The case for urgently transforming behavioral healthcare in the U.S. is clear. Suicide rates are up 25 percent in two decades, the nation’s opioid crisis claims 175 Americans a day with no sign of waning, and our emergency departments are crowded with patients struggling with mental illness and addiction, too sick to go home but nowhere else to turn.
We need a targeted, coordinated and ambitious approach, one as profound as the efforts that dramatically improved cancer outcomes. Remember when we spoke of the "Big C"’ in hushed tones? Today, more than 16 million people are living with the disease. Death rates have dropped 23 percent in two decades. More breakthroughs are imminent.
Let’s invest in a similar strategy, one that helps us reach our goal of improving outcomes and lowering costs for the treatment of chronic illnesses including depression and substance use disorder.
First, we must start with integrating treatment for mental illness and addiction into healthcare. Our network, like many, has embedded behavioral health care specialists in physician offices so patients can have immediate access to care.
More than a quarter of Americans 18 and older suffer from a diagnosable mental disorder in a given year, but we know that far few of them seek treatment or have the insurance or resources to cover it. Far too many end up in our nation’s emergency departments and the ranks are growing: The rate of visits for patients suffering from depression, anxiety, bipolar disorder and other mental illnesses increased by more than 50 percent from 2006 to 2013. We can do better than having psychiatric patients boarded, sometimes for days or even weeks at a time, for care that is ineffective and too costly.
A good start to connecting patients with quality behavioral health care is through the Collaborative Care Model, which is team-driven, population focused and evidence-based. Care managers are the vital bridge between primary care physician, patient and psychiatrist. They are saving millions in fewer hospitalizations and other downstream utilization.
Second, we must approach behavioral health as we do other illnesses and rely on evidence-based treatment. While health networks are improving the treatment of cancer, cardiac disease and other illness through patient-centered models, it hasn’t caught on as readily in behavioral health.
That’s in part because most providers don’t use standardized metrics to gauge outcomes and small centers don’t typically invest in electronic medical records and other technology necessary for data collection and sharing.
However, there’s promising news from CMS. Under a pilot program it created, eight states, including New Jersey, launched Certified Community Behavioral Health Clinics. This initiative is expected to infuse more than $1.1 billion into community-based services, making it the largest investment in mental health and addiction care in generations. The clinics are using evidence-based practices, integrating behavioral health in primary care and increasing access to treatment.
There are other promising developments with patient-centered models, including bundles created to improve outcomes and lower cost for the treatment of depression and other mental illness. These pilot programs will hopefully reduce the trial-and-error approach that so often characterizes treatment.
Though New Jersey is adding more than 800 psychiatric beds over the next two years to relieve long waits for admission and backups in EDs, expanded access to care can't be accomplished by simply adding more beds.
Access can and must grow in more unconventional ways, too – by creating behavioral health urgent care centers or "living rooms," a hybrid of hospital and community settings with the goal of diverting patients from EDs and lowering their anxiety levels. These upstream solutions are not as common as they should be but warrant consideration from every health network in our nation.
Our network, New Jersey’s largest, is taking a bold approach to expand access and enhance care by merging our 16-hospital network with the state’s most respected provider of behavioral health, Carrier Clinic. This allows us to share best practices and create centers of excellence, just as many networks have done for cardiac and cancer care. We will introduce innovative technology and treatment and scale the most successful advances throughout our network. Put simply, this partnership allows us to write a new narrative for behavioral healthcare.
And let’s be honest, mental health innovation is long overdue. However, with the profound need to expand access to treatment and advancing research, more companies are innovating in the space than ever before. Some of these trends could truly transform care.
Let me provide a few examples. Telemedicine in psychiatry is advancing and is essential given the dearth of providers. We are piloting facial recognition software used by the Department of Defense which detects subtle expression that can’t be seen by the naked eye. It aids in diagnosis and guarantees our patients treatment with an expert on the spot – without having to wait in an ED for treatment.
There’s also a wearable device – it’s like a Fitbit - that can detect your mood without the need for manual entry on an app. It goes well beyond the mood ring. It can detect emotions, breathing patterns and other physiological signs that signal how users are feeling. It can signal the need for intervention to avert an emergency.
I believe we can transform behavioral healthcare in our nation, that we can achieve results as profound as our success in the fight against cancer. It’s hard to think of a more worthy investment in our nation’s health system at this time.