Measurement frameworks can shift anecdotal validation to trackable results, offering proof that behavioral healthcare can generate tangible ROI.
Sorenson Impact Institute
Despite decades of evidence linking behavioral health to productivity, public safety, and economic stability, reimbursement and budgeting practices can leave behavioral health services with relatively thin margins, effectively treating them as a cost center. This model often fails to support prevention and routine care, funding treatment only after individuals are facing mental health crises or their possible downstream consequences, such as homelessness or incarceration.
For Dr. Mark Rapaport, president-elect of the American Psychiatric Association and former CEO of Huntsman Mental Health Institute (HMHI) and Chair of the Department of Psychiatry at the University of Utah, that disconnect has defined a career-long frustration — and a clear opportunity. What if mental health outcomes could be valued the same way as avoided surgeries or reduced hospital stays? What if these returns to society could be measured, monetized, and reinvested?
These questions catalyzed a cross-disciplinary collaboration between HMHI and the Sorenson Impact Institute (SII), led by impact finance expert and Managing Director of Impact Finance at SII, Janis Dubno, in partnership with Dr. Fernando Wilson from the Clinical and Translational Research Institute’s Health Economics Core (HEC). Together, they built a monetization framework designed to quantify the economic and social value of mental healthcare and substance use disorder treatment. Among other findings, the framework shows HMHI’s services led to reduced ED use, with treatment linked to a 2.7-visit drop in use per patient. In addition, the report documents material financial gains attributable to behavioral healthcare. For example, maternal mental health services generated an estimated $2.3 million to $7.4 million in socioeconomic and health savings from 2019 to 2024, while substance use disorder treatments saved $5.0 million to $12.6 million over the same period — delivering measurable value across a wide range of beneficiaries.
Rigorous measurement frameworks can shift anecdotal validation to trackable results, offering proof that behavioral healthcare can generate tangible ROI. The findings associated with these frameworks spur a larger conversation around how behavioral healthcare value is measured and funded, which is especially important against a backdrop of state- and national-level mental health crises.
The implications of undervaluing behavioral healthcare reach well beyond Utah. As policymakers, employers, and insurers grapple with rising mental health needs, healthcare costs, and workforce stress, a measurement framework could offer a new lens for value-based care, one that positions behavioral health as a driver of economic resilience rather than a drain on resources. It also underscores how fragmented incentives in the current fee-for-service model ignore the full benefits of treatment: for example, hospitals save money when ED visits decline, but behavioral health providers rarely share in those savings even if they directly contributed to them. By quantifying these cross-system effects, Dubno’s team supports the case for better models that reward prevention and recovery, not just procedures.
In the following conversation, Dr. Rapaport and Dubno discuss the need for collaborative projects that measure and demonstrate behavioral healthcare impact and what it takes to translate care into data. Their conversation highlights the need for a joint effort among the fields of psychiatry, economics, finance, and systems design — one that could fundamentally reframe how individual states and the nation as a whole perceive and invest in mental health.
Why is it important to quantify and monetize the broader value of behavioral healthcare?
Dr. Mark Rapaport: It’s something I’ve been thinking about my entire career. Like many psychiatrists, I’ve been frustrated by how mental health has been treated as a less important branch of healthcare. From a financial standpoint, cognitive and preventive care are often seen as costs rather than the investments they are — investments that pay off in productivity, family stability, and overall societal well-being.
That view comes from the reimbursement model. In a fee-for-service system, you get paid for procedures and hospitalizations, not for keeping people healthy. So the system doesn’t recognize the economic return of treating mental illness — better work performance, fewer ED visits, reduced law enforcement costs. Our goal is to build a framework that captures those returns and makes them visible in tangible economic terms.
Janis Dubno: Absolutely. Oftentimes when looking at an intervention or program, everyone’s focused only on clinical outcomes. But the reality is that improving clinical outcomes not only improves individual lives, but it often has direct or indirect social and economic benefits that are not well documented or quantified broadly and are not considered in funding decisions, particularly with respect to who the beneficiaries are. The beneficiaries, then, are not adequately contributing even though they are benefiting. Better measurement frameworks have the potential to change that.
Why do you think there’s such a gap in funding when it comes to prevention?
Dr. Rapaport: It’s financial. It hinges around the reimbursement system, and preventive mental healthcare doesn’t fit into the traditional reimbursement structure. Systems make money from surgeries, infusions, or radiology — not from preventive interventions that actually reduce those costs long-term. That’s why there’s been movement toward at-risk models, where providers are incentivized to keep people healthy. But we’re still far from fully realizing that shift.
What will it take to change how mental healthcare is reimbursed and valued?
Dr. Rapaport: It’s a huge, multi-level effort — Congress, Centers for Medicare & Medicaid Services, the White House, insurance companies, and lobbyists all play a role. You’re essentially playing three-dimensional chess to align interests across government, industry, and advocacy. States can help lead the way, though. For example, based on reports like the HMHI report, Utah’s Crisis Care Center could demonstrate how prevention saves money and improves public safety by reducing incarceration and emergency room use.
