What Does "Quality" Mean in Behavioral Health? Until we define quality for ourselves, systems will continue to define it for us.

December 29, 2025

Rannon Arch, Author & Director of Co-Occurring Clinical Services, Hazelden Betty Ford Foundation 

Reviewed by Wes Arnett, Subject Matter Expert

Rannon Arch, a seasoned professional and trusted figure in the field, has spearheaded organization-wide change initiatives at Hazelden Betty Ford. His focus on integrating mental health services into recovery programs and on ensuring collaborative, standardized care has led to the successful launch of Co-Occurring Enhanced programming regionally and to a nationwide rollout of Co-Occurring Capable services.

Currently, Rannon is a licensed clinical counselor and a licensed alcohol and drug counselor, with a master's degree in addiction and mental health treatment from the Hazelden Betty Ford Graduate School of Addiction Studies. Additionally, Rannon is a board-approved mental health supervisor, certified therapy dog trainer, and published researcher on college drinking behaviors and family dysfunction.

Hazelden Betty Ford Foundation provides addiction treatment, mental health care, research, and reconnection to individuals, communities, and families in crisis.

According to Rannon Arch:

In the realm of behavioral health, we often find ourselves in a paradoxical situation. We are frequently asked to prove something we haven't fully agreed on: what does quality care actually mean?

Health plans demand outcomes. Employers want data. Systems invest in tech solutions promising to measure what matters.

However, here's the problem: we lack a shared, scalable market for quality in behavioral healthcare.

Recovery is a non-linear matter. Co-occurring care, mental health stabilization, trauma recovery – these don't always follow predictable metrics. The patient experience is deeply human, relational, and contextual. And yet, we are increasingly being asked to package it in key performance indicators (KPI's), dashboards, and efficiency models.

The debate on quality in behavioral health is not just a matter of interest; it's a matter of urgency, innovation, and leadership. It's a conversation we must have to ensure the best care for those in need.

Where Are We Now

Behavioral health care is under immense pressure. Employers want to know if their benefits are making a difference. Health plans want to see measurable outcomes. Funders and policymakers want to ensure that dollars translate into value. The current state of behavioral healthcare is a heavy burden that we all carry, a weight that demands our attention and action.

So systems are investing millions in evidence-based care platforms, digital health solutions, symptom tracking, and standardized outcome tools. These aren't inherently wrong. But here's the tension: we are trying to measure something we haven't collectively defined.

What Outcome Were You Actually Chasing? 

Are there reduced depression scores? Continuance abstinence? Reduced emergency room utilization? Improved relationships? Better sleep? More meaningful engagement in life? These are the questions we need to answer to define quality in behavioral health.

The field is awash in efforts to 'prove,' but what we truly lack is a shared understanding of what quality truly entails. This lack of consensus is not a barrier, but a call for collaboration and a shared experience—a need we must collectively address.

Why It's So Hard to Define Quality

Behavioral health isn't a single condition or diagnosis. It's deeply personal, layered with trauma, identity, social context, relationships, access, and history.

Recovery is also multi-dimensional:

• A clinician might see progress when symptoms reduce.

• A patient might feel progress when they reconnect with family, reclaim agency, or feel safe in their body for the first time in years.

• A system may be considered to be making progress when readmission rates decrease or the length of stay is reduced.

These aren't always aligned.

Clinician experience matters too. Workforce retention, burnout, and ethical practice are often overlooked in the quality conversation, even though they are at the core of sustainable care. This is why defining quality is challenging: it's not a single factor. It's a constellation of factors, many of which are difficult to measure.

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If we were to build a vision of quality in behavioral healthcare, it might need to include:

• Clinical outcomes: Symptom reduction, stabilization, functional gains (return to baseline before onset of condition)

• Patient-defined progress: Safety, agency, belonging, meaning

• Engagement + retention: Staying connected to care (when appropriate)

• Relational quality: Therapeutic alliance, trust, rupture, and repair

• Workforce health: Clinician well-being, ethical practice, supervision, and support

• System performance: Access, equity, intake efficiency, integration of care disciplines, and appropriate utilization of care

In other words, both hard and soft data. Quantitative and qualitative. Outcomes that reflect human experience, not just system efficiency.

How Do We Build Standards That Scale?

The challenge isn't just defining quality – it's building scalable standards that honor complexity and drive ROI.

This is where innovation is needed.

We need:

• Measurement tools co-designed with patients and providers, not just payers

• Standards that capture short-term gains and long-term recovery

• Metrics that reward relational work, not just procedural checklists or benchmarks

• Incentives that align system goals with human outcomes

This won't be solved by simply adding another dashboard on top of existing models. It will require cross-sector collaboration, experimentation, and a willingness to hold complexity without collapsing it into convenience.

A Call for Innovation and Leadership

Behavioral health is at a threshold moment. We have the opportunity to shape a vision of care that is both accountable and deeply human. But we cannot do it without naming what we value, what we're measuring, and why it matters.

It's not about asking, "Can we measure quality?" The real work is asking, "What do we believe quality is?"

The answer to that question might be the most important innovation of all.

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For more information, Rannon Arch can be reached at 

arch.rannon@gmail.com and

Hazelden Betty Ford Foundation at https://www.hazeldenbettyford.org

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