The mounting behavioral health crisis is our next pandemic
“We know we have an intense need. Behavioral health is the next pandemic.” This is how an IT leader at a large health system recently opened a conversation about 2021 goals. Two things struck me: addressing the behavioral health crisis is a rising priority across organizations, and IT leaders are folding behavioral healthcare into their system-wide digital transformations.
Prior to Covid-19, the gap between behavioral health supply and demand was staggering. In 2018, only 43% of adults with mental health needs were able to receive services for all necessary conditions. And it’s only gotten worse. Data from mid-July showed that 53% of adults in the United States reported that the pandemic has negatively impacted their mental health.
Importantly, the pandemic also highlighted racial and ethnic disparities related to access (e.g., Black and Latinx individuals with behavioral health diagnoses have lower access to needed treatment, and experience less culturally responsive care than the general population). And the mental toll of the pandemic is felt even more acutely among the healthcare workforce. One study of 1,119 healthcare workers reported that 93% were experiencing stress, 86% were experiencing anxiety, and 76% were experiencing exhaustion and burnout.
The demand is significant and rising, but so is the potential to improve how behavioral healthcare is delivered to individuals with diagnosed needs as well as those seeking services for the first time.
3 digital opportunities that drive clinical innovation:
Screening, integration, and emergency department (ED)-based interventions have the ability to optimize clinical behavioral health resources and services to reduce practice variation, improve outcomes, and reduce cost of care.
Universal screening allows health systems to capture patient behavioral health status and need for intervention, track changes in behavioral health status and the efficacy of interventions over time, and accurately depict patient population trends. These
assessments, which can be administered digitally by clinicians or pushed out to patients and employees, identify individuals with an unmet behavioral health need, assign early estimates of acuity, and prompt triage to appropriate services.
- Behavioral health integration at scale
Placing behavioral health and primary care providers in the same location, either
physically or through digital modalities, enables more efficient care delivery and allows for timely consults and patient triaging. There is evidence showing the effectiveness of behavioral health integration, particularly Collaborative Care, but organizations struggle to scale due to staffing and data-sharing challenges. This is where digital can play a transformational role. Organizations that are able to scale these programs have screening, therapy, psychiatric consults or e-consults, and substance use disorders (SUD) services embedded into standard workflows across all settings of care.
- ED-based interventions
A significant percentage of ED visits are related to unmet behavioral health needs, and nearly half of ED visits in the US are related to SUD. On top of that, Covid-19 continues to place great strain on ED and inpatient capacity. Digital solutions can be used to direct patients to more appropriate care settings and free up essential capacity. Organizations that have successfully transformed their EDs screen all individuals for behavioral health status upon admit. From there they can facilitate appropriate, evidence-based treatment for all acuity levels, including medication-assisted treatment, comprehensive Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs, and peer recovery engagement.
3 digital opportunities that expand access and capacity for behavioral health:
On-demand tools, peer-based care, and telebehavioral services allow organizations to build consumer-facing infrastructure to extend reach and deliver services beyond provider walls.
1.On-demand behavioral health tools
Providing on-demand resources that address behavioral health needs across the acuity spectrum, either synchronously or asynchronously, equips individuals with tools to take an active role in their own treatment. These resources can be supplemental benefits to employer-sponsored health insurance or support primary care physicians who provide behavioral health treatment to a subset of their patients. With guidance from a clinician/supervisor or with little to no intervention, these tools offer an effective, immediate option for individuals in between appointments, those waiting for referrals to behavioral health specialists, or to those experiencing stress, anxiety, and burnout as a result of Covid-19.
- Digitally-enabled peer-based care
Scaling peer-based care can provide patients with a sense of community to help them more effectively engage in their care, improve adherence to treatment plans, build resilience, and decrease unnecessary hospital utilization. Peer-to-peer programs have proven to be effective and can be designed for many conditions, but recruiting and managing these groups can be expensive and time-intensive. Using digital tools to scale peer-based care removes geographic barriers, reduces stigma, promotes improved matching between the patient and peer, and serves as an engagement mechanism to support patients in between visits with their care teams.
- Telebehavioral health
This allows organizations to virtually deliver psychiatry, therapy, and/or tele-Medication Assisted Treatment (MAT). Telebehavioral services can be leveraged for multiple use cases, including provider-patient visits and provider-provider consults, and complement an organization’s existing network of providers. Telebehavioral visits have increased significantly since Covid-19, with one source reporting an increase in mental health-related telehealth visits from 35.11% in October 2019 to 58.38% in October 2020 across the Midwest alone. Providing virtual access to these services reduces barriers to care and helps organizations broaden access points while filling gaps in areas with provider shortages.
Covid-19 will continue to illuminate the behavioral health crisis, but effective use of digital solutions can drive clinical innovation and expand access to care. To get started, organizations need to:
- Determine which opportunity areas are of highest priority
- Understand the technology landscape
- Define what financial and clinical success looks like
- Activate an appropriate multidisciplinary team
- Measure performance and focus on the shift from pilot to scale
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