Mental Health Care: Challenges Faced and A Path Forward

July 16, 2019

By Billy Deitch, Oak HC/FT

Getting help shouldn’t be this difficult

Let’s start with the good news: everyone in healthcare wants to do more to improve mental health.

The challenge? The term “mental health” is so broad, it can be hard to know what we’re really talking about at any given time. Mental health (and its first cousin, “behavioral health”) captures everything from wellness and meditation apps to the treatment of the most severe psychiatric issues. And it often seems that these ends of the spectrum get the most amount of attention.

At Oak HC/FT, we have partnered with companies solving some of the most daunting challenges in behavioral health. This includes US HealthVest’s network of inpatient psychiatric hospitals, axialHealthcare’s efforts to fight opioid abuse, and Quartet Health’s platform connecting primary care physicians with a network of mental health providers. These enterprises are attacking the messiest and most costly areas of mental healthcare, and we are proud to support them.

Meanwhile, we see hundreds of millions of venture dollars flooding into companies that allow consumers to take a “self-serve” approach to improving their mental wellness (think Headspace, Calm, etc.). It is encouraging to see the broad interest in the category, but the long-term efficacy and sustainability of these apps has yet to be proven.

I believe that there is a “middle ground” within the massive umbrella of mental healthcare that remains radically under-addressed. These are people who don’t need a pharmacological intervention, but who would benefit from treatment beyond the capabilities of a smartphone app. This isn’t a small group: it consists of millions of Americans who should be working with a therapist to address mental health challenges, but for a slew of reasons fail to do so.

So how did we end up with this underserved population? I’d point to three primary trends:

1) Stigmas around mental health still exist

Too many people believe that if you go to therapy, it’s a sign of weakness and something to be embarrassed about. This dynamic is sad, frustrating, and not going away quickly enough. It’s even scary for me to admit in this post that I’ve seen a therapist on and off for several years (but I suppose the only way to alleviate stigmas is to address them head on!). As mental healthcare takes on a more prominent role in the national discourse, these perspectives are beginning to soften, but it’s clear there is a lot more work to do.

Part of the issue is the misconception that mental health services are used solely as a treatment for an illness. You get sick — be it acute anxiety, depression, bipolar disorder, anorexia, extreme phobias, etc. — and then you go see a doctor who provides treatment, often in the form of pharmaceuticals.

This approach is too limited. My hope instead is that mental health is viewed the same way we think about physical health: it’s not just about treating a disease, it’s about maintaining fitness. Akin to working out and following a wholesome diet, ensuring mental fitness also requires commitment, can be challenging, and consumes financial resources. But importantly, it leads to better overall health. And, hopefully, one day a visit to a therapist can be viewed no differently than a trip to the gym.

2) There is no easy way to find the right therapist

Sadly, even when stigmas are overcome, there are roadblocks that make access to behavioral resources difficult.

The team at Oak HC/FT has partnered with companies helping to expand access across the healthcare continuum for decades. And there are few areas within healthcare where this access gap is starker than in behavioral health. People who want to find therapists often don’t know where to begin, what type of therapy they are looking for, or what modalities even exist. Helpful resources to find the right therapist are scarce.

I live in San Francisco, a city whose well known progressive attitude is praised, often teased, and occasionally maligned (depending on your perspective!). One could imagine that finding a therapist here would be as easy as spotting a venture capitalist in a Patagonia vest or grabbing a kale smoothie. However, that’s far from the case: even in the Bay Area, finding a therapist is no easy task.

My wife happens to be a San Francisco-based clinical psychologist in private practice. I’ve gotten more text messages than I can count with a note along the lines of, “Hey Billy, I’m looking for a therapist and don’t know where to look. Can Jess recommend anyone?” I think we can all agree that you shouldn’t have to have a friend who is in the mental health field to find the right therapist!

And if that’s a common route taken in the Bay Area, one can only imagine that it’s even more challenging in other markets. If you want to see nearly any other medical professional, you simply ask your primary care doctor and he or she can make a referral. But when it comes to finding a therapist, the resources are nearly non-existent.

3) Insurers undervalue behavioral health services, making care cost prohibitive

One place where people attempt to find a therapist is their insurance provider — this would seem logical enough!

But these prospective patients quickly learn that in-network availability can be scant. Therapists are far less likely than other medical professionals to accept insurance. The reason for this? Payers fail to adequately incentivize practitioners to go in-network. This pushes patients in need to either wait for weeks or months to see a provider or look out-of-network (which, as discussed, is challenging). Sometimes out-of-network services are at least partially covered by private insurance, but sadly in many cases, care then becomes cost prohibitive and serious issues remain untreated.

So What Can We Do About It?

I recognize this is a somewhat depressing picture — but there are solutions to these problems!

Let’s imagine a world where it is easier to find a therapist — and more precisely, the right therapist. Those people who are willing to overcome the social stigma (and who can afford care) begin seeing the benefits of improving their mental wellbeing and tell their friends.

Maybe one or two friends take them up on a recommendation. Now these stigmas start to break down! Next thing you know, even more people dip their toe in the water and a flywheel effect begins.

With more volume, data becomes available. This can demonstrate to payers the benefit to the total cost of care by providing mental healthcare services. Now armed with proof points, insurance providers can enhance their efforts to ensure their covered lives have access to great behavioral health practitioners.

Perhaps payers raise rates and more therapists go in-network, which further fuels access, which lowers stigmas, which increases engagement, which provides more proof points, thereby increasing access even more! All of this meanwhile lowering our overall healthcare spend through preventative mental healthcare.

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This is undoubtedly an idealistic vision — but one that I think many in the industry aspire towards. And while the full benefits of this dynamic will likely take years to develop, we can already sense the mental health paradigm shifting. I truly believe that as mental health services and technology reach the masses, health outcomes will improve and overall costs will come down.

But it all starts with access and I’m encouraged by the numbers of entrepreneurs looking to address this challenge. We are eager to hear their stories and help them make an impact.