(This is an unedited transcript. For accurate quotes and presentations, please refer to the full-event video.)
Good afternoon, everybody. I’m Sarah Dash, President, and CEO of the Alliance for Health Policy. And I want to welcome you to the 19th event in our coven 19 Webinar Series.
For those who are not familiar with the Alliance, welcome. We are a non partisan resource for the policy community dedicated to advancing knowledge and understanding of health policy issues. We launched a series to provide insight into the status of the … 19 response and shed light on remaining gaps in the system, that must be addressed to limit the severity in the United States.
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The covert 19 pandemic has had significant implications for mental health and well-being.
Evidence suggests that social isolation, disruptions to physical and behavioral health care and the economic circumstances will have long term implications for mental health.
Today, I am pleased to be joined by a group of distinguished panelists who will explore how the pandemic has impacted mental health and introduce us to promising evidenced based interventions and solutions to help improve outcomes during the pandemic, and long after First, we’re joined by doctor Ken Duckworth, Chief Medical Officer of the National Alliance on Mental Illness, and Associate Director for Behavioral Health at Blue Cross Blue Shield, Massachusetts.
Next, we have doctor … Elise Anderson, Assistant Professor of Behavioral Health and Education at the University of Michigan School of Public Health.
Next we’ll hear from …, founder, and chief executive officer of Cognitive, Behavioral, health, consulting firm.
And finally we’re joined by doctor Benjamin Millar. Chief Strategy Officer of well-being Trust.
Thank you all so much for joining us today. Now, pleased to turn it over to doctor Duckworth for his opening remarks can go ahead.
Thank you for having me.
Couple of thoughts.
Mental health has had a substantial increase in activity for the National Alliance on Mental Illness helpline.
And I run a series of Ask the Expert webinars. And our attendance has gone from about 250 to about 2000.
As it relates to the pandemic and the mental health effects on part-time for NAMI, which is my dream job and the largest group for people with serious mental illness and those who love them. I also have a pragmatic job in Boston, where I’m the doc in Mental Health for Blue Cross Blue Shield of Massachusetts.
And the story from that is the American mental health system made the fastest pivot in its history a field that resists innovation. I say this as a child and adolescent psychiatrist, a field that is slow to move, pivoted to Telehealth.
Within two days of the shut down and locked down and said it happened across America and what I’ve seen in my blue cross job is that fully 50% of all telehealth visits are happening in the mental health space.
So as demand has increased and the restrictions on telehealth have been eliminated and I can get into those weeds later, mental Health practitioners are providing services. They also notice that the patients show up on time there are no show rate, is virtually zero. And everyone is surprised that this appears to be a highly effective way of delivering care, which had been demonstrated in the literature. But now people have actually been thrown into the deep end of the pool and find they can swim just fine. I anticipate that many of the mental health services going forward will be delivered through Telehealth, and I think this has been a game changing moment and mental health.
I would also say that on the NAMI help line, which are staffed typically by peers, living, well, with mental health, our utilization is up substantially. So the good news is, people are reaching out for help, whether it’s through an advocacy organization or for the use of their traditional health plan, and in both my roles, I’m seeing this fairly actively.
I’ll stop there, and thank you.
Great. Thank you so much. We’re pleased now to hear from … Andresen ahead.
Doctor Andrew, you might be muted now.
While we’re waiting for her slides to come up.
All right, Well, thank you so much for the introduction. It’s a pleasure to be on the panel. And I just want to, of course, start us with a Happy Juneteenth greeting. This is a wonderful day for folks who are doing any work of introspection, or of thinking about how they can improve the community, specifically with what we’ll be talking about today. So really pleased to be on the call for this day. So we’re gonna get into mental health and community responses, with respect to how cov at 19 has been shaped by cultural differences.
So let’s start with some facts. So, if you are in any public health realm, you know the social determinants of health and you know them well, You know that there are various interlocking systems that work together, that really speak to how well the folks in a given community are.
But one thing that’s really interesting, if you think about what rescan has offered to the social determinants of health model is to understand again that those systems around any community or organization still exists. But crucially and critically in the middle are all operating under the guise of racism and some of the practices of discrimination that then play into each of these health factors. So, social determinants of health, in essence, are all umbrella under this idea of racism and how racism plays out in these systems to impact our health.
Some of the ways that I want to demonstrate that, through some figures: I live in Detroit and I’m a University of Michigan faculty member. And so, something that I noticed very early on were some of the differences that were happening between me and my colleagues. So not everyone lives in Detroit, and that I don’t understand. But, if you take a look at what the University of Michigan Institute for Social Research found, which was that black, each Reuters, essentially, are about half as likely to know, or, excuse me, one out of two or half of black Detroiters are likely to know someone who has passed by Cove it.
Whereas about one in ten to 15 of their white colleagues are likely to know someone who can code it. So, we’re not just talking about experiencing it yourself, which I in fact had Mount … at the beginning of March. So, it’s not just about the experience but, it’s about knowing someone and knowing someone who died, so we’re talking a four fold likelihood for Black Detroiters to know someone who died relative to their white peers.
