The Behavioral Health Last Mile: How Can Providers Complete the Journey?
Author(s): Michael Tang, M.D., Head of Behavioral Health, Cityblock Health; Kameron Matthews, M.D., Chief Health Officer, Cityblock Health
Mental Health Awareness Month 2022 comes at an opportune time in the country’s health history. The prolonged COVID-19 pandemic, racial injustice, and acts of violence continue to drive feelings of anxiety and depression to record highs, across all generations, with the numbers among young people surging. The rate of suicide in the general population is the highest since World War II.
Behavioral health is the most prevalent patient condition inadequately served by our established medical system — and the impact on the individual goes beyond their psychology. Even among patients with behavioral health or substance use disorders, approximately 80 percent of health plans’ spending is for medical services, despite as much as 70 percent of health outcomes potentially driven by non-medical behavioral and social determinants of health. Beginning in childhood, the effects of structural racism on people of color can be a profound medical contributor. Trauma can cause changes in the brain leading to increases in psychological disorders, substance use, and medical conditions such as diabetes and heart disease which in turn can cause lower employment rates, and decreased future income.
Some of the soaring behavioral health needs have been addressed by the expansion of virtual care; however, that can still be limited by barriers to access such as broadband, privacy or cost, or even siloed cultural approaches to intervention, which fails to differentiate care among patient populations with vastly different needs.
As a country, how did we find ourselves in this state, failing to sufficiently address the behavioral health needs of so much of the population? The answer is we never have had an effective public health approach to begin with. Behavioral health in its western mode has deep roots in 19th century Europe, where it mostly served elites. Asylums in the United States particularly mistreated underserved populations, including people of color. The people who need care now are left out because they were never part of a quality care system.
Our concern for behavioral health is as much for the patients we don’t see as those we do. What’s necessary to remedy the inequities of care is a completely new model. How does that work? It starts with radically human transformation.
The vital change necessary to remedy the lack-of-adequate care affecting millions of Americans is the systemic integration of medical, behavioral, and social intervention, an investment in whole-patient care that will create more positive patient outcomes. Systemic integration, not just in a single clinic, requires collaboration, interdisciplinary teams, and a financial model that supports both. As clinicians, we need to have the resources to connect with the patient outside of an office or clinic — to mobilize care and have the patient and population data to plan for supporting that need. The prevailing system isn’t equipped to meet the patient where they are geographically, situationally, and medically. Providing the resources for ease and privacy of treatment as well as smooth transitions between hospital and home is essential for decreasing the rate of readmission and breaking the cycle of illness. We are proud that Cityblock’s mobile health teams have the capacity for individual outreach for all types of care. That mobilization isn’t a tangential “nice thing to offer” for care. It is a critical component of our relationship with each member — meeting our patients where they are. In addition, having the member be comfortable with that professional meeting them in their home — experientially, culturally, geographically — can be a pivotal factor between engagement and rejection. In particular, our Community Health Partners are key to gaining the trust of the patient, translating this new model for care into action.
At Cityblock, we know the behavioral health needs of our population are present not only during Mental Health Awareness month, but have deep roots in the centuries of systematic inequality facing our members. This is why we came to Cityblock. We believe in the potential of a fully-integrated model to begin to make the connection among medical, behavioral, and social needs for this population who is marginalized and not served best by traditional healthcare. We believe in this new approach, delivering better care where it is needed the most.
