Web Clips: Our Mental Health System is a Disaster

Dr. Andy Sekel: “Many of you are designers of system. Matter of fact, all of you are. So, I'm curious how you see an entire pathway. Where do you start? Where does it go? When does it get hit the traditional system? Tell me your thoughts about that, please.

Dr. Stuart Lustig: “Well, I'll start. Clearly there are people for whom digital solutions may not make sense initially, but I think they're really a small minority.

“I’ll give you some examples: someone who is actively psychotic and out of touch with reality, or a three-year-old with autism, or someone who is, suicidally depressed and needs to be in the emergency room.

“Those are a few examples, but many kinds of services can be delivered remotely and delivered digitally.

“Even folks going through a substance abuse withdrawal have been able to make use of digital solutions. So the convenience is just overwhelming. Not having to wait as long, or being able to access some content that doesn't even require active engagement with another human being in real time is very valuable.

“There are myriad examples of folks who would benefit from a digital first approach right out of the gate.”

Steven Blumenfield: “When we talk about designing for employers at Willis Towers, Watson, we try to help them first start where they are because, to your point, Andy, you have to work with the current system and everyone can use help if we can get them the help.

“So everyone's got an EAP (employee assistance program) for the most part, high 90% of folks. Companies have an employee assistance program and an increasing number of companies won different EAP solutions.

“About 5, 6, 7 years ago we saw a lot of resilience and stress release types of solutions coming into the market.

“Then we saw some navigation solutions come into the market that help your people a little bit to get them access a little earlier.

“Then we saw these access systems that were more telemedicine, whether it's through a telemedicine vendor or through virtual care provided.

“But, what we didn’t see happen, and wanted to see happen, was an end-to-end solution – that’s what everyone wanted.

“So what we spend a lot of time doing is helping employers figure out how to catch their folks early, so that you can engage a big swath of people who might need care and then steer them to that care.

“And, if the network isn't sufficient - the physical network around them - can you digital system supplement that network to give people the care they need or want to? At least for a period of time, because EAPs are not meeting their needs.

“So that's, that's what we have seen. We either help employers take what they've got and fill in the gaps so they have an end-to-end set of capabilities to catch people early, to guide them along, to provide the care or to go with a solution that can be put on top of current systems and provide that end to end solution, but still integrate into the physical system with the networks that exist today.

Michael Thompson: “Andy, I love the way the question was posed, right?

“It was posed: How do you build a system? Because what we have is not a system. What we have is a disaster. So, we have people listed in networks that say they may not be available in the timeframe you need them.

“In this current system, we call it a good thing if they actually just return your phone calls. So frustration with the current system is at an all-time high.

“You asked how would you organize this? Well, we need to get organized across the entire spectrum of needs. Some of those needs are not that heavy, they're fairly light. And frankly, a lot of times our digital solutions could just remove the burden of things that don't need to get into the current behavioral health system, or at least inform how they should get into that system effectively – the digital triage system that Stuart referred to before.

“Second: most people start getting their behavioral health treatment in primary care, and we need primary care to be empowered, to do a better job at managing those patients and integrating virtually integration, because many primary care practices are not large practices.

“Virtual integration of behavioral health into those practices is going to be critical.

“Third: I think as we're thinking about needs, and there are people with serious mental illness needs, and those are not going to go away and are not going to be treated necessarily digitally in the long run, maybe at some point, but I don't think we're there yet.

I think we need tools to better assess what the specific needs are - even things around diversity and equity, or pediatric versus otherwise. Who within our networks have a track record of dealing with my issues effectively and who's available so that I am not doing it randomly and getting frustrated.

“Remember, this is an area that people aren't sure they have a problem. Even when they do have a problem, we need to make it easier for them to get to the right answer faster.

“Technology can help us to do that more effectively if we're organizing around that. And I think there are good examples of provider systems today that have already started to do that.

“These good systems know which patients are available and they know what type of patient they're better at treating, but those same provider systems don't flow through the entire healthcare system today.

“The larger system is actually blind to the typical employer. And so we've got a lot of work to make this this come about.”