So, when you think about what that means for the mental health of folks like Black, Detroiters in which we had a lion’s share of not only the cities but the States covitz cases. We’re gonna look at this Washington Post Guide for Mental Health to see how mental health shifted in the past few weeks. So, again, this is a national representation, but I think about it from a very granular level thinking about how Detroiters would be impacted by this. So, if you take a look at the top two lines of gray, and green with Latino and black, you see that there are higher levels of depression and anxiety throughout code it.
So, in April, to May, you’re seeing higher levels for Latino and Black relative to their White and Asian counterparts, but as you move down the line to May 21st or July 26, more video of George Floyd’s killing began to spread on the last day. Of that section, you see that spike, you see that there is an increase, particularly for black people, with respect to their anxiety and depression. So, you can see this happening in two ways: the racism that’s already embedded within our systems, having disparities at the beginning of this graph, in which covert is rampant. But then you see after another particular racist practice within another system, that number increasing. And so, I would be remiss if I were on this panel and did not address how other racist practices have impacted our mental health and well-being during Kobe.
And the reason that we’re finding that the foundation is that as doctor Edelin Hammons indicated, there has never been any period in American history where the health of blacks was equal to that of whites disparity is built into the system. So, even though I am an interventionist, and I’m someone on this panel today, who’s going to be talking about intervention. What I really want to stress with, respect to the fixed, is that the first thing we have to do is change the system. So, we are living in a world in which racism is highly embedded, within every system that impacts the health and well-being of Black folk. So, just to intervene on, 1 or 2 of those factors, are, 1 or 2 of the systems, is not going to bring a complete, systemic change. So, we need to really think about how do we change the system of practice, and of mental health writ large.
And some of the ways that we can go about doing that is by utilizing community strengths and partnering with the community. So, I know I’ve shown a lot of graphics to you thus far, and a lot of circles at that.
But to the left, you’ll see a very common partnership or community based or participation research model in which we’re understanding how CBPR partnerships impact the well-being of folks.
I’m going to talk very briefly about my work with community partners in Detroit. So the embrace program or engaging, managing, and bonding through race is a program that was developed during my postdoc, but that I’m bringing to Detroit, in which we’re talking about race, specifically. So racism, as the driver of these determinants of health is something that we’re actually hitting on the head. Were not skirting it and thinking about, Well, what are the risk factors that come out of that? We’re saying, if racism is the issue, let’s create space and time to talk about race. So we’re engaging in the talk in a way in which black families are able to unpack the anxiety, the depression, the stress, the things that have come out of what we’ve indicated with this double pandemic in the past few weeks.
So, we’re partnering with the Children’s Center here in Detroit and also Black Family Development Incorporated. These are people who are already focused on the population that we want to work with. So we’re not recreating wheels, we’re creating partnerships between groups in order to address the coping strategies, and the stressors that are specific to this group.
So what community based participatory Research allows us to do, is to think about, not only the groups that are doing this work, but the issues that are important to them. So out of years of work, figuring out what are some of the issues that are most pressing for black populations, discrimination, and racism, are, among the top. So I’m happy to give more information about embrace at the end of today’s session, if you have questions. But the long story short, is our work in intervening on the main issue of racism and negative mental health outcomes, is that we’re disrupting this systemic problem and improving the mental health and well-being of black children and their families. So that’s, again, a complementary approach.
So in closing, the future, of what we would like to do is to restructure mental health provision, including unlimited sessions and free telehealth offerings, as doctor Duckworth just said. So that’s fantastic, that we’re providing those things. We also need to be mindful of communication, language, and purpose of programming. So we know that if black folks have greater stigma around mental health and well-being and this is a time where they need it puts particularly the most because of this double pandemic we might want to target and use appropriate language that fits within their understanding and their well-being. So, we don’t want to to push therapy. It’s something that everyone would want, because that’s not the case for some of our communities.
But, again, with respect to embrace, we want to consider how unique stressors and solutions that impact black and indigenous folk of color, might require specific interventions and act accordingly.
So, thank you so much for your time today.
Thank you so much Briana.
And, and while we’re returning to …, I wonder if you could just comment, as you mentioned, you’ll work with children and families, could you comment just a little bit on, on just the inter-generational aspect of mental health and trauma, and particularly, know, how does that affect communities of color? Or does that affect communities of color differently than, than, than others? But if you could comment on that.
Sure. So there’s some research around how trauma impacts the, even the cellular kind of development of youth and how there’s almost a stamp, if you will, of how trauma gets passed down from generation to generation. But the other way that it gets passed down is just through narrative, or through learning how to address trauma and stress. So again, in my work with that talk, we’re thinking about what are the strategies that folks have passed down to you, and some of them might be effective, but others might be strategies that end up amplifying the anxiety and depression of children. And so we work through, how do we find things that worked not only well for you as the parent, but is the best thing for their child as well.
Great. Thank you for that clarification, and so now I’m pleased to turn to fill in a pivot element that ahead.
