Overcoming 3 barriers to mental health care access

May is National Mental Health Awareness month. To kick it off, on May 1, Catalyst Payment Reform (CPR) held a podcast to discuss the challenges employers face to integrating mental health care into their benefits packages and the workplace–and what employers are doing to overcome those challenges.

“Employers can look at their data and think they don’t really have that big of a problem, but that’s because the data is hidden,” said podcast guest Mary Kay O’Neil, a partner with Mercer. “People don’t get diagnosed at an accurate level. Anybody who works in the employer world and HR knows there are people who are at work and struggling, and the actual problem hasn’t been identified.”

This overlook costs employers 2.5 times more in medical claims, not to mention the dramatic decrease in productivity. So why aren’t employees getting the help they need? There are several problems, notably the stigma associated with mental health disorders.

Related: Latest in-demand employee training: Mental health first aid

Even if a person is brave enough to admit they need help, getting that help requires overcoming myriad hurdles: they often don’t know where to start getting help. “The biggest challenge we have right now is adequate access to high-quality services,” O’Neil said. “When they have gotten to the point of identifying the need, it’s so difficult to figure out how to access the appropriate level of high quality care, how to identify the right care, how to get in without a long wait.”

The team at CPR identified three barriers currently preventing employees from getting appropriate behavioral health care, as well as what’s being done to overcome them.

1. Integration of behavioral and medical services

From a benefits standpoint, behavioral and medical health have long been siloed. “We previously had behavioral health benefits carved out,” said podcast guest Sara Rothstein, deputy director of 32BJ Health Fund. “They were paid by a separate vendor. That led to situations where if someone was engaging in self-harm, the behavioral and medical vendors would play hot-potato with the claim. It’s terrible for the member to try to figure out how to get their care covered.”

Also complicating the situation was the reluctance of many behavioral health providers to participate in a network plan and all the administrative paperwork that comes with such involvement. But as the health care landscape evolves, these two siloed services are seeing more and more overlap.

Carved in, or integrated behavioral and medical services reduces that confusion and allows better case management and coordination of care. The most notable marker of success in this area is including behavioral health screenings as part of a primary care visit. According to Rothstein, interventions at the primary care level improve access to behavioral health services by:

1.  Increasing the rate rate of diagnosis.
2. Making it easier for patients to figure out how to get that first appointment.
3. Helping patients navigate the process of finding a provider.

Tim Blevins, senior vice president of behavioral health at Optum, noted that the integration of medical and behavioral health comes with trade-offs. While including behavioral as part of the medical plan may increase access to care, many patients, particularly those on high-deductible health care plans, may put off seeking help due to the cost.

Continued integration of behavioral and medical benefits should be a top priority, but the unique challenges of behavioral health should not be forgotten. “Not all patients experience behavioral health condition or medical condition are going to need integrated care,” Blevins explained. “The interaction between those two can result in unnecessary cost or compromised quality of life outcome.”

Tools to identify the right level of care for the right individual can help cut down on their costs as well as the employer’s. Also, tools like Employee Assistance Plans can be used as early interventions to engage employees without tapping into the health insurance network.

2. Removing barriers to access

A major hurdle for patient care is a lack of in-network providers, as well as a lack of providers in general. “Even if you have what looks like a robust network, you dig in and those providers may not be accepting new patients,” AT&T’s Matt Phillips told the podcast audience. “Even if they are, there’s a long wait. This is a significant barrier to accessing care. When they finally do take that step forward to seek care, having to wait two to three weeks is just not acceptable.”

Even when they want to get care, finding a provider in network that is seeing new patients can be a monumental task. AT&T is one of many companies turning to new solutions, such as virtual tools, to get employees to the right care in a timely fashion.

One such tool is meQuilibrium, is a virtual resilience platform based in behavioral psychology that can help employers mitigate many of the basic stressors their employees face.

“When we roll out, we’ll see a wide range of adoption, anywhere from 10 percent to more than 80 percent,” Linda Natansohon of meQuilibrium said. “A lot of it comes down to best practices, how it’s integrated into the ecosystem of health and wellbeing. Leaders are important: when they get behind this tool it makes a big difference.”

3. Measuring and improving quality

The final barrier commonly cited by employers is the lack of standardized measures for identifying quality care and providers. When a patient has a negative experience with one provider, it will discourage them from seeking further care. And even if a patient has a good experience, there are few standards to determine how successful those interaction are. And, when 3 to 4 percent of employees with behavioral health conditions account for 30 to 35 percent of total costs, according to Michelle Harika, CCO of Equity Health care, that’s a big problem.

Harika noted several other issues with quality, including the need for evidence-based mental health solutions, lack of transparency for employees when selecting a provider, and inconsistent screening measures.

She outlined four priorities for improving quality of behavioral health services:

• Push to standardized screening measures
• Defining high-performance criteria
• Monitoring the network to remove low-quality providers
• Improving reporting of member satisfaction

Still, increasing the quality of network providers is difficult when the choices are slim. Enter another telehealth opportunity: AbleTo. Addressing medical and behavioral health issues, AbleTo programs last approximately eight weeks and utilize virtual therapy sessions and digital support tools to create measurable outcomes for patients–and their employers. Measuring patient satisfaction and utilizing credentialed providers trained specifically for the program allows the program to measure its impact.