CommonSpirit Health

Paul Rains

Rollercoasters are supposed to be fun, but not when they apply to the delivery of behavioral health. In our American healthcare system, we have made some major strides with several diseases, yet not with behavioral health. Unfortunately, our behavioral health patients still face many of the same issues that they’ve faced in the past. However, there is hope on the horizon.

Going down…

Mental health disorders are chronic diseases, just like diabetes. The challenge lies in that expected outcomes are often less clearly defined than those we have in other medical diseases. Continuing the metaphor of diabetes, we can follow response to treatment based on objective measures like glucose and kidney function, then make rational treatment decisions based on those numbers. A similar metric is much less clear in, for example, schizophrenia. Because of this, attempts to define “standard treatment” for mental health disorders have been elusive.

The challenge, then, for payers is that outcomes and expenditures are often difficult to predict. Payers can predict costs for the treatment of a tumour, for example, but not as much for major depression. For general health care, third-party payers can allocate funds based on tables of known outcomes. However, the outcomes are often not known in mental health. Government and private payers are often seriously underfunded, and the funding for mental health care in our country has not even kept pace with inflation. They are being asked to do more with less.

There are serious barriers to receiving care in behavioral health. There are personal and cultural barriers, with stigma being a major obstacle in several populations. Attempts to destigmatize mental health care have met with some powerful successes as well as many failures. Not all insurance programs cover mental health care, and out-of-pocket costs can become prohibitive. Effective care may require multiple weekly visits, making compliance an issue for people with jobs or limited transportation. Laws passed in the past few decades to protect patient privacy have created a new layer of difficulty when it comes to information sharing, and building a comprehensive multidisciplinary system of care is more challenging when each provider is only allowed access to limited information regarding a patient.

Given these barriers, each party—patients, providers, health care systems, third-party payers, and government programs—have each created well-meaning approaches to care, resulting in a system that is disjointed, inefficient, and poorly accessible, sometimes with different components acting at odds with each other. Each party is pointing fingers at each other.

Going up…

There is hope for this quagmire. As in most human conditions, the answers lie first in communication. New technologies have enabled effective communication using encryption methods that guarantee patient privacy. Using secure communications, including e-mail and video conferencing, stakeholders can work together in real-time to develop optimum individualized and evidencebased care systems. Video conferencing has also led to the increased use of telehealth, video therapy sessions, video group sessions, and video care team meetings. Today, that team of experts can extend beyond a single zip code to include thought leaders worldwide.

Artificial intelligence (AI) has the potential to dramatically impact behavioural health care. AI can help with effective communication, especially in patient-facing applications where explanations developed by AI are generally more comprehensive and well-written than those created by humans. AI is based on big data and works best with data. As we understand the power of combining genetics, epigenetics, nutrition, biomarkers, functional MRIs, PET scans, population demographics, environmental toxins, weather, and a host of other data points as they may apply to a single patient, we will see dramatic improvements in care outcomes, access, treatments, and costs.

Buckle up…

Behavioral healthcare has indeed been an exciting rollercoaster ride. Hop in, fasten your seatbelt and restraints, and get ready for the ride of your life. This will be epic!