Hi, everyone, My name is …, I’m the founder and CEO of …, a behavioral health tech consulting firm. I’ve pretty much been involved with behavioral health tech as long as I can remember, but really, these last couple months, last couple of years, but really, last couple of months has been just tremendous for our space. As many of you might know, telehealth has been surging like, just really wild numbers, like 500 to 1000%. And I think this is really exciting in terms of expanding access, but there are some barriers with this, too. So, I want to talk a little bit about that and some ideas for what we can do about it.
So, just even in the last couple of days, I hosted an event called Going Digital Behavioral Health Tech. It was all about virtual therapy and bringing together stakeholders about how to advance emerging technologies in the space. And it was super exciting to see all of these novel digital behavioral health startups presenting like everything from virtual … to to new tech digital enable peer support startups, telehealth specifically for underserved populations, tools tailored to providers. I can just give you a couple examples.
one of them was called real health which is virtual IOP for alcohol use disorder.
So, they’re they’re a Joint Commission, accredited, tele mental health service that basically offers everything from virtual medicated assisted treatment, digital therapeutics for the consumer, peer and family coaching, and other tools to support individuals with alcohol use disorder. Another one, virtual IOP for eating disorders was called equip behavioral health. So, instead of residential programs, costly residential programs that are, you know, in light of sheltering in place, pretty hard to access right now.
Equip has created a way to deliver eating Disorder care in the home, and they’re already partnering with a couple of health plans. And then, finally, just as doctor Anderson had alluded to earlier, you know, minorities are there disproportionately facing the most trauma, but accessing the least amount of mental health care, so it was exciting to see a bunch of startups aimed at underserved minority populations. one of them was a company called …
Health, which they provide digital mental health coaching for youth of color So they can text and access a coach who’s culturally competent coaches across the board, who get training for this population seven days a week, 365 days a year.
And so, I mean, these are just a sample of so many emerging behavioral health startups in the space, and each of them have their own special way. That is I guess you could think of as the second wave of more specialized telehealth services for Everyone struggling with behavioral health conditions.
But the challenge is, with a lot of these companies is still today, the main buyers of these solutions are health insurance companies, or employers as well, But it’s really hard for a lot of these startups to navigate health plans. The sales cycles are so long, and the reimbursement process is really challenging for so many of them.
And so something that a number of digital health startup founders and CEOs had talked about recently is, could we, could we have a standard digital health contract, no, whereby they can actually get their solutions paid for by payers. And, wouldn’t it be great if CMS could lead the charge in that? And so, that concept was super exciting, and I’d like to see more traction on that front.
Another issue is, there are a bunch of startups that are starting to tailor their offerings to help systems and behavioral health providers, like one of them, marigold Health, They partner with substance use clinics for group based Peer Support Text, chat.
And so you can be amongst peers 10 at a time in a chat room, and AI will listen to anything that needs escalation. And there’s a moderator, And so it’s a neat service that providers can monetize and offer to their patients.
But the problem is, still, today, behavioral health being still fee for service, there’s not a whole lot of incentive for providers and health systems to adopt a lot of these digital, behavioral health startup solutions.
Certainly, there’s been some traction with collaborative care startups, but it’s hard to see much beyond that.
And then, finally, I’ll just point out, while there has been traction, internet access, for a lot of folks who could really use these services, is just not available, and so exciting to see, that telehealth policy changes lately. But, many of them still have to access services, telephonically, and there are novel behavioral health startups who have offerings in that space to like happy a telephonic based peer support startup. But, again, need a payment model that will support startups, being able to deliver those cares. So, happy to talk more, but that’s just a lot of what I’m seeing right now.
Thank you so much, …, will turn next to Ben Miller, and go ahead.
Thanks so much, Sarah. Thanks for the opportunity to be here today, alongside my highly respected and knowledgeable colleagues.
As has been mentioned, this is a propitious moment. Perhaps, once in a lifetime, coven 19 has laid bare the failings of American Health Care Public Health and Public policy.
It’s impacted us all in different ways: from job loss to fiscal distancing and social isolation. We are witnessing a truly unprecedented moment.
And as I lay on just the next 4.5 minutes, without immediate and notable action, some of our country’s failings will be on display for generations.
We continue to make the investment to fight the crooner virus when we make the investment to fight mental health and addiction. It’s time for courageous policy, leadership and action, because there was an academic way before a pandemic ever hit. More lives were lost to drug, alcohol, and suicide, the last 20 years preventable losses, 151,000. A little over 150, 102018, the economic downturn, social isolation and uncertainty only could exacerbate these deaths of despair.
So many more lives we could lose if we don’t take action, and we can’t afford to not take action.
And our nation’s pain is on display. Even as we present on this webinar today, too many black lives have been lost too many children, who grew up in fear. Too many structural inequalities and examples of systemic racism to name. So while we focus on mental health today, know that these issues of mental health, or not, just because we don’t have access, notice these issues of mental health, or not, just because of our benefits in their design, know that many of these issues a mental health or exacerbated, because of deep seated structural inequalities in this country.
We are in pain, and have been in pain, and many of us are still suffering. Next slide, please.
