The State of Mindlessness
Vince Salvo
I build, grow, and lead ambitious AI-adaptive people and companies to improve lives.
Texas Mental Health Ranks Worst in the Nation
There are over 350 people in the U.S. for every one mental health provider.??
Based on a recent 2023 Mental Health America (MHA) report:
Everything in Texas is bigger — including the mindless variation in mental and behavioral health.
Texas has the highest rate of uninsured people in the nation, with 18.4% of the entire population without coverage— about 6 million people. Texas consistently ranks in the lowest quartile in national healthcare performance.
Per the MHA report, Texas also is in the pole position of having one of the poorest mental health rankings in the nation, with a high prevalence of mental illness and a low rate of access to care.
On a scale of 1 to 51 (50 states and the District of Columbia), with 1 being best (a low prevalence of mental illness and high access to care) and 51 being worst (a high prevalence of mental illness and poor access to care), Texas ranks close to the bottom, at 46.
When measured against the 15 assessment criteria listed in the MHA report that comprise the scoring, Texas ranks at the absolute bottom at 51.
On overall access to care and mental health workforce availability, Texas again comes in at the bottom — 51 and 50, respectively.
Similar to physical healthcare (e.g., cardiovascular, musculoskeletal, cancer, diabetes), a practitioner hierarchy in mental and behavioral health also exists. Clinicians trained, licensed, and specializing in performing a procedure or prescribing medication are generally at the top of the practitioner hierarchy.?
Mental health providers that can prescribe and monitor medications include psychiatrists, psychiatric or mental health nurse practitioners, and psychiatric pharmacists. Primary care physicians and family nurse practitioners also can prescribe medication but are typically not trained in mental health. Psychologists, licensed clinical social workers, counselors, therapists, and advanced practice nurses cannot prescribe medication. At the bottom of the hierarchy (viewed by those towards the top) are sub-clinical professionals — social workers, pastoral counselors, and certified peer support specialists.?
So, what can Texas do to improve mental and behavioral health, move out of the national ranking dregs and reduce harm??
1- Expand Medicaid - Studies show that in addition to providing increased access, the positive economic impact for the state would be in the order of $100 billion to $300+ billion over ten years. Seventy percent of Texans support expanding Medicaid, but legislators will not have it.
2- Increase federal grant submissions - The Substance Abuse and Mental Health Services Administration (SAMHSA), a part of the U.S. Department of Health & Human Services, provides hundreds of millions of dollars in grants each year to help solve the mental health problem. Texas and other states that maintain a high prevalence of illness and low access should increase the submission frequency.
3- Establish efficacy and efficiency metrics -?Many stigmas exist in mental health. Most view it as abstract, subjective, and difficult to measure, qualify, and quantify. What it has in common with physical disease, however, is that it is primarily an economic problem. Healthcare in the U.S. is a high-value extraction and low-value creation model. Those extracting the highest value are the stakeholders providing care and services. Extracting the lowest value, comparatively speaking, are those receiving care and services.??
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It is time to cut through the abstractions and use value metrics that balance economics, accessibility, actions, and clinical and social outcomes.??
There are hundreds of outcome measures established for mental and behavioral health. Texas doesn’t need to look far to identify a small set of measures outlined by MHA.??
4- Reconsider medication use and leverage sub-clinical support? -?According to the CDC, the average number of people who took medication for mental health reasons was 15.8% in 2019.?It is now 24% and rising.?
If you listen to health system shareholder calls, especially systems that have acquired primary care physician practices, the two areas encouraged to drive revenue and profit are increasing specialty care referrals and medication prescriptions. ?
The U.S. healthcare system is still predominantly incentivized to over-treat and over-prescribe, which is problematic. For example, the startup Cerebral recently found itself in hot water for — you guessed it — over-prescribing ADHD medications.?
The use of prescription medications to solve mental health problems is not always warranted. Depression, anxiety, loneliness, and addiction recovery can often be reduced by:
For instance, Peer Support Specialists are behavioral health service providers who have lived experience with behavioral health conditions; they work to increase access to mental health and addiction treatment services and support recovery among people with behavioral health diagnoses.
Per the Behavioral Health Workforce Research Center at the University of Michigan, Texas ranks at the bottom of the 50 states and the District of Columbia for peer support services.
States like Texas should incentivize sub-clinical mental health professionals like peer support, transformation, and recovery coaches. Nationally, peer workers and coaches average between $37K-$43K per year ($17-$20 per hour) -- many make much less.?It needs to be much more given the value this work provides. This must-have behavioral health role is marginalized, like many other sub-clinical roles in the healthcare system. The peer specialist and recovery coach role presents an opportunity to scale mental and behavioral health and improve its economics and outcomes.??
It’s time Texas becomes a state of mind-care. ?
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About Vince Salvo - Vince builds, commercializes, advises, coaches, and leads ambitious digital health companies, and people — from startup to large enterprise.
When you are ready to get your digital-first, virtual care, remote monitoring, and mental health product and service unstuck, profitable, growing and making a meaningful difference in people’s lives?— connect with Vince on LinkedIn - www.dhirubhai.net/in/vincesalvo .
Artwork / illustration by Daise Terazono - https://www.instagram.com/d.terazono/?hl=en
? 2022 Vince Salvo
just me
2 年Sadly Texas ranks last, but that seems to be a problem across the country in many community health systems....there is supposed to be parity between physical and mental health..Under medicaid most mental health claims won't be paid .but usually gets paid by states medicaid program...the community system can be rebuilt creatively and cost effectively so people can get the treatment they may need...problem is mental health treatment seems to be a one size fits all with little consideration for people's individual trauma reactions....it's a bad system all around