Building the bridge to better mental health care

By:

Jul 30, 2020

While COVID-19 is well known for its physical impact, the rippling effect of the pandemic is taking an equally large toll on mental health. A survey conducted by the Kaiser Family Foundation found that 35.6% of adults reported symptoms of depression and anxiety, compared to 11% last year. Elongated periods of isolation, loneliness, and fear of job loss, among other stressors, have created a perfect storm for poor mental health. In addition, research from the University of Cincinnati College of Medicine suggests the disease itself may cause depression-like symptoms by using the nose and central nervous system to reach the brain. 

Beyond the significant emotional toll of mental illness, studies show that mental health plays a large role in physical health, and vice versa. Unfortunately, the systems for treating mental and physical health in the US continue to operate largely independent from one another. Both have their own unique challenges, but they share a glaring need for tighter integration to achieve better outcomes for patients. 

The link between mental and physical health

Right now, mental and physical healthcare are treated in separate, modular units. Modular systems typically work best when the components fit together in crisp, understood ways 100% of the time. But this is not the case with the link between mental and physical health. Though they are intrinsically connected, how they interact with each other is unique to each patient. Their relationship lacks the predictability that modularity requires. 

A prime example is the relationship between chronic illness and depression. According to the Cleveland Clinic, one third of people with a chronic illness subsequently develop depression. This relationship has several potential causes, including chronic illness’s impact on brain chemistry, side effects from medication, illness-related stress and anxiety, pain, and fatigue. 

But the relationship isn’t one sided; depression itself is a chronic illness with its own physical impacts such as pain, fatigue, a weakened immune system, and an increased risk of heart attack. Many physical symptoms of depression are symptoms of several chronic illnesses, making it difficult to detect their true cause. Adding to this complexity is the fact that not everyone suffers from a chronic illness the same way, nor does everyone suffer from depression the same way.  

The why and how of integration

Because the interplay between mental and physical health is too unpredictable to effectively address them separately, it’s better for a single system to integrate and control both components. Integrating mental and physical health into one comprehensive service not only improves care quality, but allows providers to consistently address the unique ways mental and physical health impact each patient.  

To that end, several models for integrating care already exist. Providers looking to integrate mental and physical health can look to these pre-established models for inspiration as they seek to find the model that works best for their practice:  

  • Hub (and Spoke) Model: an approach that enables primary care providers to easily connect with a number of health and social services that will benefit the patient, including psychiatric specialists. The model includes one central “hub” offering comprehensive services, supplemented by a number of “spokes” providing additional resources. Mental healthcare can either be a part of the central hub, or one of the spokes.
  • Collaborative care: an approach where a behavioral healthcare manager joins a patient’s primary care team. This manager works with the patient’s existing primary care providers to coordinate physical and mental health plans, and care plans are reviewed with a mental health specialist. 
  • Patient-centered medical homes: a team-based approach centering around the patient’s unique needs. Providers work in teams, coordinating every aspect of physical and mental care that a patient needs—from chronic disease management to acute and preventative care—as well as providing family support and social service recommendations. This model takes a whole-person approach to patient health, and is the most integrated of the three. 

Intermountain Healthcare is already seeing positive results from its proprietary, integrated approach to treating patients’ physical and mental health conditions. The hospital system has found that treatment provided through care teams has not only improved health outcomes, but also lowered care costs for Intermountain and patients alike.

As COVID-19 continues to plague our everyday lives, it’s essential that providers acknowledge the toll that the pandemic is having on mental health. A healthcare system that not only understands, but addresses, the interdependencies between mental and physical health is one that is better equipped to tackle the whole health of all patients.

Jessica is a research associate at the Clayton Christensen Institute for Disruptive Innovation, where she focuses on business model innovation in healthcare, including new approaches to population health management and person-centered care delivery.