- Mental and behavioral healthcare options are currently too fragmented to facilitate easy patient access to care, according to a survey of healthcare industry leaders in a recent NEJM Catalyst Insights Council report.
The US healthcare industry has traditionally dealt with mental and behavioral health needs separately from physical health needs, a system that has proven ineffective, according to Amy Compton-Phillips, MD, executive vice president and chief clinical officer for Providence St. Joseph Health and theme leader for NEJM Catalyst’s Care Redesign sector.
“In the US, historically we have separated out mental and behavioral illnesses from physical illness,” Compton-Phillips said in a statement. “What we are learning – at a pretty high cost – is that having two separate and unequal systems of care results in suboptimal treatment of a patient.”
Fifty-one percent of respondents said their organization’s mental and behavioral healthcare offerings are not adequate to meet the needs of their unique patient populations. Forty-five percent of respondents said their offerings are adequate.
About three-quarters (77 percent) of respondents said their healthcare organization offers a basic mental and behavioral health screening. Sixty-eight percent said they offer psychiatric medication and 62 percent said they offer psychological counseling.
But less than half of respondents said their organizations offer group or family counseling, and a total of 14 percent of respondents said their organization offers no mental and behavioral health treatment at all.
For the organizations that do offer some mental and behavioral health support, these options are not expansive enough. For example, although 68 percent of organizations offer psychiatric medication, this treatment option does not support a holistic approach to wellness.
“Prescribing medications alone is rarely the right thing to do, even if it is the most expedient; medication usually works best when prescribed along with other forms of treatment, such as cognitive behavior therapy,” the report pointed out. “Yet medication is what clinicians jump to when other services aren’t readily available.”
The Insights Council respondents reported that inadequate insurance coverage is the top barrier to mental healthcare, with 34 percent of respondents reporting such. Thirty-three percent said fragmentation of care is a barrier, and 32 percent lack of access to specialty care is a significant hindrance.
Creating more and better pathways to mental and behavioral healthcare services is the top strategy for supporting specific patient populations, the respondents said. The healthcare industry needs a wider range of clinicians, better availability of mental and behavioral health services in the primary care setting, and better options and access for low-income patients.
The report cautioned against simply layering mental and behavioral health over primary care services, however. Instead, organizations need to conduct a community health needs assessment (CHNA) to pinpoint the specific areas in which it can enhance these care options.
A CHNA might reveal underlying factors that drive mental and behavioral health issues – a prevalence of domestic violence, child abuse and neglect, and intimate partner violence, for example. Integrating programs that target those social determinants of health will help mitigate downstream health issues. In turn, this addresses the need for standalone mental health organizations.
Incorporating more mental and social health work into the primary care setting will require a cultural change related to patient data sharing, the report noted.
“Clinicians should be able to easily access and share information about patients, enabling different specialties to work together to create comprehensive treatment plans,” the report stated. “Doing so would also more easily allow the integration of primary care services into psychiatric services, which 81 percent of survey respondents enthusiastically support.”
Separate research has confirmed that patient access to care for mental and behavioral illnesses is inadequate. A recent study in the Journal of General Internal Medicine found that only 35 percent of patients with a mental health diagnosis are receiving treatment.
Part of ensuring patients access the mental and behavioral healthcare they need is properly identifying patients with a health concern, according to the JGIM article lead author Beth Waitzfelder, PhD, an investigator with Kaiser Permanente Center for Health Research.
“Our study, which was much larger than previous studies, provides important new evidence about the current scope of the problem among leading health care systems across the country that are striving to improve depression care in primary care settings,” Waitzfelder noted, pointing out that screening for mental health issues is one way to overcome those care disparities and reach all patients.
“Screening for depression in primary care is a positive step toward improving detection, treatment and outcome for depression, but disparities persist. We need a better understanding of the patient and other factors that influence treatment initiation.”
The healthcare industry is currently undergoing a transition to more value-based reimbursement models. Approaching patient wellness in a holistic manner will help to drive some of the goals of value-based care, including creating better health outcomes at a lower overall cost.