But little to no action has been taken to date. Congress has not prioritize mental health budget dust, as I say. And it’s hard not to see. This is the ongoing marginalization of mental health, full stop.
I know myself, and many of my colleagues are fighting fiercely to get more attention. Given to this topic from op eds to webinars to TV, everywhere they’ll take us. We’re out there trying to be as loud as we can on this issue.
As are many of you, and I know my fellow presenters are, as well.
But we are in pain and we need a solution, a plan. Next slide, please.
Webbing Trust, alongside many other organizations has created a Federal Guide for Advancing Mental Health.
We call it Healing the Nation. As I mentioned, our Nation is in pain, So, too, must heal solutions abounded, but, what we tried to do was to pull together a policy plan that took into account everything from the structure to the nuance of specific programs, and attempted to do it all through the lens of equity. Next slide, please.
But, we must have hope. There are evidence based solutions, as Sarah mentioned at the top, that can bring rise to a new generation of excellence in this country. And it begins here with the framework.
Something that says, mental health should be everywhere, we are, that we should bring care to those in our communities. Rather than always asking the communities to come to us, we should make it more integrated, we should make it more seamless, and most importantly, we should make it where it’s everywhere that people would want it. Next slide, please.
On the website, which you can see the link there at the bottom, you can find concrete federal policy recommendations on many things. From coverage to delivery to financing, it’s all there and it’s firmly rooted in an integrated and comprehensive framework for excellence. We lift up all those places that you can see the five big areas that we think could do a better job integrating mental health.
So, you can go see more specific policy recommendations on the website. But for today, let me give you just a few examples of some policy recommendations. Next slide, please.
I broke these into two categories: immediate changes and then those that are daring for the courageous visionaries, and I’ll talk about both of these briefly.
First of all, why not make it easier for people to access care all the time? So let me talk about this a little bit in her some of the innovations that she’s seen. Why only make telehealth? A provision that has expanded. We’re in a crisis.
Why is healthcare one of the most difficult and frustrating things for us to get into ironically, at times when we’re most often meeting things to be easier in life, and we have to work harder to get in?
So, calling for Congress, or anybody, for that matter, who wants to pay attention to this, to really invest in not only the ongoing continuation of some of the telehealth services that have been expanded. Make this permanent, but also to look at really turning on the broadband. That is not in all communities, again, an issue of inequity that we can see here.
We need criminal justice reform period And while we work towards that, let’s offer people coverage so that they’re guaranteed help when they re-enter into the re-enter into the community. Experience allowing for Medicaid coverage, 30 days prior to an individual being discharged from prison, is an extremely powerful tool to make sure that people do not fall into the cracks.
And as many of you have seen, there’s been a recent survey of providers that shows the danger is imminent, when it for mental health conditions on the front lines, more than 60% of providers have already been forced to close one or more programs. And 62% of providers cannot survive more than three months with that emergency financial assistance assistance.
There’s been lots of calls to put money into the pockets of our clinicians right now to help them keep their lights on with a specific focus on Medicaid providers, who we know are oftentimes in the frontline of a lot of the mental health and addiction services in this country.
Meat is already skyrocketing for certain crisis services. And I think we’ve heard this said said today, SAMHSA’s disaster distress. Helpline has experienced an 800 plus increase.
So, why not begin to think about fully embracing and supporting the 9 8 8, A hotline number that really provides an opportunity for us to more seamlessly integrated and create more of an integrated approach to how we manage the volume and crisis calls that come into our country.
Let’s make sure to have an adequate crisis infrastructure for each of our communities. So, let’s fund that.
Now, here’s where it gets a little bit deeper here. And this is only for the courageous because what would happen if Congress re-assessed certain longstanding policies and administrative structures that often impeded our ability to achieve meaningful mental health reform?
From only allowing certain mental health clinicians to bill Medicare, to how we pay our mental health conditions, the pre coronavirus road wasn’t really working that well, to support team based and integrated approaches to mental health. So, why not reconsider this policies now?
So, what would it look like to create a structure? An actual structure, integrated, and system that could accommodate integration?
Bring mental health everywhere, as I said, through the framework. What would happen if we created an entirely different type of workforce, one that was grounded in community built off the back of the National Service Corps and National Health Service Corps and allowed for people to really train up on mental health and addiction skills. It happens all over the world. Why not have it happen here in the United States?
Then, last, but not least, what would happen if each of our communities were given a gift? They were given resources to really lean into their own ingenuity and creativity and solve problems with Federal dollars to create new programs? Where new opportunities for economic development? Or growth to address issues of racism and poverty, and to do that on their own, with their own ideas.
It’s, it’s novel, but it’s not, because it’s the way that our nation has it was founded, is that we need to build in opportunities for communities to really lead, into step up and to provide some type of meaningful interventions for themselves.
And Inclosing, as I said at the top, the Coronavirus has shown us some of our failings, and I’m afraid that without immediate action it will do the same for the already fragile mental health system investment in that system Or a re-imagined system. When they integrate, mental health fully will pay off, not just in terms of lives, saved and bettered, but in monetary savings as well.
