The recent announcement by the Biden administration illuminating new resources and regulations specific to addressing the teen mental health epidemic in America was certainly a welcomed effort for the industry.
As a clinical psychologist, mom and former corporate executive managing a very large book of behavioral health business, I found these new resources and regulations to be a boost for this space but still inadequate and incomplete—especially when it comes to America’s youth.
Our main focus must be breaking out of a fee-for-service mindscape and reactive care mode that has dominated mental health care for too long. When service volume is the sole priority, it constrains us from having a more expansive mindset to experiment or iterate, particularly since teens outnumber providers so heavily (and, spoiler alert—always will).
Sure, this approach has sufficed for a while, but the scope and scale of the current teen mental health crisis is rendering this legacy environment unsustainable. We have reached the limits of what we can achieve clinically, and what we can extract financially, from this methodology. Yet there is an equal and opposite issue worth paying attention to. At the very same time, we’ve exhausted the patience of parents and caregivers who are succumbing to the status quo believing that this industry is incapable of change.
To break the mold and unleash the multiplier of personalized, preemptive mental health care, we need to take a fresh look at why we remain stuck in the past and how we can move forward in lockstep to bring value to payers, providers, innovators, other stakeholder groups and—most importantly—the tens of millions of teens necessitating mental health support.
Trusting a broader pool of experts to address mental health workforce shortages
The chronic shortage of qualified, licensed behavioral and mental health care providers is impeding our progress toward creating a value-based environment grounded in preemptive care. As of March 2023, 160 million people live in a mental health professional shortage area. And studies project a further shortage of up to 31,000 behavioral health workers by 2025.
To solve this problem, we know too much to accept that simply relying on the recruitment of budding therapists and psychiatrists is where the answer lies. We must go on the offensive and add a fresh layer of support that gives us flexibility and stratification capabilities by developing and deploying innovative strategies for integrating non-licensed mental and behavioral healthcare workers, too, into the ecosystem.
Non-licensed professionals, such as certain types of counselors, can bridge the gaps in care by serving as a resource in the interim when teens in need cannot immediately access higher-level services. These same professionals can also function more as targeted support when low-touch services are what is warranted. This added interpersonal support could be rooted in technology or in-person relationships, such as the “lay counselors” in Stanislaus County, California, who are receiving extensive, targeted training to supplement their backgrounds in case management and patient outreach.
When applied correctly, these emerging mental health workforce solutions can augment our industry with new vehicles for connection and provide long-overdue agility so that we can work smarter. This will also allow us to proactively manage the never-ending conundrum of scarcity of resources and harness enhanced interventions by combining best-of-breed technologies with a devoted workforce for teens to combat the opportunity costs and real costs that we simply cannot afford.
Closing access gaps in mental health care by meeting teens where they already are
The delivery of mental health care must ever evolve to meet the modern demands of a nation in mental anguish. That means getting upstream on the crisis with more proactive, prophylactic and personalized approaches to delivering evidence-based mental health care.
Integrating a digital-first approach that’s built on science-backed principles can be uniquely suited to accomplish this goal. The current generation of teens is eager to use their smartphones to engage with apps that teach stress management, help them practice mindfulness and provide education on how to cope better or differently.
As an example, a 14-year-old who was struggling and feeling isolated was unable to access therapy similar to many other teens. As an alternative, he received support from a mental health coach via a secure app. The modality coupled with bullish privacy guardrails enabled the teen to access support with psychological safety so he could share his painful experience of identifying as trans in an unsupportive home environment. This was further compounded by being a victim of sexual assault and managing intrusive symptoms of anxiety. Across seven coaching sessions, he reported feeling validation and a sense of not feeling alone anymore, equipped with tangible coping skills to employ and a newfound motivation for his bright future.
In a recent survey of Latinx youth aged 14 to 22, 69% of teens also reported using a mental health app for activities, including sleep and mood tracking, meditation and stress reduction, signaling that this digital native generation is taking their mental health into their own hands. They will not stand for traditional care delivery being their only option. This puts the onus on providers and payers to endorse different pathways and paradigms that transcend “what has always been done.”
Today, teens are demanding that mental health care fit into their world. Teens have always been difficult to reach and notoriously nonadherent, but this generation is adding new complexity with their digital-first mindsets. They now have social media as their de facto provider of mental health information and will lean on this mechanism willfully despite being misguided unless, or until, we have alternatives. A key part of our response as a mental health industry must be generating always-on, always-available technologies that offer support and safe interventions that are backed by data and research.
Value-driven models are key to powering proactive, personalized mental health care
The change to value-driven, preemptive mental health care is slow-moving and often beset by systemic barriers. It’s important to acknowledge that the shift to proactive, personalized mental health care will take time—and that means ROI will not be immediate.
However, with the nation currently spending $280 billion per year on largely fee-for-service mental health services, there are enormous opportunities to leverage value-based care models alongside digital innovation to reduce waste, improve outcomes and generate better experiences to meet the ever-changing needs of teens.
Digital health companies, payers, providers and parents all have vital parts to play in making the change to value-driven mental health care a reality. Digital health entrepreneurs are pioneering the next generation of tools that combine accessible, equitable, evidence-based interventions capable of merging with new approaches to measure the value of care and the outcomes of mental health interventions. These efforts are well underway: People who use digital apps and platforms to supplement or, at times, replace traditional mental health care are already achieving promising real-world results.
Concurrently, it is incumbent on payers to lean into betas and testbed collaborations around teen mental health care that might not fit neatly into current traditional reimbursable categories.
Some payers are already all-in on this strategy. At CareSource, a nationally recognized regional health plan, for example, they are now offering digital tools, content and activities, and clinical care aimed at helping more than 19,000 teens who are part of Indiana’s state Medicaid program. These efforts are designed to embrace innovation and drive new, science-backed approaches to teen mental health in order to strengthen some of Indiana’s most at-risk teens by bolstering their sense of agency as they navigate the challenges of being young in a tumultuous time.
To truly accelerate the shift to value-based digital health care, federal lawmakers and regulators will also need to design new reimbursement codes for mental health tools that don’t fit the traditional way of doing business. In parallel, payers can absolutely run smaller-scale deployments that don’t require excessive up-front investment. The critical success factor of these partnerships will be predicated on effectiveness and impact as evidenced by data-driven metrics and proven outcomes.
Millions of teens—and parents, for that matter—are counting on us to rethink, reimagine and redefine mental health care, and the latest efforts from the White House represent an important step forward. But teens expect care to fit what they like and what they need, which means the mental health industry must offer fully customized mental health journeys that account for and respect the dominant digital realities of this generation.
By focusing on these three areas—adoption of supplemental workforce approaches, fresh care delivery models that demonstrate flexibility in digital and in-person treatment modalities, and pairing financial innovation with value-driven pathways—we can and will create new-to-the-world categories for teen mental health. I can think of nothing more significant and rewarding than to spend our days improving our understanding of teens well enough to successfully intervene and move an at-risk teen not simply to more stable footing but to a life worth loving.
Dr. Nicoletta Tessler is a clinical psychologist and CEO of teen mental health provider BeMe.