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Best Practices to Improve Mental Health Access & Outcomes

July 28, 2022 • By The UCI Paul Merage School of Business

On Thursday, June 16, the Center for Health Care Management and Policy at the UCI Paul Merage School of Business hosted its Spring Speaker Program for 2022. A panel of four experts on health care and mental health: Dr. Robert McCarron of UCI, Dr. Adam Solomon of MemorialCare Medical Foundation, Jena Jensen of Children’s Health of Orange County (CHOC), and Marshall Moncrief of Mind OC/Be Well OC, was moderated by Dr. Romilla Batra of SCAN Health Plan.

The event was focused on mental health and the lack of effective access and care for patients, especially in the context of the COVID pandemic and its subsequent lockdowns. Speakers highlighted issues within the field from their unique perspectives and brought up both ongoing and potential solutions. One theme was clear throughout the event: it is vital, now more than ever, to address mental health within our community.

 

The Issues

Although each speaker brought different perspectives on the issue of mental health care access in the United States, each viewpoint was a puzzle piece that came together to form a fully formed picture by the end of the program.

The statistics from June of 2021 show 40% of adults were struggling with mental illness and 10% were contemplating suicide. Pre-COVID, one to three adolescents in California reported serious psychological distress, and about half of all kids between the ages of 10 and 17 had some type of identifiable mental health disorder. Suicide is the second leading cause of death among adolescents.

The symptoms of this mental health epidemic are manifested through rising rates of drug use, suicide and decline in productivity that cost the world around 390 billion dollars a year. Dr. McCarron, Director of Education at the Susan Samueli Integrative Health Institute and Professor at the UCI School of Medicine, said, “about 60% of those really struggling are just not getting treatment, they’re just not. They’re struggling, they’re suffering, they’re disabled–and this is a huge problem. For those who are getting mental health care delivery, most of it is done by non-behavioral health trained providers, most of it is done in the primary care setting.

Dr. Solomon, Chief Medical Officer of MemorialCare Medical Foundation, gave insights on the current mental health professionals shortages. He explained that years ago, “behavioral health was carved out of the commercial plans for our managed care population” and now patients, who have little to no access to mental health professionals, have to work with undertrained and underfunded PCPs.

Jena Jensen, Vice President, Chief Advocacy and Public Policy Officer at CHOC, added that “mental health is a pediatric disease,” claiming that “if we’re not taking care of children who have these mental health conditions, obviously we’re going to continue to have this intractable crisis in adult mental health care.” She shared a powerful illustration: there are “3 Angel Stadiums” full of kids and teenagers with diagnosable mental health disorders and only 1/3 are receiving the treatment they need. Half of the adults that have mental health conditions had symptoms before the age of 14 and 75% of adults who have mental health symptoms had symptoms before the age of 24. The estimated costs worldwide of not providing treatment is $390 billion per year. CHOC had some alarming statistics from 2020-2021. There was a 27% increase in CHOC ER visits, 71% increase in requests for services, and 108% increase in the number of children hospitalized with eating disorders. Jensen shared that public policy is beginning to take action and “we’ve seen large new investments at the state level, $4.4 billion dollars that they’re looking to invest in pediatric and adolescent mental health.”

Moncrief, Chief Executive Officer of Mind OC/ Be Well OC, commented on the difficulty of tackling the issue of mental health from a multitude of fragmented perspectives and said “because of all that fragmentation, the crises are increasing in Orange County. We’ve engineered a system where law enforcement and EMS are default responders and so we’ve engineered a system where hospitals and jails are the default destination.” In Orange County, 50,000 people are in the hospital for substance abuse or mental health needs at a cost of $100 million dollars to our community yearly. BeWell wants to unify all the segments into one ecosystem to offer support regardless of one’s payor status or clinical condition. The goal is to address the growing needs of the community by coming together as a unified community and create one unified system of care.

 

The Solutions

The main step in fixing the disparities in behavioral health care is to increase access to behavioral health services in the first place. UCI and Dr. McCarron have launched the Train New Trainers (TNT) Primary Care Psychiatry (PCP) Fellowship, which addresses the issue of undertrained primary care providers by providing the necessary training for basic behavioral health care. This program gives primary care physicians training on how to conduct quick and targeted primary care-based psychiatric exams and also focuses on how to treat common psychiatric conditions. Most importantly, though, TNT trains more people to get more qualified physicians out into the community.

Dr. Solomon and MemorialCare added another solution through their Collaborative Care Model (CCM), which embeds behavioral health care specialists within the primary care setting. CCM makes mental health services more accessible to patients. This mode of care has incredibly positive results, with over 90% of patients achieving depression remission within 90 days. Because the CCM is resource intensive, MemorialCare has launched another, more scalable initiative called SilverCloud. The latter is an online program that is suitable for less extreme cases and is more accessible to patients since it does not require in-person care They have also partnered with PATH which is a coordinated network for all mental health services and is contracted with most commercial HMO and PPO payors.

On top of increasing access to behavioral health services in the United States, it is imperative that these services are implemented in the right way for the right people. CHOC’s Mental Health Continuum of Care focuses on mental health education in the community, well spaces on school campuses, embedding mental health practitioners in primary care settings, substance use outreach, psychiatry consultation line and an 18-bed inpatient unit. This model of care gives appropriate treatment to all levels of mental health, from prevention/early intervention to inpatient care so that children and adolescents grow up to be happy and healthy adults.

To tie together all of the above aspects of solutions, Moncrief and Mind OC/Be Well OC hope to consolidate the resources and leadership of all of these organizations along with private and public insurance companies in order to fight the mental health epidemic. They focus on the following 6 areas:

  1. Reducing Stigma
  2. Preventing and Acting Early
  3. Closing Treatment Gaps and Improving Access
  4. Strengthening Crisis Response
  5. Establishing Community Wellness Hubs
  6. Aligning Partners, Policies and Programs

As Moncrief said during the event, “the challenges in mental health are pretty big, but so are the opportunities.” And the opportunities here are a brighter future of mental health in the United States, despite how great the obstacles to overcome.