The demands for money to ease economic, medical, and social problems are going to accelerate, especially when the coronavirus pandemic apps the US can allow the needs of mental health to be pushed aside by other priorities. It’s really happened too long. And if that happens again, or continues to happen, I’m afraid that the price that we’re going to pay as a society is going to be frank.
So, let’s take action together. Thank you.
Thank you so much, Ben, and thanks to all the panelists. So we want to get into a discussion, and I want to, again, invite our friends who are listening to, go ahead and submit your questions through the online platform. We’ll get to as many of them as we can. So each of you has really describing, you know, told the story of mental health in America, through this lens of, you know, we had kind of a weak foundation to start with, with high existing challenges. Deaths of despair and others that we were talking about. There’s now been a spike in demand and need for mental health services, obviously, throughout with longstanding inequities. And some of that bike and demand is being met through innovations such as through new technologies or existing technologies that have sort of maybe maybe liberated some payment models just at least in the interim.
You know, through the, through the resilience of communities and then Ben and another and you’ve talked a little bit about how we can kind of envision a future that maybe not only meets the current need but also goes maybe farther and actually re-imagined Vision for the future, in which in which mental health is truly taking care of. So I hope I’ve kind of done done just as I want to talk about through each of those components and a little bit more detail. Let’s just start with where we are with the pandemic.
We have been many of us kind of in lockdown mode or social isolation mode for for going on three months now.
There’s a very fractious and and sort of not necessarily streamlined approach to re-opening throughout the country. Talk about the challenges around social isolation and loneliness as they re as az.
They relate to mental health status, and I’ll ask just maybe, …, would you be willing to start with that question? And I’d love to hear from other panelists as well.
Sure. So briefly we know that black communities often rely on each other in ways that are more frequent than some of our other communities and certainly latin X folks are high along that list as well.
So when we know that social support, communalism, familial, lytham, all work together for the network of folk. We also know that it works for their psychological wellness. So to really not allow folks to utilize their social support networks, especially, And I continue to go back to the black community, because that’s my population of interest, But when folks within our community don’t have those same support networks, and also have stigma toward mental health and therapy, it can be really challenging for them to be well at this time. So we’re really trying to figure out how can we impress upon folks? Your family is there. So how can we utilize the network that’s already within your family? But if there’s a port, is there a safe way that we can create some sort of visitation, or ways that you can still get your needs met, but to keep everyone within the family safe?
Thanks, anyone else want to chime in on that prompt?
Yeah, I’ll build off on that, sir, I think that was really well stated and we know we’ve done a lot of studying the social isolation elements here that have come along with covert, and I think for folks that are aware of the literature, you understand that loneliness and isolation can be really bad for your overall health and mental health and well-being. And when we looked at the data, we know the risk factors, such as unemployment, can lead some people to be at higher risk, for a depth of despair. What our country has never experienced, though, is an economic downturn at this level of severity, alongside social isolation at this level. It’s not been studied at this magnitude. And I am afraid that if we don’t pay a lot of attention, and create strategies specifically around addressing some of the social isolation elements, that we are going to have another problem on, top of our hands. Just yesterday that, there is a survey that came out from four H, and some of you may have seen this, but it was really surveying.
or use ages 13 to 19.
And there was two data points that stood out there, 64% of the teens believe that the experience of covert 19 will have a lasting impact on their generations mental health. Another survey, or, excuse me, another survey item, said that 82% of the teens are calling on America to talk more openly and honestly about mental health issues in our country, which is an extreme breath of fresh air to see that.
So, if anything with this moment has offered, is a, an up, again, another opportunity for us to reflect to, get creative, to do what we’ve done in my community, to draw a chalk circles on the street and and put chairs out and still see each other and try and be there for one another. But, to not necessarily, you know, be in the physical connected. Like, we have been before we have to get creative or a colleague of mine yesterday on, our webinar said that what he’s been doing is sending hand-written letters to folks throughout his network. And what he does is in that letter, he includes another envelope stamped, and he encourages them to do the same to symbol and within their network, just to let each other know that we are here, we’re here for each other and we need to be there more now than ever before.
Ana asked about technology and, and we, we had a question from the audience about letter, whether the panelists have suggestion and are there any other, any organizations addressing how to get computers and internet connectivity to those who have mental health needs, but who can’t afford a computer or connectivity? The questioner knows that his or her patients still have flip phone, which which don’t seem to work to opera tele therapy. So care money, Let me ask you since you, you talked about the uptake and telehealth usage, do you have any comments on that on that question?
Yeah, flip phones are covered through Blue Cross, and one of the things we’re learning is that there are populations.
The elderly and minority and rural populations that don’t have as much access to video enabled chat are using flip phones.
And this is, it’s hard to know, because they’re not coded differently, But this is actively under discussion, because we’re realizing that Internet access is not equivalent across the population nor comfort with it.
So, this is an active area of discussion among the policymakers around telehealth.
The practitioners are fine with it.
They feel that this is another advantage for how to connect to people, but I think the end of the emergency, which you know, has encouraged the use of Flip phone conversation’s, will require the health plans to reflect upon this and make some decisions about it.
