​Originally published on Health Leaders on September 10, 2026.

A new report from Array Behavioral Care highlights a range of challenges facing providers of behavioral health services, including over reliance on care in the emergency department setting, care coordination failures and discharge gaps, and patients frequently being matched to the wrong level of care.

Earlier research has shown that behavioral health is one of the most problematic sectors of the U.S. healthcare system. Access to care is particularly troublesome, with 25% of adults reporting an unmet need for mental health treatment, according to Mental Health America. Inadequate financing for behavioral health services is a primary driver of limited capacity and access to care, research published by the National Institutes of Health shows.

The new report is based on survey data collected from 253 health system and hospital leaders as well as 261 clinicians. The report features several key findings:

• Every hospital and health system leader surveyed reported their behavioral health capacity meets or exceeds current demand. Yet, inside those same organizations, 95% of clinicians reported making a clinical decision in the past year they weren’t fully comfortable with, driven by capacity pressures, staffing shortages, or a lack of step-down options such as intensive outpatient care. 
• Thirty-nine percent of clinicians say patients with behavioral health needs frequently experience gaps or delays during care transitions, and 30% warned poor coordination between care settings negatively affects patient safety or clinical outcomes. 
• Seventy-one percent of hospital leaders reported emergency departments had become their community’s mental health safety net, and half said more than 20% of ED beds were occupied by behavioral health patients who could be treated in a less intensive setting. 
• Ninety-five percent of clinicians reported considering reducing their hours or leaving their current role due to burnout related to behavioral health patient volume or complexity. 
• Eighty-four percent of clinicians reported virtual behavioral health services produce better patient outcomes than in-person care for similar acuity levels, and 98% reported an expectation that AI tools would meaningfully reduce their workload within three years. 
• Sixty-seven percent of ED clinicians reported patients are frequently matched to the wrong level of care, with 35% saying patients receive less intensive care than clinically necessary and 32% saying patients receive more care than clinically necessary. 
• Ninety-eight percent of clinicians reported directly observing a patient’s condition worsen due to care coordination failures or discharge gaps.

The reported disconnect between health system and hospital leaders versus clinicians on the adequacy of behavioral health capacity is particularly concerning, according to Sara Gotheridge, MD, CMO of Array Behavioral Care.

The financing mechanisms for behavioral health services are largely to blame for this disconnect, Gotheridge explains.

“We must be able to move to measurement-based care and different reimbursement structures to help hospital system leaders understand that they are not winning the behavioral health war,” Gotheridge says. “We’re not even close.”

Health system and hospital leaders need to take a broader view of behavioral health services, according to Gotheridge.

“Generating revenue by treating patients with the staff that you have is a narrow way to view behavioral health,” Gotheridge says. “If we treat patients correctly and solve care fragmentation, patients will not be as sick and the healthcare system will not be as strained. This kind of approach will reduce costs.”

There are two primary ways for CMOs and other senior leaders to reduce behavioral health patients seeking care in emergency departments, Gotheridge explains. The first step is to identify patients who are considering seeking care at an emergency department and keep them out of the ED. The second is to make sure the patient doesn’t return to the ED for more care.

“You need to identify patients who are facing increasing acuity and a potential crisis,” Gotheridge says.

Risk assessment and continued monitoring are crucial to direct behavioral health patients to the right level of care.

“You need to assess patients and to reassess patients. In between each intervention, you don’t know how a patient is doing unless you assess them,” Gotheridge says. “As you see a patient’s acuity change, you must change the intervention.”

Gotheridge says a measurement-based risk assessment can include the PHQ-9 questionnaire for depression and GAD-7 questionnaire for anxiety. In addition, she says patients should be asked about access to firearms, suicidality, substance abuse, and medical comorbidities.

Health system and hospital leaders as well as clinicians must strive to have an awareness of care coordination and discharge gaps, according to Gotheridge.

“You need to know that gaps exist and that a patient needs to be treated across the continuum of care, not just in a particular care setting but also in the next stage of care,” Gotheridge says.

Technology plays a pivotal role in closing care coordination and discharge gaps.

“At Array Behavioral Care, one of the ways we avoid care coordination failures and discharge gaps is using Epic as our electronic health record,” Gotheridge says. “Epic is used by the majority of health systems in the country. By having the same EHR as our health system partners, we can share data and other information about our patients.”

To address care fragmentation in behavioral health, service providers need to be able to flex according to the needs of patients and understand that most behavioral health conditions are chronic, Gotheridge explains.

“We know that we need to manage services across the care continuum,” Gotheridge says. “That means care may flow from an outpatient setting involving therapy and medications, then the intensity of care may need to increase. This can include working with partners such as an intensive outpatient partner, hospital partner, or medical provider partners with whom we can collaborate to stabilize a patient.”