州报销，一些法规已经放宽，允许远程开药；可以使用创新的远程医疗工具。问题在于，私募股权在疗养院护理和青少年行为护理方面的记录都很差。私募股权模式及其财务激励措施与良好的护理相矛盾。其次，由于大流行期间的需要而已经使用的远程心理健康工具似乎很有吸引力。这些工具需要更少的资金来治疗更多的患者，并有望大大改善因旅行距离、成本和时间限制而无法获得此类护理的人群获得心理健康治疗的机会。问题在于，远程心理健康工具尚未经过循证测试。我在本文中的目标是测试私募股权和远程心理健康这两项发展是否能够以可接受的质量水平改善患者的获取机会。我的结论是，两者都存在重大问题，并且我提供了一系列监管方法来控制患者虐待和不良质量。