David Mou, CEO, cerebral,
The healthcare system has reached a crisis point; Millions of Americans who suffer from mental illnesses cannot get care. According to the National Institute of Mental Health, an estimated one in five adults suffers from a mental illness, and more than half do not receive treatment.
Our mental health system is failing Americans. As a psychotherapist, I have seen patients wait months for their first appointment. More than half of the US states have absolutely zero psychiatrists. this is unacceptable. But there is a promising solution in telehealth. Unlike other medical specialties, where in-person physical examinations are important, psychiatry typically relies more on building trusted relationships that can lend themselves to this form of remote health care.
Barriers to accessing mental health patients
I think stigma serves as a major barrier to mental health care seekers. Many people do not feel comfortable sharing their struggles with their family members or friends. Some of my former patients went to extraordinary lengths to conceal from their loved ones the fact that they were seeking mental health care. Overcoming this culturally ingrained stigma should not be a prerequisite for receiving care.
Convenience is another constraint that needs to be considered in the industry. Taking an afternoon off each week to attend in-person therapy sessions is a luxury most people cannot afford. The National Council for Mental Wellbeing reports that nearly half of Americans know someone who has had to travel more than an hour to seek mental health treatment.
Finally, the match between clinicians and patients is especially important in mental health. The more physicians there are to choose from, the better patients will be able to find physicians that best match what they’re looking for.
Three areas of focus for the industry
Taken together, these barriers explain why mental health practitioners need to meet with patients, not the other way around. Telehealth in mental health is just getting started. What do we need to do to get to Telehealth 2.0? Here are three areas the industry should focus on.
1. Historically Underserved Communities
Telehealth can be leveraged to help those who have historically been disenfranchised, including those who are geographically out of reach of physicians, as well as those who are culturally disenfranchised; Many races are particularly hostile to the idea of mental health care. As a Chinese-American, I have seen this firsthand.
Telehealth providers should prioritize hiring a diverse group of physicians who understand cultural contexts and the unique challenges any individual may face. Furthermore, marketing campaigns should be designed in a culturally sensitive and accessible manner.
Finally, telehealth solutions can serve as a first option for care, but if patients require an enhancement of services, telehealth providers must be able to refer them for in-person care. Brick-and-mortar clinics, hospitals, and telehealth providers must partner to create an integrated experience that puts the patient at the center. The future of care will allow patients to move seamlessly between different levels of care.
2. Outcome Based Measurement
Amazingly, most mental health professionals do not measure clinical outcomes. A survey in 2015 showed that a large percentage of psychiatrists do not even use electronic medical records. Without data on how patients are doing, physicians will have trouble knowing which of their patients needs attention.
Lessons from telehealth practices can help address many of these issues. Given that telehealth platforms are built on newer technology platforms, important clinical measures are more easily monitored. Depression scores, medication compliance and other data empower physicians to adjust their treatment plans accordingly so patients get better, faster.
For example, you can determine which patients haven’t completed their labs and remind physicians to follow up with those patients to make sure labs are completed. You can use machine learning to scan patients’ messages for suicidal content and proactively reach out to those patients within minutes. This is only the beginning of how data can be leveraged to improve care.
Cost is a major barrier to care. Millions of Americans struggle to find a mental health care professional who takes their insurance. Studies show that the acceptance rate for all types of insurance is significantly lower for psychiatrists than for physicians in other specialties. Many psychiatrists are reluctant to seek insurance given the low pay, cumbersome logistics, and delays in payment.
They are often wary of taking on the most difficult cases; It’s a shameful fact, but I’ve seen many psychiatrists actively avoid taking on patients with suicidal thoughts. Why take a high risk patient when you get paid the same for taking a patient with mild depression? Our most vulnerable patients face the hardest times to access care. It is unconscious. Involvement of these patients is not only the ethical thing to do, but it helps improve the reputation of our industry.
Using data, there is a unique opportunity to drive a virtuous cycle that can benefit physicians, payers, and most importantly, patients and their families. The data can demonstrate how providers can improve the quality of care (for example, preventing unnecessary emergency room visits) while reducing costs. This, in turn, allows health insurance companies to better identify the best physicians and pay them more. I believe this will make physicians increasingly open to taking on insurance-based patients, given that their compensation will be linked to performance. With this, more patients will be able to get treatment.
As medical professionals, we have to do a better job of meeting patients where they are physically, culturally and emotionally. I believe telehealth is an important part of the solution. For example, most of the patients my company helps have never received mental health care before.
The future of mental health care should allow patients to seamlessly transition between all levels of care: app-based, telehealth, in-person, urgent care, and inpatient care. New technologies and systems are opening doors and have the potential to improve the lives of millions of Americans who have long been underserved.
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