The fact that thousands of mental health providers at Kaiser Permanente, the nation’s largest nonprofit HMO, are currently on strike in Northern California—at a time when the nation’s demand for mental health services has reached some of its highest levels high – is indicative of a much bigger problem. than the operations of any mental health service provider in any health care system.

America needs to rethink how we address mental health needs.

Two of the main reasons organizers cited for the Kaiser strike are the ever-increasing workload and excessively long wait times for patients to access care. While the pandemic certainly exacerbated these issues, none are new. According to a projection tool from the American Psychological Association, which looks at both the supply and expected nationwide demand for licensed psychologists through 2030, we are currently unable and will continue to be unable to meet the demand for the foreseeable future. The same is true for social workers, psychiatrists, psychiatric nurses, and licensed mental health counselors. The nation’s need for these mental health professionals continues to outstrip our supply—leading to an overstretched mental health workforce and contributing to long waits.

But underlying these issues is an even more fundamental problem.

In the US, the dominant model for how health maintenance organizations like Kaiser and other large health organizations provide mental health services is through patient-to-provider, face-to-face, face-to-face treatment with a trained mental health provider. who has a master’s or doctoral degree. In other words, it’s a resource-intensive model in an area that we already know has extremely limited resources.

But the reality is that not every person needs this type of intensive treatment to meet their mental health needs.

For example, consider a person who is experiencing mild depression. Perhaps they have lost interest in activities they once enjoyed, have trouble concentrating at work, feel more irritable or angry than usual, and are experiencing some unwanted changes in appetite or weight. Let’s also say that this person has a supportive network of family and friends, stable housing, and a good job. This person likely doesn’t necessarily need an hour a week of long-term personal therapy with a doctoral-level psychologist. Instead, they may find tremendous benefits by seeing a behavioral specialist in their primary care setting or participating in short-course (five to 12) individual therapy sessions. Or they can use group interventions, the Internet, app-based or even evidence-based books – known as bibliotherapy. Additionally, they may find support through trained lay professionals or peers.

By continuing to treat patients with common mild to moderate mental health disorders using a resource-intensive approach, and all regardless of the level of care they need, the mental health care system is depleting its own resources. that we the need to treat patients – mental health professionals.

Clearly, we need to become smarter and more efficient in using the tools and resources we have so we can increase and expand access to care.

One way to do this is by shifting our mental health care system to a tiered care model – which is a system of delivering mental health treatment so that the most effective treatment is provided first, but with less resource intensive. The treatment only then “increases” to a more intense level as needed.

Continuing the previous example, if the person with mild depression experiences an increase in intensity, frequency, or associated distress, or if the person begins to have thoughts of wanting to harm themselves or others, their treatment may be shifted from an intervention with lower intensity. such as group therapy, for example, in ongoing one-on-one therapy with a doctoral-level psychologist.

While not widely implemented in the US, stepped care is now the recommended way to treat common mental health problems in the UK, and studies have shown promising clinical benefits and cost-effectiveness. For example, a 2019 economic analysis of stepped care in the Australian healthcare setting found that it was a cost-effective way to approach the treatment of adults with mild to moderate anxiety disorders. Additionally, a 2016 meta-analysis of studies on stepped care found that the model was significantly better at reducing anxiety symptoms than standard care. The same review also found that stepped care allowed patients to receive treatment for their anxiety disorders at a higher rate, concluding that stepped care “has the potential to reduce the burden on existing resources in mental health and increase the reach and availability of the service”.

This is exactly what America needs.

To be sure, some people seeking mental health treatment will need access to more intensive and specialized resources. In a stepped care model, those individuals will have access to the resources they need because patients who do not require those high levels of care will have their needs met through other channels, giving more trained resources more plenty of bandwidth to address patients who critically need their attention. This will ultimately improve and expand desperately needed access to mental health services.

The current mental health care system in our country is not working. To meet the growing demand for mental health services without depleting our limited and currently taxed mental health workforce, we must fundamentally rethink and redesign the system. Our nation’s mental health depends on it.

Joan Cook is a clinical psychologist and professor at the Yale School of Medicine.

By admin

Leave a Reply

Your email address will not be published. Required fields are marked *