Unmet mental health needs show up every day across the District — in emergency rooms, shelters, schools, and homes. When care is out of reach, life gets harder. People struggle to remain housed, stay connected to work or school, and get help before challenges escalate. What often looks like a housing, workforce, or public safety issue is, at its core, a mental health issue.
Mental Health Awareness Month asks us to confront that reality and move beyond awareness. Access to care must be consistent, community-based, and designed for real life — not limited to moments of emergency.
In Washington, D.C., the need for behavioral health care is clear. One in six young people experience a major depressive episode each year, and entire neighborhoods are designated as Mental Health Provider Shortage Areas. These gaps affect whether people stay connected to care and avoid crises across areas such as housing, education, workforce participation, and more.
As CareFirst BlueCross BlueShield concludes a three-year, $8 million investment, its impact across the region comes into focus. The initiative supported 19 community-based organizations working to address barriers to behavioral health care heightened by the pandemic, particularly for children, adolescents, and families, while also expanding the behavioral health workforce in communities with limited access to care.
This investment spanned many communities and approaches, but its impact is most visible where unmet mental health needs collide with everyday realities. For some, gaps in care have immediate consequences. Nowhere is that clearer than in housing.
For many people experiencing chronic homelessness in D.C., serious mental illness has gone untreated for years. An estimated one in five of the roughly 5,000 unhoused residents in the District lives with a serious mental illness, often cycling between the streets, shelters, emergency rooms, and jails, without coordinated housing and health support.
CareFirst and Pathways to Housing DC share a core understanding: Housing stability and behavioral health are inseparable. Homelessness is not only a housing issue, but also a behavioral health issue, shaped by where and how people live and by their ability to access sustained, coordinated care.
For decades, Pathways has delivered community-based behavioral health care and housing for individuals experiencing chronic homelessness and serious mental illness in all eight Wards of D.C. Their model meets people where they are, providing relationship-based, coordinated care that supports long-term stability. Pathways was one of the organizations supported through CareFirst’s behavioral health grant investments, which were informed by extensive engagement with community providers and subject matter experts across the region.
But access to care does not exist without the people providing it.
Pathways’ work depends on multidisciplinary teams that include psychiatrists, nurses, social workers, addictions counselors, and peer specialists. These teams provide comprehensive support, help individuals navigate complex needs, and build trust over time. When services are disrupted, people are often forced to start over — retelling their stories and re-engaging with systems that may not have worked for them in the past.
Across the District and the broader region, community-based behavioral health providers continue to face workforce shortages. Burnout remains high, and many clinicians leave for roles with higher pay or more predictable hours. When staffing gaps grow, services contract, waitlists lengthen, and care is interrupted for those who rely on consistency most.
That is why CareFirst’s behavioral health investments placed strong emphasis on workforce expansion and retention. Through this partnership, Pathways expanded its community-based mental health and Integrated Health Care teams while also investing in workforce development — advancing education, creating pathways into behavioral health careers, and supporting professional growth, job satisfaction, and long-term retention.
Mental health care is not transactional. It requires time, trust, and continuity. It depends on providers who know their communities and can build relationships that last. Without that consistency, even the most effective care models cannot achieve their full impact. And this model works. Pathways to Housing DC outpaces outcomes in traditional housing models. They boast a 90% housing retention rate — with 9 out of 10 individuals remaining successfully housed despite being typically deemed “treatment resistant” or “not ready for housing.”
While CareFirst’s behavioral health grants have concluded, the need has not — and the work is far from finished. Organizations like Pathways have demonstrated what sustained, community-based care can make possible when access and workforce are addressed together.
Expanding access, strengthening community-based organizations, and supporting the workforce remain essential to building stability for individuals, families, and communities.
Mental health cannot wait — and neither can the people depending on us to keep moving this work forward.
Dr. Bryan O. Buckley is head of public health and community impact at CareFirst BlueCross BlueShield. Christy Respress, MSW, is president and CEO at Pathways to Housing DC.