Historically, no health plan has covered non video enabled telehealth.
So, I think this is a transformational opportunity to have that discussion.
Just one quick follow up, and then I want to own A as a, as an entrepreneur. What you think about this, but can, you know, do you think either other health plans are following suit, with the, you know, covering the non video enabled rotation at the federal level?
I mean, how quickly do you think the change is going to be kind of manifested throughout the country? And do you think it’s going to stick?
I don’t know if it’s gonna stick, because now, you know, remember, with private health insurance, this requires employers and, of course, the public health insurance, Medicaid, right? No, you have to remember, there are people underwriting these kind of services.
So this is now a complex equation, because many employers, and many states are experiencing financial distress in the economic impact of the kogod 19 crisis.
So, to me, this is an ongoing conversation.
I do think the transformation in the patient comfort with telehealth and practitioner telehealth has been remarkable. I mean, this was not expected.
We’ve gone from microscopic number of claims being telehealth to 100% of the claims bein’ Telehealth, and, you know, over a half a million and I think a period of six weeks or nine weeks at Blue Cross. So people are using the service. People are actively using it.
There are some variables that are a yet unknown, and I think this is an important conversation to have with employers, with your employers. Doctor Anderson, I’m a graduate of the University of Michigan, very fond to the University of Michigan, right? I undoubtedly they have a benefit package. You know, this is a conversation.
I encourage people to get engaged with their HR departments about what you want as employees because most large health insurance purchasers are self insured and decide upon their own benefits.
This is something I learned in my health care fellowship that the large organizations, like universities, like big businesses and the small organizations are more likely to be fully insured, not taking risk. And then the health plan makes decisions for them about what benefits will be covered.
So, I just leave that with people to consider your health care benefits. Not as the thing you sign up for every fall, which is what I used to think.
Before I took this part-time leadership job at Blue Cross Blue Shield of Massachusetts, or is rather an ongoing engagement, you can advocate for, you might have to pay a little more in your monthly premium. But I think it is possible that shelf insured big companies, big organizations, big universities, can have services tailored to them. and flip phone, non video enabled conversations, or tele therapy would be one such area.
Great. Thank you. So, you mentioned in your remarks, kind of some challenges with entrepreneurs, with no startup in the mental health base. You know, connecting with health plans are getting things covered. Can you, you know, if you want to comment on that, I’m very protective of what Ken was just talking about. You know, also just, how, how can entrepreneurs and startup companies, you know, think about addressing the needs of diverse population? You know, whether or not they have access to the latest technology, or, you know, the most data on their phone. Or so forth.
Yeah, I actually, if I can, just follow doctor duckworth’s comments a little bit.
It’s interesting, with the, the mental health startups that are focused on employers on one hand, they can make the argument that, just as as, as we’ve all been saying, the meet, the demand is, should be no higher than ever. But, on the other hand, there’s a lot of anxiety among those employer focused startups, at least, from what I’ve heard. Because, at this point, you know, companies are linked bookshelf, and not competing as much to have the latest perks and benefits, until they have some concerns about, are they going to be able to sell it to employers as easily. But then, at the same time, this influx of Medicaid enrollees, you know, there’s still demand elsewhere, and so, they’re looking to see, to figure out, how can we change our businesses?
But, then that kinda leads to your question, which was, no, are a lot of these solutions tailored for various populations, and one challenge for a lot of emerging behavioral health startup entrepreneurs is they’ll think, OK, we’re gonna go tackle all lines of business. And we’re gonna start with commercial and go from there. But then they realize, OK, this, this doesn’t necessarily work for everyone, and certainly that, that piece about access to Wi-Fi, to Internet is a big one. And so.
There are some companies that are doing, as I mentioned earlier, either have solutions that are telephonic only. There are others who are really focusing on ensuring that their staff are providing culturally competent virtual care. But one issue is that there just aren’t a ton of minority providers. And so, a big question is, you know, how can we leverage peers more, or maybe not the highest level credentialed clinicians to be able to offer support? So, that’s a, that’s a common question among a lot of startups these days.
Well, that’s actually a great segue into a couple of questions we have received, again from, from our listeners. So, one is you can tell them mental health work as effectively for populating with severe mental illness can can replace The person named them an intervention here, clubhouses or HCT teams or drop in center. So, let’s talk about both the severe mental illness for a minute and then, and then let’s get into some other evidence based interventions as well.
Phone, I don’t know if you want to start with that or somebody else wants to jump in there.
Yeah, I’ll just say real quick, I know that there are startups who are attempting to tackle that. The guy’s name is just escaping me. Positive something. I’ll think of it once we, once you get back to me, but there are certainly startups who are attempting to.
This has been, I think that it’s an interesting topic of conversation because clinically, how we begin to describe levels of severity, in which intervention is best for which population, based on diagnosis, based on, again, the presentation. There’s a lot of nuance there. And so I don’t want to necessarily not answer the question, but I think if you look at the literature, depending on the specificity of the types of interventions that are used through telehealth, tele mental health, whatever your nomenclature is, then the likelihood of the effectiveness on certain populations is kinda directly related. And so we’ve spent quite a bit of time thinking through the literature, talking about it with folks who have done a lot of the investigation here. And I think it’s safe to say that there’s a lot of promise there, especially for some individuals who might have mild to moderate. And then even cases in the literature.
