Addressing the Mental Health Needs of the Pandemic Generation: Accessible, Stigma-Free, High-Quality Care

Mental health is equally important to our physical health. Accessing high-quality mental health care without stigma is essential for all North Carolinians. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is working across the state to achieve our purpose for all who seek mental health services.

About one in five Americans will experience a mental health illness every year. Mental illness does not have a specific face or name. Just like physical health, it can change over time. As the world continues to emerge from the COVID-19 pandemic, we must now reckon with what may prove to be one of the COVID era’s longer lasting effects: mental health trauma.

As a pediatrician, I am concerned about our youth. For children who are five years old today, virtually all of their conscious memories are of the COVID-19 period. Younger people don’t have the context of a lifetime of ups and downs – a lot of them only have downs. We don’t have to rely on suppositions for this. There is already data to illustrate the disproportionate effect of the pandemic on younger people. Even before the pandemic, the number of high school students in our state reporting feeling sad or hopeless was on the rise: from 28.3% in 2011 to 36.3% in 2019, according to the North Carolina Youth Risk Behavior (NCYRB) Survey .

That’s a troubling trend even without considering several years of pandemic-related stress and anxiety. But we know that a major part of the solution lies in how we structure the mental health system; it must provide care that is accessible, stigma-free and high-quality.

Access to Mental Health Services

Further research reveals some startling trends. According to America’s School Mental Health Report Card :

·??????132,000 children reported at least one major depressive episode in the past year

·??????74,000 children with major depression received no treatment for their problems

·??????31,000 young people reported a substance use disorder in the past year

And amid these alarming numbers, our state doesn’t have enough licensed mental health professionals to meet the need. The recommended ratio of school psychologists to students is 1 to 500 – we’re at 1 school psychologist for every 2,527 students . North Carolina needs to ensure that we have enough medical professionals to meet the needs of our citizens, especially young people.

America’s School Mental Health Report Card doesn’t issue our state an actual grade, instead ranking North Carolina at #42 for youth mental health services. We are failing our young people at a time when they are most vulnerable: 63 of North Carolina’s 100 counties have no child or adolescent psychiatrists; 27 counties have no psychiatrists at all.

During our company’s Extra Miles Tour – with Blue Cross NC leaders visiting every county in the state – we’re hearing from the communities we serve about the lack of mental health care professionals across North Carolina. Our company is taking action, investing in colleges and universities across the state to draw and train qualified mental health practitioners to meet the growing need.

Blue Cross NC invested $1.54 million to East Carolina University to provide telepsychiatry services over the next five years for students at Elizabeth City State University. This investment bolsters the ECU-led North Carolina Statewide Telepsychiatry Program (NC-STeP), connecting patients in hospital emergency departments and community-based settings with expert psychiatric care using telehealth technology. NC-STeP enhances access to mental health care, especially in North Carolina’s rural communities. Telepsychiatry helps address the shortage of providers for patients who otherwise may not have access to services, all while reducing unnecessary hospital admissions and improving after-care and patient outcomes.

We are at a tipping point; we must move quickly to build a sustainable pipeline of mental health care professionals and not only incentivize them to remain in the state of North Carolina to practice, but also encourage them to practice in rural and underserved areas of our state. To that end, the Board of Directors of the Blue Cross and Blue Shield of North Carolina Foundation recently adopted access to care and health care workforce development as key focus areas. The Foundation is currently in the initial stages of reaching out to key stakeholders, including the North Carolina Medical Society, health care training institutions and others to think through a sustainable framework and approach.?

Mental Health De-Stigmatization

Blue Cross NC is working with a company called Quartet to integrate mental health into primary care. This collaboration is helping primary care physicians identify patients with underlying mental health conditions and providing resources to refer patients to a trusted network of mental health providers. This integration is especially important for younger people who may face more social pressures than older generations. ?

Additionally, this work is building out the capacity for more self-referrals. This puts the power in the member’s hands to seek out the services they need while avoiding what could be an uncomfortable conversation.

We’re also designing a strategy to make telehealth and virtual health care an affordable option for people seeking mental health treatment. In the first year of COVID-19 in 2020, Blue Cross NC saw the use of telehealth for physical and mental health services increase by 7,500% -- a trend that continued into 2021.

Virtual health care is perhaps one way to lessen the stigma that some attach to seeking treatment for mental health problems. But a broader cultural shift is really what’s necessary.?

High-Quality Mental Health Care

We must be thoughtful in how we improve mental health care. We need mental health care to be based on the best, most up-do-date evidence and research.

We have to be able to measure outcomes and pay for effective, efficient care – this includes accountability for outcomes, including remission rates. We must speed up the process of evaluating what’s working so we can scale those things up. And we have to be comfortable moving on from things that don’t work.

As health care moves away from the traditional fee-for-service model – which paid for the volume of care delivered instead of paying for outcomes – mental health care should be included in the transition to value. Blue Cross NC’s Blue Premier payment model now includes Blue Premier Behavioral Health , a payment model that integrates mental health and physical health, rewarding providers for effective care while meeting cost measures.

Better mental health care for North Carolina’s younger people is within our grasp. And we can’t afford to let it slip through.

If you or someone you know is struggling with mental health or substance use problems, the phone number for Hope4NC is 855-587-3463. Help is available 24/7 and provides free and confidential support. Hope4NC assistance is available to people with and without health insurance.??