Details seven strategies to address mental healthcare
Each year in this country, one in five adults and one in six youth experience a mental health disorder. Mental illness is associated with considerable disability and societal cost. It is the leading cause of disability worldwide and individuals with serious mental illness die an average of 25 years younger than the general population.
The social determinants of mental health have been described in the literature, and they are associated with mental health disparities. Growing evidence suggests that racial and ethnic minorities and the lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) community are disproportionately impacted and that experiencing racism, discrimination, and inequity over one's life-span can significantly affect a person's mental health. Furthermore, many communities also are negatively impacted by limited access to employment and educational opportunities, safe neighborhoods, healthy food, secure housing, and early detection and health screening, and lack access to crucial mental health services (i.e. therapy and psychiatric care), contributing to sustained distress and impairment. Mental health stigma also is a major reason many people avoid or delay seeking treatment.
The prevalence of mental illness in the United States was steadily on the rise prior to COVID-19, but it has nearly doubled during the pandemic. The American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children's Hospital Association as well as the U.S. Surgeon General have declared a national state of emergency in children's mental health, citing soaring rates of mental health challenges among children, adolescents and their families. Almost half of all U.S. adults report feeling worry or stress related to the pandemic that has had a negative impact on their mental health, causing psychological, addictive and health behavior issues. Restrictive eating disorders have tripled in prevalence in adolescents and young adults, as isolation and distress leads to destructive attempts to take control. In addition, many losses, experiences and emotions are not reported, contributing to the increasing prevalence of "silent sufferers" among us. Now, more than ever, mental health is a public health issue that impacts all of us.
As a society, we must seek to understand better mental health needs and improve mental healthcare access and outcomes, change how and when we treat people suffering with mental health issues, and prevent mental healthcare from being overlooked and underfunded.
At Baylor College of Medicine, we collaborate with community partners (e.g., Clinic for International Trauma Survivors, Coping with COVID, Texas Child Mental Health Care Consortium, Alliance Wellness Clinic, among others) to provide access to quality mental healthcare to the adults, children and families of Houston and the surrounding areas. We prepare the next generation of healthcare providers by offering various training programs – addressing sampling, measurement, analytic strategies, legal and ethical concerns and policy issues. More than 40 funded investigators are conducting research in most major psychiatric disorders and technologies, and many are examining key ethical and social issues in mental health, including mental health inequities, differential impact on vulnerable populations (including pediatric and adult groups), preventive approaches to promote emotional well-being, and allocation of scarce resources to address the current mental health crisis, to name a few. Yet, there is still much more we all can do to improve mental healthcare in this country and worldwide. We believe there are opportunities to implement smart solutions that can help build systems and cultures that promote mental health and improve the lives of those suffering due to mental illness.
Recommended strategies to address mental healthcare
- Improve access to services by investing in telehealth solutions, mobile health clinics and other online community programs. We, like many institutions, rapidly implemented an array of telehealth and other creative options (like the nation's first portable and adjustable SmartPod clinic, "Access2Health") during the pandemic. We pledge to continue to invest in making virtual care and digital technologies, especially for mental health services, a priority and encourage others to do the same. We also call on insurers (federal government, many state governments, and commercial insurers) and state and federal legislatures to permanently remove barriers to access to care (e.g., waived enforcement of HIPAA for Facetime and Skype, relaxed written consent and online prescribing laws, and expanded and ongoing Medicaid coverage of telehealth services), while continuing to focus on efforts to ensure privacy and quality of care.
- Improve access to evidence-based treatments. There often is substantial lag between onset of mental illness and treatment initiation. Further compounding this problem is that treatment received does not always conform to accepted evidence-based standards. Thus, we highlight the need to promote the consistent use of evidence-based treatments for mental illness and ongoing training of professionals in application of proven, effective interventions.
- Address workforce challenges and advance diversity and inclusion in mental health treatment. Even before the pandemic, there was a known shortage of mental health providers, especially in rural areas. We need to look at other ways to reduce the shortages in mental healthcare, such as supporting the education of nurse practitioners, physician assistantssocial workers, community health workers, peer counselors and physicians to increase their self-efficacy for supporting individuals with mental health needs (i.e., recommendations, referrals). In addition to expanding the workforce, there is a critical need to advance mental health workforce equity to meet the various needs of patient populations, including those with co-existing medical and psychiatric complexity (e.g., anorexia nervosa). We need to prioritize increasing the proportion of providers from socially and economically disadvantaged backgrounds through dedicated programs to foster interest, engagement, leadership, career advancement and retention opportunities.