For those that have more severe mental health needs, Know, I’m glad that the question came up about co palaces and some of the drop in centers. These are amazing innovations that, really bring back the need for folks to be taken care of in community.
If we go back 40 years, and we think about, you know, how initially some of the conceptualization was around the Community Health Center Act. Really, a lot of the goodness of those ideas are found in places like the drop in centers and the clubhouses. Because it really is truly about a community of care.
And in times like this, when you have to be more, you know, physically disconnected, I think that they are up against a lot of re envisioning and re-imagining some of how they can still provide care for their folks by by using some of those technologies and providing those type of social connections while not necessarily having to drop.
And so, I think that we, as a nation, are going to have to investigate this together and spend a lot of time really thinking through which intervention, which platform works best for whom, where, and then, of course, the ultimate policy question and how much.
Great. Thanks, Ann. And I want to ask you, since you had mentioned earlier this idea around Community Health Service Corps. And there was a question from the audience, as to whether you could just elaborate a little bit more on that concept.
Yeah. So thanks for the question. I mean, for us, when we begin to think about the capacity of the current workforce that exist in healthcare. And you look at mental health, you can look at primary care. You can look at others. Oftentimes, we’re, at capacity, we don’t have any more bandwidth to take on more patients, more clients, more folks, within our clinics. And so the idea is to shift some of the interventions, It’s called, task shifting in the literature. You can go and look at it from other countries to begin to shift some of those, really, those concrete aspects of what makes a good intervention into communities. So what would happen if you trained everybody in your neighborhood, how to be more empathic, or how to listen better and respond in ways that showed empathy respect? It’s not a psychologist’s giving, you, know, DVT CBT type of intervention. But it might be enough to help that person get through that day.
It might be enough to help that person come up with a new strategy, a new skill on how to manage their problem in a little bit different type of way. So the whole, the whole premise here is that we have to re-imagine our workforce. And so we can think about the pipeline issues. Let’s have more child and adolescent psychiatrists. That’s a dream for everyone, but it’s not going to happen at the levels that we need it to.
Let’s look at the current workforce. We get a lot of folks out there that are doing great things, but sometimes they’re in the wrong places, and they’re oftentimes not even trained in culturally linguistically competent ways to be in some of the communities that they’re in.
Then the final pieces where we come at it from the Community Health Service Corps type of mentality is that why not really democratize the knowledge. The evidence that’s out there that’s robust around mental health and put it into the hands, put it into the hearts, put it into the minds of our communities that can be there for each other, and really, I think, quite effective way. So it’s, it’s one of the big ideas that we’re talking a lot about right now. And as I mentioned, in the previous comment, it’s really somewhat predicated on the National Health Service Corps, and incentivizing people to go into certain types of healthcare delivery. You can think of community health workers, Promotoras. You name it. We’re looking at this as a viable solution.
Great, thank you. And I’ll add a comment from our audience, which is coming from Texas, where there are over 40% of Latinos and Therapy mental health providers who can speak Spanish. They note that they are the Promotoras Community Health Worker Program that has been key to bridging that gap and even started a Telehealth Community Navigation Program. Though, something else for us to take a look at. I do want to just quickly follow up on the work workforce thread, though, because, because, I believe it’s on a maybe earlier mentioned, or … around, let you know, not enough, providers of color, Do you have any comments on that and thought about how we can address that need, both now, during the crisis and going forward? We haven’t heard from you in a while, if you want to start with that.
Sure. And you know, I’m mindful that this is a policy call on-site.
I’m thinking about that.
The literature, really, though, it supports what mashing does for us, the sense of, of a client’s engagement, and essentially how they view the process of therapy.
We also know that there are results that can happen outside of an ethnic match, so my, my work, especially with embrace, is to think about how do we enforce what the APA multicultural guidelines are suggesting, that we have with the cultural competence, and the ethical provision of services, with all psychologists.
So, I really, I don’t think that it should be specific to just folk of color, though, I think it is important for people to see themselves represented in the field, which can also increase, the utilization rates, decrease. Some of the stigma aside, I don’t want to take away from that. That, that’s not important. But, from a policy initiative, we already have ethical guidelines that exist for multicultural, recommendations that the APA has been making over the past, few decades, And so, enforcing it, and understanding how clinicians of all backgrounds can support.
Folk of color is really quite crucial in this time.
So, rather than trying to do anything new, utilizing what we have, creating ways of, assessing better and, and enforcing those standards that have been developed, will be my recommendation.
If I could just add one Q.
Real quick, Sarah?
