Behavioral health and mental health conditions are highly prevalent across generations. About 11% of adults and 3% of youth had alcohol use disorder and 21% of U.S. adults had a mental health condition such as depression, anxiety, or schizophrenia a 2020 National Survey on Drug Use and Health found. More recently the U.S. Department of Health and Human Services found that 1 in 20 Americans live with a serious mental illness (bipolar disorder, major depression, etc.).
Behavioral and mental health are critical aspects of whole-person care. Behavioral health relates to the specific actions a person takes surrounding their health. Mental health is related to a person’s thoughts and feelings and is usually connected to one or more biological factors that influence a person’s mental state.
Both can significantly impact physical health outcomes and a person’s social and economic well-being. Individuals with behavioral and mental health conditions for example have a higher risk of developing chronic diseases (like diabetes) and are more likely to face employment and housing problems.
Ensuring that member populations get the behavioral health care they need is pivotal to providing a whole-person care approach and enabling better health outcomes and quality of life.
Below we quickly look at the current challenges surrounding behavioral and mental health care and then provide five ways care teams can better connect members to behavioral and mental health services.
The Existing Challenges Around Accessing Behavioral and Mental Health Services
Despite the importance of behavioral and mental health, barriers created by systems and structures exist that make it challenging to access needed services.
Barriers members encounter when trying to access behavioral and mental health services may include one or many of the following.
- Financial (high costs)
- Lack of or limited access to mental health care professionals and services
- Limited mental health education and awareness
- Social stigma surrounding conditions and treatments
- Discrimination based on race, ethnicity, gender, or sexual orientation.
Lack of access to professionals and services is especially concerning and can have dire consequences, especially for people in need of immediate help (i.e., crisis stabilization services).
Beyond this, payers, providers, and care teams also face challenges:
- Lack of access to needed resources. A core challenge is actually accessing available behavioral health and mental health resources, services, and support options to tap into and provide to members. In the United States, more than 150 million people live in federally designated mental health professional shortage areas. For those living in rural areas, some may not have access at all. And experts predict that within a few years, the country will be short between 14,280 and 31,109 psychiatrists, psychologists, social workers, and others will be overextended.
- Data silos. Sharing information about an individual’s mental health – specifically related to substance use disorder treatment and services – is protected by federal regulations. When care team members don’t have a whole-person, 360-degree view of the patient, or a secure way to collaborate on a member’s behavioral health-related needs, gaps form (and quickly widen) regarding care and treatment.
- Resistance to accepting or seeking services. People often hesitate when it comes to getting help with behavioral or mental health due to the social stigma attached to and fear of being judged for seeking treatment for mental and behavioral health conditions.
5 Ways to Enable Behavioral and Mental Health Care
How can payers and providers better serve populations in need of behavioral health and mental health services and take the pressure off care management and clinical teams? Here are five ways to better support and connect members.
- Consider an integrated care model that includes a licensed clinical social worker (LCSW) or other behavioral health and/or mental health professional(s) co-located in a primary care office. If this isn’t feasible, consider offering telehealth services to link members virtually.
- Address social determinants of health (SDOH) first to remove identified barriers to behavioral and mental health services. They are often a big piece of the puzzle. Here are some ways to help address SDOH.
- Leverage relationships with community pharmacies to serve as a safety net and bridge gaps in medication adherence. They may offer enhanced services including medication review, reconciliation and management, delivery services, blister packaging, syncing refills, and possibly even home visits.
- Employ care management services often and early as an additional layer of support for assessment, and education, and as the eyes, ears, and point of continuity in the member’s home environment.
- Link members with peer support and other locally managed entities or managed care organizations (LME/MCO) support and resources, such as the Assertive Community Treatment Team (ACTT) and mobile crisis teams.
If it seems like putting these ideas into action may be hard, fortunately, that’s where technology comes in. Especially when serving lower-income and underserved member populations with behavioral health and mental health needs. Telehealth tools and other care management configurations uniquely designed for behavioral and/or mental health are key.
Supporting Behavioral and Mental Health with Technology
Some tech-based tools to look for when considering a care management platform to support whole-person care with behavioral and mental health in mind include:
- Telehealth capabilities/tools that allow for “face-to-face” encounters when a home or in-person visit may not be feasible or safe.
- Built-in behavioral health care pathways that guide end-to-end care planning for members.
- Predictive analytics to help care managers identify members likely to be experiencing either behavioral or mental health conditions and issues
- Out-of-the-box, industry-standard behavioral health assessments, and screening tools that help ensure members receive the right care at the right time.
- Medication management tools that support adherence assessment and reconciliation.
- Integrations with community partners so care managers can quickly link members with local resources and services that support behavioral and mental health and SDOH
- AI-driven automations that save time by streamlining administrative tasks so care managers can focus on building trust with members and encouraging better acceptance of and adherence to behavioral health and mental health support and treatment.
When Behavioral and Mental Health Needs Are Unmet, Everyone Suffers
Integrated, holistic, whole-person is key for everyone. It’s something that can negatively impact patients, health care providers, and care staff, as well as payers.
Patients experience poorer health and quality of life. Most concerning is the link between untreated mental health needs and higher rates of attempted and death by suicide. Unaddressed conditions also interfere with members’ ability to engage in their physical health and may even result in their being discharged from medical practices for non-adherence to treatment.
Providers face staff burnout and negative impacts on quality measures. The shortage of behavioral and mental health professionals and resources places an additional burden on primary care staff, who are often unequipped to address these needs. HEDIS and other quality measures take a direct hit, too. Left untreated, mental health and behavioral health conditions can contribute to physical symptoms that result in potentially avoidable emergency department (ED) visits.
Payers experience increased costs. Member populations not receiving the behavioral and mental health support they need drives up costs for payers in terms of higher rates of out-of-network usage, as well as high ED utilization and overall cost of care.
Making sure to include behavioral and mental health as key components of patient views and care plans can benefit all involved in both the short and long term.