- Integrate behavioral and mental health screening more broadly. Early detection of emotional and behavioral problems is crucial. Embedding and integrating mental health into primary care improves access and reduces stigma. Mental health screenings need to be a routine part of primary care services throughout the lifespan, and we must invest in other ways to make screening more manageable (i.e., effective mental health apps, use of readily available and representative screeners, investigation of ways to financially account for screening time (i.e., billing), trained mental health professionals on staff, especially in urgent care and childcare facilities). We also support screening in the workplace and believe schools (especially K-12) need to be equipped to provide on-site mental health services with careful consideration of privacy and trust concerns. We also support incorporating social media questions into routine clinical assessments, especially for adolescents.
- Mitigate early symptoms of and stigma and discrimination associated with mental health through widespread culturally and linguistically appropriate education, programs and policies. Leadership from employers, community groups (i.e., faith-based organizations) and schools is needed to reduce stigma and discrimination. Community partnership is needed to recognize and respond better to mental health challenges and remove barriers that prevent people from speaking up and getting the help they need. Developing and implementing curricula that are tailored to the individual, culturally informed and include non-stigmatizing, humanizing language related to mental health will aide in the recognition of signs of emotional distress and encourage access to early intervention and treatment. This approach should include tools to manage stress and resolve conflict. Thought and expertise is needed to ensure appropriate format and style (i.e., materials or toolkits in multiple languages, videotaped and print-outs, diverse images represented in these materials) and to select the messengers used (i.e., individuals who diverse communities value/respect).
- Create a culture that encourages and normalizes seeking care for mental health issues. This is especially true in medicine, where reports abound of burnout among healthcare workers and underutilization of mental health services. Trainees in particular may be at risk given their vulnerable position related to evaluation. We need to help people where they live and work to recognize and respond better to mental health challenges and remove barriers that prevent people from speaking up and getting the help they need.
- Prioritize and conduct empirical, longitudinal research to help identify, evaluate and address mental health. We can improve our understanding of protective factors and disease risk assessment, early diagnosis and multisector models of care. There are additional opportunities for supportive treatment interventions that address inequities in partnership with communities. Further research is needed to evaluate the effectiveness of communication and screening programs and to examine the lived experiences and structural environments and realities of those most affected by mental illness. We also need to consider how this varies by gender, race and ethnicity. There is an opportunity to examine and better address significant disparities in pain and pain treatment as it relates to mental health, including health conditions that disproportionately impact minority populations and possible bias from providers in responding to pain associated with those disorders. Additional studies also are needed to refine interventions based on the interactions between the social determinants of mental health that include the complex relationship between race/ethnicity, socioeconomic status, mental health and healthcare.
Together, we can focus on improving the well-being of individuals and families by examining and improving mental health systems and creating a culture of empathy, humility and equity. A critical look at mental health challenges (while recognizing that each person's obstacles are personal and different) requires a systematic, evidence-based assessment of existing interventions, policies, resources and support to identify what has and has not worked. We believe that with further collaboration and commitment across all groups – providers, employers, policymakers, community stakeholders and consumers – we can take what we have learned, leverage emerging technology, and create a better future for mental and behavioral health that is inclusive, representative and accessible.
For more information on Baylor mental health services, click here.
For adult mental health resources:
- Baylor Medicine Psychiatry and Behavioral Sciences
- Harris Health System
- Menninger Clinic
- Michael E. DeBakey Veterans Affairs Medical Center
For pediatric mental health resources at Texas Children's:
- The Meyer Center for Developmental Pediatrics and Autism
- Texas Children's Psychiatry Service
- Texas Children's Pediatric Psychology
Contributors: Clarice Jacobson, Faith Fletcher, Ph.D., Mary Anderlik Majumder, Ph.D., Eric Alan Storch, Ph.D., Toi Blakley Harris, M.D., J Wesley Boyd, M.D., Ph.D., Virginia D. Cline, Ph.D., Catherine M. Gordon, M.D., M.S., Wayne Goodman, M.D, Holland Kaplan, M.D., and Amy L. McGuire, J.D., Ph.D., on behalf of the Center for Medical Ethics and Health Policy, Department of Psychiatry, and Department of Pediatrics at Baylor College of Medicine.