Declining mental health underscores the urgency of scaling up prevention

Behavioral health stakeholders are striving to make mental health preventive measures as normal and regular as old-fashioned annual medical exams.

Industry participants have begun to appreciate the benefits of screening for mental illness. This fall, the U.S. Preventive Services Task Force released draft recommendations for screening for anxiety in adults, pregnant women, and youth ages 8 to 18.

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

Preventative measures could help get patients into care faster and potentially save money by preventing a mental health crisis. In fact, every $1 invested in mental health and addiction prevention services yields $2 to $10 in savings, according to a joint analysis by the National Academies of Sciences, 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 US Preventive Services Task Force and director of the Institute for Excellence in Health Equity at the New York University (NYU ) Langone Health. But screening can be a chance for providers to detect concern in patients who may not have sought care.

“If you’re screening people, then they can have a significant following because [clinicians] can connect them to care,” Ogedegbe told Behavioral Health Business. “But when you don’t do that, then there are a lot of people who are just walking around, they have no symptoms, they have no signs, but they actually have an anxiety disorder.”

The benefits of prevention can be key

While there can be many benefits to mental health prevention efforts, the majority of insurers are not set up to offer this type of service.

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

Today, most preventive benefits are used in the primary care setting. 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 can facilitate access to services for patients.

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

Having a behavioral health provider on site 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 this type of service.

Still, prevention efforts can be cost-effective. Just as with physical health care, if a condition is detected early, treatment may require less time and experience.

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

Accessing mental health care can be especially difficult if the patient does not have a diagnosis. Typically, the clinician will need to submit a claim with a diagnosis to receive reimbursement for the services. But this may mean that patients are excluded from care early in their mental crisis.

Cigna is an example of a commercial insurer that has taken steps to implement preventive behavioral health measures, Guerra noted. It has teamed up with digital provider Ginger to offer online coverage of behavioral health coaching.

“Early intervention programs invest in benefits up front,” Guerra said. “It’s value-based care, and then you can potentially prevent all those costs down the line.”

Could digital be the answer?

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

The majority of these technologies are focused on the lower-acuity space of behavioral health. Now, some stakeholders argue that these tools can be a gateway for patients who need preventive services.

“I think teletherapy and telehealth is certainly a key component to the current continuum of human care,” Vitoria Lecomte, CEO and founder of Sesh, told BHB. “I think the prevention component of the continuum of care is about something that is more accessible and affordable than the current traditional options.”

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

While some payers cover virtual instruments, many offer digital packages to employers. This may be an opportunity for employers to consider preventive measures for mental health.

A recent Credit Suisse survey found that 29 percent of health benefits managers say depression is a top concern for their company.

“I would say their employers definitely have a responsibility to their employees,” Lecomte said. “I think the difficulty with relying entirely on insurance is that with insurance there is still often a co-pay. There are also a limited number of solutions that are related to your specific insurance and insurance plan. So it is important to consider how we can reduce the cost of accessing therapist-led support and contribute to this preventative care.

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