Why Behavioral Healthcare Can Add More Stress – And How to Avoid It 

Data consistently shows that America is in the midst of a major behavioral health crisis. 

A recent report from the CDC found poor mental health remains a “substantial public health problem” in the United States. Unfortunately, systemic flaws make the behavioral healthcare system too challenging to navigate, often creating additional stress for the struggling individuals the system is designed to help. 

Flaws in the system are correctable but present a major barrier to care for many Americans. A recent report from CVS Health shows that while 60% of Americans say they are concerned about their mental health only 1 in 10 (12%) regularly see a mental health professional like a psychiatrist, psychologist, psychotherapist, or well-being therapist. This is just one of a number of statistics that underscores the ways the behavioral healthcare system is failing those who need it most. These issues did not start with the COVID-19 pandemic and have been straining the mental health care of Americans for years. The pandemic helped surface the extent of the problem and increased our collective awareness about mental health and the need for quality treatment. This awareness brought with it increased demand, which is showing no signs of slowing down and making it critical to finally address the many challenges people experience when seeking care.

Friction on the path to care  

As scores of people seek behavioral healthcare treatment, they’re encountering roadblocks that add significant stress to their journey. For example, just look at the typical process a person goes through when they ask their health insurer for a referral to a behavioral health provider. Calling a health plan to get a referral to an in-network provider that is seeing new patients should be a fairly simple task for someone who is already struggling with and doing their best to address mental health challenges. But too often, this is just the beginning of a saga in which the burden falls on the patient/member to navigate a complex and broken system themselves, at a time when the system should be taking burden off their shoulders and caring for them. 

Today, when a member calls their health plan and asks for assistance seeing a behavioral health provider, they’ll usually get a list of 10-20 names of people who “might” be able to help. After that, it’s on them to start making calls. The first challenge they typically face is finding out that most of the providers on the list aren’t actually accepting new patients. In fact, this is a challenge that has become so prevalent that it’s drawing the attention of the U.S. Senate. Earlier this year, Senate staffers investigating the issue called 120 behavioral health providers listed as being in-network with Medicare Advantage plans. They were only successful making appointments 18% of the time, according to a report released in May.

When a person is fortunate enough to connect with a provider who is actively taking patients, the stress continues to build as they try to book a timely appointment. This wait time can be discouraging, leading some patients to give up seeking treatment all together. In addition, delays in getting an appointment can compound challenges even more and have an adverse effect on treatment and outcomes. For example, one study plainly states that “longer waiting time is significantly associated with a deterioration in patient outcomes.” Long waits can be especially challenging for those struggling with behavioral health and substance use disorders. In many cases successfully engaging these individuals can depend on the availability of a provider when they decide they are ready to enter care. If a connection isn’t made during that important window, the opportunity to connect a person with care could be lost for good.  

If a person makes it this far and the day finally comes for their first appointment with their counselor, the stress doesn’t always stop. Sometimes, it could take only minutes into an appointment to realize that the patient/provider relationship will not be a great match, whether it’s for cultural reasons, incorrect specialty or focus area, or something else as simple as incompatible personalities. With the frustrations people face trying to find someone who will see them in the first place, they’re more likely to take an appointment with any provider who will see them. At this point, checking for “the right fit” is not their top priority. And remember, the current system forces the patient – who is obviously not a mental health professional – to arrange care for themselves. We should not expect that they’d be able to ask the right questions when booking an appointment. It’s something we should help them navigate.

This path to care featuring so many obstacles is not beneficial to anyone’s mental health. By creating additional stress for people who are already facing challenging times, and ultimately only having mediocre success actually connecting people with care, the current system is exacerbating the national mental health crisis it was designed to address. 

Collaborating for better results 

If health plans could snap their fingers and increase the availability of in-network behavioral health professionals, it would solve many of the issues straining the system. The unfortunate reality is that demand continues to surge while we’re in the midst of a behavioral healthcare provider shortage, so we have to work to together to seek real solutions. Fortunately, there are concrete, common-sense ways that payers and providers can work together to decrease stress and improve access to care. 

As a simple first step, payers can do a better job managing and keeping information about their provider network updated. This means investing in resources and developing new processes for continuously vetting providers to see if they’re accepting new patients, if they’re seeing patients in-person or virtually, or if their areas of focus have shifted or expanded, for example. In the spirit of collaboration to solve these challenges together, this is an area where providers can meet payers halfway by taking responsibility for more frequently notifying payers when updates to their practice occur. Together, the two sides can ensure people seeking care are referred to the right providers from the start, removing much of the stress from their initial interaction with the system. 

There are also ways payers and providers can work together to remove stress from next step in the process – scheduling. Providers can help streamline the scheduling process by giving payers direct access to their calendars. This gives payers the ability to develop systems that will allow them to schedule members for appointments immediately – even during their first interaction with their health plan. Supercharging this pathway to care is a simple way to end the waiting game that so many patients play when seeking care for the first time. 

Better utilizing the clinical and claims data that both payers and providers already have access to is another way to improve the process of connecting people with the right care. This data provides a lot of information about a person and the challenges they’re facing that can be used to construct hypothesis about the type of mental health support they may need. By putting this data to use when a member calls for assistance, it can help a health plan accelerate the path to care. The health plan can also use this information alongside its (continuously updated) provider network database to ensure they’re connecting a member with the right provider for their clinical needs.  

Once treatment starts, payers and providers can also work together by committing to measurement-based care. Measurement based care involves using data to help patients track progress towards specific goals. Setting and working towards concrete and measurable outcomes and the positive influence of seeing progress as it happens, will only accelerate a patient’s journey. Committing to measurement-based care can also be particularly valuable for payers, since, knowing which providers are effective across diagnoses can better inform the referral process for new members seeking care. 

Better Outcomes For All 

The process for people seeking mental health care in the U.S. has been broken for too long, causing unneeded stress for individuals when they’re often in their most vulnerable moments. As we work to address the country’s mental health crisis amid a troubling prodder shortage, removing stress from the process to prevent additional burden on patients and members is one area where we can work together to make a difference. We have to start now.