There is no replacement for experience, and no perspective more insightful that of those who have been there – especially when the “there” refers to mental healthcare delivery and treatment.
As a social worker, Theresa Nguyen, LCSW, Senior Director of Policy and Programming at Mental Health America, has over a decade of experience as a clinician, educator, and mental health patient advocate. Working with children and adults suffering from serious mental illnesses, including those with both behavioral and physical comorbidities, Theresa has been focused on early intervention and pushing forward improvement in mental healthcare treatment and access across the nation.
What are some of the barriers to mental healthcare improvement, and how can technology address the many challenges that patient and providers—both general medical and behavioral—currently face in terms of care delivery?
Theresa shares her perspective with the Quartet team below.
Q. What do you feel are the biggest barriers to patients seeking and receiving treatment for their mental health conditions?
A. One of the biggest factors is that it’s really confusing for people. A lot of times, patients don’t get screened, so they struggle with their emotional problems for a while before realizing that what they are experiencing is actually linked to a mental health issue. And they can often end up struggling for a long time.
Another barrier happens when patients tell their primary care physicians (PCPs) of an issue or symptom they’ve been experiencing, but those doctors aren’t in tune to how those issues might actually indicate mental health concerns. For those PCPs who are in tune, they might not feel comfortable with or know the correct protocol for treating people with more severe mental health issues. A lot of time, PCPs are not connected with a behavioral health specialist that can support them in this process.
Families, too, are often consumed with their loved ones’ issues but don’t know how to get help for their family member and for themselves. When they get to someone who can help, it’s really confusing how to talk to a behavioral health specialist or how to navigate the mental health system.
Also playing a part are workforce shortages. Sometimes the waitlists to see a behavioral health specialist can be months long. If a PCP has a personal relationship with a psychiatrist that can help immensely with providing a warm handoff, but all too often that’s not the case.
What it comes down to is that our systems are still siloed, and yet we’ve been talking about trying to fix this problem for the last decade. There is urgency behind the problem that Quartet is trying to solve.
Q. How can technology help patients get access to the behavioral healthcare they need?
A. The internet has been pretty awesome. Before the internet, where would patients start to get help? Now we have things like MHA Screening, where people can get free, confidential, and anonymous online screening for mental health problems. You have tools, like SAMHSA’s treatment locator, where you can enter your zip code in and find help in your area. And there are websites allowing people to search for providers, look at reviews, and find someone that they feel is a good fit. It’s a lot like finding a friend, or even dating! It’s more person-centered, gives patient more access and control, and gives them a good sense of a provider’s personality and specialties.
Also, mobile solutions, mental health apps and telehealth processes have all been a huge help. Some providers offer 24-hour care where you can call a provider and they call you back either for a phone or video chat.
Technologists have been striving to share patient records electronically and link providers up with one another. From a policy standpoint, we have wanted to streamline the sharing of both behavioral health and physical health records with one another for a while. This will only help ensure people can get the care that they need.
Q. For many reasons, behavioral health specialists and general medical practitioners are not coordinated in their treatment of mental health patients. What are some of the key reasons for this disconnect and how can we fix this?
A. Historically, part of the reason for this lack of coordination in public mental health is that the funding streams were completely siloed. There are also policy problems, like no same-day billing, that create significant barriers. This means that if you came in and saw your PCP, and the PCP then referred you to a behavioral health specialist right away, you might not be able to see them immediately because of the inability to do same-day billing. We are still working on fixing these policy issues.
Another issue is in relation to prior authorization and referrals from PCPs to behavioral health specialists. It’s like a toss of the coin whether or not PCPs and behavioral health providers communicate with one another after a patient has been referred. Essentially, getting good, coordinate care is really difficult, unless you are embedding collaboration into the framework, which is generally not what happens.
And as a practitioner, I’ve been in jobs where sometimes I had a caseload of 100 people. How does a provider seeing so many people even begin to approach coordinating care well? I think that’s a role that technology can play. If you can streamline tech, and all providers can see the records, you have the ability to follow patients through their care delivery, and that’s a great help!
Q. The prevalence of patients suffering from both a behavioral and physical health condition is a growing problem. For example, 48 percent of patients who have depression also suffer from a chronic, comorbid medical condition. What steps do you feel the industry – whether providers, payers, solutions providers or policymakers – must take to better care for patients with comorbid behavioral and physical health conditions?
A. At the very least, providers need to ask patients the right questions. If I’m a behavioral health specialist, I should ask, “How is your physical health and do you think it affects your mental health?” and vice versa. General medical practitioners should ask, “Do you think your emotional wellbeing is playing a role in your physical health?” This way, patients and providers can begin a very necessary dialog. If, as providers, we don’t ask, potential conditions don’t get discussed or brought up as a treatable issue.
We can also streamline the sharing of information, remove barriers in billing, and remove the brick and mortar only structure. We can embrace the collaborative care model, which is built on integration. Any one of these steps is better than doing nothing.
When we take these actions we can ensure that we’re treating people early, before Stage 4, when things get much more difficult to treat. Every person in the system–whether you’re a payer, provider or policymaker–can identify a solution. There’s no one fix that can improve it all, but we can each do our small part to remove barriers and take action to improve it for the better.
Theresa Nguyen, LCSW is the Director of Policy and Programming at Mental Health America. Along with supporting MHA’s federal and state policy agenda, Theresa manages various programs including MHA Screening, Mental Health in the Nation, and Workplace Wellness. She was an adjunct professor in California and North Carolina teaching Mental Health Recovery, Psychosocial Rehabilitation and Social Welfare Policy. As an advocate her efforts focused on growing a consumer based mental health workforce, ensuring access to treatment, improving community-based and recovery-oriented mental health programs, and treatment for underserved communities.