Dubno: I agree. The first piece is, of course, awareness of the full range of benefits and articulating what those benefits are and how to value them. Once the socioeconomic benefits are better understood and their values rigorously quantified, insurance companies, jurisdictions, and other stakeholders will have a more tangible appreciation of how improvements in mental health are improving their own situations, their budgets, and their communities. Capturing the value of those benefits can help us recruit the beneficiaries who can help pay for interventions.
What outcomes matter most when we talk about behavioral healthcare?
Dr. Rapaport: Prevention and preemptive care are crucial — intervening early before people get sick. For those already struggling, it’s not just about symptom reduction but about restoring quality of life and functioning. That’s what drives productivity, family cohesion, and healthier communities. We often overlook that recovery means being able to live fully again, not just being “less sick.”
Dubno: I’d add that we need to show policymakers that behavioral health improvement is intergenerational. If you help adults stabilize, you help their children, and you reduce future costs tied to homelessness and criminal justice involvement. Right now, policy tends to respond after the fact — once people are already in crisis.
Dr. Rapaport: I agree, Janis. There seems to be some disconnect between the ways in which preventative care in behavioral health and their effects on homelessness and criminal justice are perceived. We wait for people to lose their homes, for them to go to jail, and then we address their mental health.
So far, what findings from the HMHI framework did you find most notable or exciting?
Dubno: Seeing measurable savings associated with reduced symptom severity was powerful, especially in substance use disorders and treatment-resistant depression. It was fascinating to see the savings associated with improvements in functioning related to treatment. Even with conservative estimates, the model showed millions in savings over just five years. That’s even before capturing intergenerational impacts or the potential economic values of the number of lives saved. The framework showed that behavioral health services reduce pressure on EDs and hospitals, but those savings aren’t shared with the providers generating them. That gap in the system really stood out to me.
Dr. Rapaport: I’ve also been inspired by how this project is already influencing the field of psychiatry. Colleagues involved in APA and DSM committees are starting to prioritize measuring functioning and quality of life, which is exactly what I’ve been pushing for my whole career. That shift could change how value is understood across all of healthcare.
Also, the results the report found have been remarkable. Decreasing ED visits by 2.7 visits per person after they’ve been seen by a mental health professional — I mean, that’s phenomenal. Decreasing the amount of time that law enforcement is spending waiting for a disposition to five minutes — you know, these are game changers.
What are some of the challenges institutions face when trying to measure and show their impact?
Dubno: Data — its availability, quality, and consistency. Causality is also tricky; you can’t run controlled experiments in live systems. We had to rely on prior literature of comparable programs or use pre-post comparisons to show impact. Funding is another major challenge. Data collection and analysis require real investment, both in systems and human resources, and some mental health systems don’t have that capacity. The good news is that if philanthropy and the public sector step in, we can find the support to make this scalable. We can help institutions develop the kinds of data collection tools and protocols they need to fill these data gaps and track their impact, leveraging their findings to attract additional investment into their behavioral health systems.
The second phase of this project, which is ongoing, involves helping HMHI set up consistent and standardized methods for collecting this type of data. Investment in the data collection process allows institutions to demonstrate the impact they’re having, creating broader awareness and improving their funding sources and programming. It’s important for providers to understand the benefit they’re providing for individuals and communities as part of a continuous improvement framework.
Looking ahead, what’s your hope for the future of this framework?
Dr. Rapaport: In the short term, we want to refine the model and share it widely with mental health leaders, policymakers, and business stakeholders. My long-term vision is that this approach reshapes how we define value in healthcare. What’s remarkable is that there’s so much meat left on the bone; we’ve only scratched the surface, and much can be done with your team’s recommendations for data collection moving forward. The savings related to behavioral health treatment found in this report represent a fraction of the real impact. If we succeed, mental health will lead the way in showing that mental health and well-being is an investment, not an expense.
Dubno: For me, the hope is twofold: first, to complete a full monetization framework of all of HMHI’s programs we’re analyzing and show a comprehensive view of the impact. And second, to help behavioral healthcare providers attract new funders who see the potential for economic and social ROI. If we can build a market for outcome payments for the social outcomes achieved through behavioral healthcare, we can leverage private capital to scale programs faster. The framework we created is replicable, which means it can be adapted widely, with modifications based on the particular patient populations from program to program. The better institutions understand their impact, the more effective they can be in terms of funding opportunities and programming improvement.
Dr. Rapaport: Exactly. If others adopt and refine this model, we’ll see better prevention, stronger communities, and a true redefinition of what healthcare investment means.
What are your thoughts on the role of cross-disciplinary collaboration in demonstrating the value of behavioral healthcare?
Dr. Rapaport: Funding in behavioral health isn’t just a clinical problem, it’s a business framework problem. So if we want solutions, we need cross-disciplinary teams, not silos. I approached Taylor Randall, President of the University of Utah, and I told him I wanted to partner on a model that quantified the social value of behavioral health. He connected me with Janis and Dr. Wilson, and the collaboration took off from there.
Dubno: This connection really represents what impact leaders seek — bringing together different fields whose combined strengths can tackle complex issues. Collaboration can achieve results where isolated efforts have failed. This has been one of the most rewarding projects we’ve undertaken. It’s inspiring to work with a leader who not only has the vision but the will to implement it.
Dr. Rapaport: I feel the same. Collaborating across disciplines has been eye-opening, and it proves that changing the system starts with partnerships like this.