Yeah, on that note, just with the lack of mental health providers, but even more prevalent when we’re talking about clinicians of color, I go back to we need to find a way to support and reimburse for some of these novel solutions that are able to offer more asynchronous offerings. Or the ability to, maybe while it’s not a one-on-one telehealth session like Henry Health care. They do for individuals seeking culturally competent care. But, more so, how. How can we create a one to many opportunity where one clinician can serve many patients at a time, or clients at a time. And, but again, it goes back to a lot of these technologies are so novel and payers may want to pay for it, but their legacy systems don’t even allow for a reimbursement mechanism to make that happen.
Thank you. I want to make sure to get through a couple more audience questions that have come in and I’m going to tend to maybe comment on these before we turn to sort of a final comment and the hour that we have together. And we’ve had a couple of questions about just what we have seen happen as a result of the Pandemic one related to evidence based interventions such as supported employment, systematic medication, management, behavioral therapies. And if you could comment on has access to service to these services have been disrupted by the pandemic. And in addition, in addition, there was a question around, you know, are we seeing more actual substance abuse now that people are having to stay and more, maybe their treatment groups are not as frequent, etcetera. Can do you have any insight on that? Yeah, a couple of things.
I’ll ask the substance use disorder question first Of some great policy moves happened and we can thank the federal government for that, allowing people to prescribe Suboxone through a video visit, which would never was allowed before. This is a medication for Opiate Use Disorder, which has fabulous evidence, and methadone is allowed to be given up to once a month.
Instead of four people going every day, at the discretion of the Medical Director and a, AA and Smart Recovery have been online for years and we are seeing an uptick in utilization of binge drinking for the most part, but it’s important to remember that many of these supports are either newly in place or have been in place.
I think that things like, supported employment are challenging in a virtual setting, and I would defer to some of my colleagues, you know, at larger community mental health settings, I used to work very actively in community mental health. I think that’s been a challenge, I will say, things like exposure, response prevention, can be done virtually, some care lends itself quite well.
two virtual visits, and I think the mental health and addiction space is among the best suited for this kind of care going forward.
As it relates to workforce, I do want to mention, I was on the Governors’ Peer Recovery Coach Commission for substance use disorders, and prior to the disruption caused by cov at 19, I think Massachusetts as a state was getting quite close to certifying and having third parties pay for peer recovery coaches, which would add new providers to the supply side as demand continues to increase.
Great. Thank you. Well, we only have a few minutes left in our time together. So, I really want to get the one final audience question, and that is, and it speak to our future, and that is: What can be done for young people? What are young people going through? How can we help to support their resiliency?
And why don’t we start with doctor Anderson with you, since you mentioned your program there, can you speak to that, and then, and then we’ll pull in A, and then they weigh in and before we wrap up, Sure. Let me just briefly say that the youth, know what they’re doing, so that’s, that’s what I would really just rest with that. If you talk to them, they, they are so aware they are the folks that are on the front lines right now. And a lot of these protests there, they know what they want and how to get it done. So I just don’t want us to undercut or devalue what it is that youth can tell us about what their future looks like and how to incorporate them. So, I would love to see them on the next panel. Or to love to, you know, just incorporate their voice more with youth advisory boards. Making sure that you’re hearing from them, so, don’t don’t. do you value them, bring them into the conversation, they have a valuable voice. And it can be bidirectional rather than us constructing the future for them.
That’s a great suggestion. Thank you. Well, we will make a note of that for the future. Much appreciated.
Lemay, anything you want to add to that, and feel free to expand on it and to, you know, anything else that you feel like needs to be done to make the future better in this space?
Yes, I was so excited about this question. If I have any optimism anywhere, it’s certainly about youth and just their entire attitude, and how they approach mental health compared to prior generations. In companies like Heads, Headspace and others are saying, they’re seeing their downloads to their mindfulness meditation. Apps around like 20 X And really, this is the next generation adopting these tools. They’ve got a different outlook on mental health care services, traditional or some of these emerging tools. And so I’m an advisor to the Velocity Youth Mental Health Tech Startup Fund, investing in emerging solutions for this market, specifically. And so I’m just really excited to see how our industry evolves, especially in light of next generations.
Thank you. Ben, any word on mental health? The next generation?
Sure. Well, I think everyone benefits when young people thrive, and sadly, adolescents have largely been overlooked and de prioritized in our national policy discussions. Just this week, we released a report with Academy Health that really highlighted what we can be doing better through policy for youth. And similar to what Ron said, we had 47 actions in the number-one action on the list, is to have used at the table. Because if we are not at the table, creating solutions for them, and it’s being created by other folks who have no idea what they actually want, we run the risk of creating programs and never good use, aren’t effective. And frankly, can be quite embarrassing for us. I think number one issue every day of the week. Have youth involved in your discussions, Haven’t met the table. Let them lead.
Well, that is a great note to end on. I want to thank each of you for joining us today, doctor Ben Miller, Doctor Anna Anderson, … , and Ken, doctor Ken Duckworth. Thank you for joining us, and it’s really important conversation on mental health and covert. Please join us next Wednesday, June 24th for the next event in our current theories will be joined by three healthcare leaders or an interactive discussion about early lessons from the pandemic and the implications for the future of healthcare. So, thank you so much again, for joining us. And please, have a Safe and Healthy weekend!