Behavioral Health: Uncovering Unmet Needs
American College of Healthcare Executives
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Editor’s Note: This content has been excerpted from the book Caring for Our Communities: A Blueprint for Better Outcomes in Population Health . The content has been edited for length.
In the United States, so many aspects of behavioral and emotional health are simply not addressed as doctors steer focus toward the pathophysiology of disease. It certainly is a lot cleaner to focus our efforts on the mechanical aspects of the body than to dive into emotional aspects such as depression, anxiety, loneliness or isolation. Physical and emotional conditions coexist most of the time. Not only does chronic illness often precipitate depression, anxiety and other forms of emotional instability, but the converse is also true.
The effects of chronic illness are as deep as they are broad. As we manage our populations, we must be mindful that mental health disorders are likely present along with chronic physical health conditions as either effects or contributory causes. Given the constraints of the system in American medicine, we often fail to focus on the behavioral aspects of care in chronic illness management. A clear-cut connection exists between people’s chronic illnesses and their mental health, and we don’t do an especially good job of identifying this and then helping patients through it.
While mental health issues were prevalent before the COVID-19 pandemic, alarmingly, the pandemic made matters even worse. It demonstrated how the need for behavioral health services is affected by social and environmental factors. Pandemic living brought about a massive outbreak of psychological illness due to factors such as social isolation, limits on businesses, stay-at-home orders, financial pressures, grief, fear of illness and death, unemployment, and food and housing insecurity. A Centers for Disease Control and Prevention study reported that from August 2020 through February 2021, the percentage of adults reporting symptoms of anxiety or depressive disorder increased from 36.4% to 41.5%. Those reporting that they needed but did not receive mental health counseling or therapy during the preceding four weeks also increased significantly to 11.7%.
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Barriers to Behavioral Health
Social stigma around seeking professional mental health services has always been a major barrier to care. One of the areas with the greatest social stigma in behavioral health is suicidal ideation. In a survey of 2,200 U.S. adults conducted by three national organizations dedicated to suicide prevention, respondents were asked, “What do you think are some of the barriers that prevent people who are thinking about suicide from seeking help?” The top three responses, in order, were feeling like nothing will help, embarrassment and not knowing how to get help.
In addition to social stigma, a significant percentage of respondents cited barriers to seeking behavioral healthcare, including inability to afford treatment, lack of access to treatment, lack of social support, fear of disappointing others and fear of losing a job. These perceived barriers are common throughout the spectrum of behavioral health management.
Breaking Down the Barriers
Many of these barriers are more than just perception—they are realities. We suffer a lack of capacity to manage behavioral health, and that perception is amplified by the lack of access to care and inability of so many to afford it. If providers are interested in advancing population health and community wellness, we must increase our involvement in the behavioral aspects of dealing with chronic illness and disability.
One encouraging step in this direction was made in early 2022, when the American Psychological Association developed a policy titled “Psychology’s Role in Advancing Population Health.”
The APA laid out four guiding principles for the use of members, committees, divisions and boards in their population health endeavors:
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Atrius Health, based in eastern Massachusetts, has been developing and refining its behavioral health program since 2015. A substantial problem before the start of the program was that full-time therapists had average caseloads of more than 100 active patients, which meant they could not see patients more than once per month, well below the once-a-week recommendation in the literature for effective treatment. In addition, new patients had average wait times of 60 days for an initial therapy session and 45 days for follow-up appointments.
The solution had two major elements:
This program has resulted in reduced caseloads for clinicians and significantly decreased wait times for new patients who need services the most. It has also helped ensure that patients are quickly routed to the lowest cost setting appropriate to their care needs. While triaging new referrals is an appropriate and timely way to serve patients with the highest needs early, suspending care for patients of any level of need is still unfavorable, especially if you or your loved one is the one in need.
Mark Angelo, MD, is CEO, Delaware Valley ACO.
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Hospitalist at Hospitalists Internists Associate with expertise in physician coaching
6 个月I would love to see big hospital systems to spend some resources to provide psych services in the acute hospital setting like employing psychologists for psychiatrists to see patient in the hospital. Actions speak louder than words!
Occupational Therapist at AdventHealth, Owner Total Body OT
6 个月Occupational therapists in primary care/behavioral outpatient are the remedy and THE "community partner". NO NEED TO WORK UPSTREAM...LET THE OCCUPATIONAL THERAPIST JOIN YOUR TEAM/PRACTICE AND DO IT FOR YOU! YOUR NEED NO LONGER HAS TO GO UNMET! :) Please reach out for more information, questions, if you'd like me to come present at your clinic and/or organization. I offer a complimentary trial at no charge to your practice to demonstrate our value. Email: [email protected] Phone: 720-772-1383
Health Care policy leader, Champion for a robust Family Practice workforce. Educator and lecturer on Health as a System and Determinants of Health.
6 个月We need tochange our approach to early childhhod and grade school education and pay attention to their emotional as well their intellectual development. Without real structural change all we are doing is sending our children into adulthood, unprepared and underdeveloped.
Health Care policy leader, Champion for a robust Family Practice workforce. Educator and lecturer on Health as a System and Determinants of Health.
6 个月I think this article is exceptionally good as far as it goes. There are two specific recommendations that I would add. The first is that we will not have an adequate behavioral healthcare system, until we take the shackles off of the referral process and reimburse providers Adequately. This is particularly important in the Medicaid program where reimbursement pay at less than $.50 on the dollar and is burdened with a bureaucratic nightmare just to get authorization to treat. The second area that needs focus is in prevention. We have not paid attention to the change in development of preschoolers and grade schoolers over the last 30 years. The environment in which they grow up is vastly different than earlier generations. They are certainly isn’t the ability to explore outside the home in the early hears that there was before and the introduction of cell phones and video games has certainly hindered the development of relationship skills, negotiation skills, etc. in the early years. In addition, our reliance on drugs at a very early age to treat “problems“ has created Several generations of young people who think that drugs are the answer to all of their problems.
CEO | Advisor | Board Member | Innovation | Health | Partnerships
6 个月Solome Tibebu Behavioral Health Tech @Mleela Tiffany Boswell Mindler Erica Larson would be great to interview on this #BehavrioralHealth topic too. They will be presenting their insights on a panel at Vitalis in May. San international perspective: USA-Sweden/Nordics and how digital care/health tech can be part of solutions.