Deteriorating Mental Health Reveals Urgency to Expand Prevention

Deteriorating Mental Health Reveals Urgency to Expand Prevention

Behavioral health actors seek to make preventative mental health measures as normal and regular as the old fashionable annual physical.

Industry players have begun to evaluate the benefits of screening for mental health issues. This fall, the US Task Force on Preventive Services released draft recommendations for screening adults, pregnant and postpartum women, and young people ages 8 to 18 for anxiety.

Since the start of the COVID-19 pandemic, rates of anxiety and depression have skyrocketed. Anxiety rates increased by 25% and major depressive disorders increased by 27.6% worldwide in 2020, according to a Lancet study.

Preventative measures could help patients get care faster and potentially save money by averting a mental health crisis. In fact, every dollar invested in mental health and addictions services generates savings of $2 to $10, according to a joint analysis by the National Academies of Science, Engineering and Medicine.

Treatment for anxiety disorders is relatively low, and many primary care settings lack screening tools, said Dr. Gbenga Ogedegbe, a member of the U.S. Task Force on Preventive Services and director of the Institute for Excellence in New York University (NYU) Health Equity Langone Health. But screening could be a chance for providers to detect anxiety in patients who may not have sought care.

“If you screen people, they may have a large following because [clinicians] can connect them to care,” Ogedegbe told Behavioral Health Business. “But when you don’t, then there are a lot of people walking around, they don’t have symptoms, they don’t have signs, but they actually have anxiety disorders.”

The benefits of prevention could be key

Although mental health prevention efforts can have many benefits, most insurers are not set up to offer these types of services.

“I think the best way, and the easiest way for people to get early intervention and treatment for a behavioral health problem, just like asthma, diabetes, or hypertension…will be using their health care benefits to access that care,” Michelle Guerra, a senior population health and health equity consultant at RTI Health Advance, told BHB. “I think right now the [way the] preventative benefits that are structured as part of a medical plan are not really designed for that.

Today, the majority of preventive benefits are used in primary care settings. This could be an opportunity for PCPs to offer universal behavioral health screenings and on-site referrals. Co-locating a PCP and a behavioral health specialist could make it easier for patients to access services.

The behavioral health provider might be available for short-term counseling or to connect patients to online modules, Guerra said.

Having a behavioral health provider on hand can come with its own set of challenges. For example, the cost, resources, and infrastructure required to implement this type of integrated care may prevent many primary care offices from offering these types of services.

Yet prevention efforts could pay off. Just like in physical health care, if a condition is detected early, it could require less time and expertise to treat.

“Not everyone needs to see a psychotherapist, psychologist, or psychiatrist,” Guerra said. “It’s not really about meeting them where they are and providing them with the best care for what they need.”

Access to mental health care can be particularly difficult if a patient does not have a diagnosis. Typically, a clinician will need to submit a claim with a diagnosis in order to be reimbursed for services. But it could mean that patients are left out of care early in their mental health crisis.

Cigna is an example of a commercial insurer that has taken steps to implement preventative behavioral health measures, Guerra noted. It has partnered with digital provider Ginger to provide in-network coverage for behavioral health coaching.

“Early intervention programs invest in benefits from the start,” Guerra said. “It’s value-based care, and then you can potentially avoid all of those downstream costs.”

Could digital be the solution?

The popularity of digital health exploded with the onset of the COVID-19 pandemic.

Most of these technologies focused on the lower acuity space for behavioral health. Now, some stakeholders claim that these tools could be a gateway for patients who need preventive services.

“I think teletherapy and telehealth is definitely a key part of today’s continuum of care for individuals,” Vittoria Lecomte, CEO and founder of Sesh, told BHB. “I think the prevention component of the continuum of care has to do with something that is more accessible and approachable than the current traditional options. »

Sesh is a digital health company that provides virtual mental health group support led by certified therapists.

While some payers cover virtual tools, many offer digital packages to employers. This can be an opportunity for employers to consider preventative mental health measures.

A recent Credit Suisse survey found that 29% of healthcare benefits managers said depression was a top concern for their company.

“I would say their employers definitely have a responsibility to their employees,” Lecomte said. “I think the difficulty in relying absolutely on insurance is that with insurance there is often still a copayment. There are also a limited number of solutions tied to your specific insurance and insurance plan. It is therefore important to think about how we can reduce the cost of accessing therapist-led support and contribute to this preventive care. »

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