Screening for mental health is a step in the right direction, but not the final destination


Jan 26, 2023

Over the last few years, acknowledgment of mental health disorders and their treatment rightly got a place in the limelight. Rates of anxiety and depression increased drastically in 2020 alone. Luckily, patients are not the only ones discussing the need for mental health treatment: health care experts, politicians, and more are bringing mental health issues to the forefront of health care conversations. 

This increase in mental health awareness is being addressed in medical care, particularly as experts stress the connection between mental and physical health and well-being. Many health care providers are, in fact, addressing mental health needs within their practice by integrating mental health screenings into visits. 

But is screening alone really enough to properly address mental health in physical care spaces? Theory tells us no: there’s too much variability in how physical and mental health interact with each other, and no guarantee that a patient will seek the care they need. What theory does tell us, and what many health care providers understand yet are not empowered to execute in practice, is that to effectively address mental health care alongside physical health, mental health treatment needs to be fully integrated into physical health care. 

Interdependence and Modularity

The Theory of Interdependence and Modularity tells us that when the relationship between two components is unpredictable, they need to be integrated together. Until the relationship between one component and another is predictable, they cannot become untethered from each other. 

In this case, physical and mental health are two components of a person’s total health. Despite knowing that mental and physical health impact each other, they do not impact each other in a standardized, predictable way 100% of the time, and people do not seek mental health care at the same rate. Without a standardized relationship, mental and physical health need to be far more closely connected than they are in the vast majority of care circumstances today.

We’ll explore this further through the example of a pressing mental health concern: postpartum depression (PPD). 

Postpartum depression and the need for greater integration into women’s health care 

PPD is the most underdiagnosed obstetric complication in the United States, which may be due, at least in part, to the lack of regulations mandating screening for the condition. Only eight states currently require PPD screening; another eight states don’t even reimburse for PPD screening at all, despite the existence of national screening recommendations. Only about 50% of PPD cases are diagnosed by a medical professional. Of those individuals diagnosed with PPD, less than 25% actually receive treatment. Suffice it to say, PPD is not adequately addressed for most postpartum mothers.   

If left untreated, PPD can cause numerous health concerns, for moms and their children. However, models integrating PPD screening and treatment into the regular course of postpartum care can address not just the mental symptoms of PPD, but associated physical concerns that arise as a result of the condition. Integration allows providers to see exactly how their patients’ physical health is impacting their mental health, and vice versa, and devise ways to help improve the two. More importantly, especially with how undertreated PPD is, integrating treatment directly into obstetrics care enables providers to ensure their patients have access to the mental health care they need. 

One provider tackling the integration of postpartum depression treatment into its care model is Pomelo Care. Pomelo Care is an on-demand virtual clinic providing personalized maternity and postpartum care. Patients don’t need to go elsewhere for their postpartum mental health needs; instead, Pomelo hires licensed clinical social workers with certification in perinatal mental health as members of their care team. Their providers don’t just screen for mental health needs postpartum, but integrate postpartum mental health care directly into their service offering, ensuring patients can easily receive the care they need, at no extra cost to the patient. 

It’s promising to see the rate of mental health screenings increasing, as it shows a commitment to acknowledging mental health on the same level as physical health. But screening alone is not enough. For providers to effectively impact mental health within their practices, especially for conditions like PPD that are overwhelmingly undiagnosed and untreated, integrating treatment into care will provide a greater health impact. Provider organizations like Pomelo Care—that hire social workers to provide perinatal mental health counseling as a part of the care model—provide a strong example for other providers to emulate as they seek to improve the total health of their patients.

Pomelo is a new provider, so they were able to design an integrated care model from the get-go. But how can existing organizations change their business models to address the interdependent nature of our health, even amidst a system designed for modularly? Health leaders can gain insights from our most recent report, Improve or Transform: Choosing the right business model to deliver health as they go about their journey to integrate physical and mental health into their care models.

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