Spotlight on BHI: An evidenced-based approach to tackling the mental health crisis
Separate physical and mental health systems can lead to fragmented care delivery, poor health outcomes, higher health care costs, and duplication of services.
Over the past couple of years, we’ve witnessed considerable momentum to address the stigma of mental health in the workplace. Employers invested more in digitally-enabled mental health solutions as part of their benefits solutions than ever before. We’ve swung the pendulum on stigma and people are raising their hand for care, but now what? Employers are still grappling with a sea of apps and the best path for integrating care delivery. While yes, society has embraced broader acceptance of digitally-enabled care models, are they really going to “solve” the mental health crisis? Particularly when they work in isolation?
A recent report by The American Medical Association has brought to light a very serious issue of which many employers and benefit designers are already aware: the current paradigm – which silos physical and mental health care – is not working. Companies are using employee assistance programs (EAPs) as a mental health front door, which has proven to be ineffective and simply not good enough to address the severity of these problems. Patients require care that incorporates visibility, collaboration, and integration among providers. The organization asserts that the solution is found in behavioral health integration (BHI), which incorporates both mental and physical health care into delivery of services, in part, through digital enablement.
The AMA research clearly suggests improved mental health outcomes will only be achieved with integrated care delivery. In other words, we cannot — and should not — separate mental and physical care. Treating mental and physical health separately within a single employee population can result in failed access attempts and a lack of cohesion among care providers. Mental health integration into the primary care model has been shown to increase access to mental health treatment for rural residents, reduce the stigma associated with seeking these services, and maximize resources. Alternatively, separate physical and mental health systems can lead to fragmented care delivery, poor health outcomes, higher health care costs, and duplication of services.
Furthermore, mental health conditions do not occur in a vacuum – they are associated with significant morbidity and mortality, and these individuals have a higher likelihood of developing cardiovascular and metabolic diseases. Those experiencing both physical and mental health conditions also incur higher health care costs and experience worse overall health outcomes for which employers’ shoulder the costs if not managed appropriately. The whole patient and how we treat them really does matter.
When desiring help, patients often turn to primary care providers who report that 70% of all visits include a behavioral health component. In fact, nearly two thirds of people experiencing depression and other common mental health conditions are treated exclusively in primary care settings. While these clinicians provide the majority of mental health care for these patients, only about 3% of the encounters are coded for primary diagnoses of depression and anxiety. These providers may not be trained on optimal treatment methods, underscoring the need for collaboration with and among mental health clinicians.
An integrated Primary Health team — in line with BHI strategies — enables partnered care toward holistic health, and the data shows it. Crossover recently evaluated the effectiveness of its integrated approach in responding to the mental health crisis. When comparing the clinical outcomes of more than 3,000 Crossover members to patients in the community, study results showed Crossover to be significantly more effective than the community in improving overall mental health outcomes.
The data from our study reaffirms that an approach to interdisciplinary care works and the urgent call for inclusion of mental health within primary care models rings loudly. Mental wellness is a relational pursuit and cannot merely be managed by isolated transactions or singular care episodes. Instead, personalized care of each member, backed by healing relationships between doctors and patients, has the power to improve overall quality of life.
Related: Two-thirds of employers plan to make mental health a top concern, survey finds
Benefits managers must look toward proposing integrated mental and physical care solutions that are focused on whole patient care. Providing access to a mental health app is no longer enough for employers looking to impact outcomes. Tackling our mental health crisis demands employer investment in and industry-wide recognition of the whole-person treatment approach – one that is only achievable through BHI. This will not only benefit employees but employers alike as they begin to move beyond basic access toward facilitating positive change.
Michael Boroff, Psy.D., is a clinical psychologist and the Mental Health Program Manager for Crossover Health.