To turn the tide around on the growing teen mental health crisis, the U.S. needs to overhaul the current behavioral health system, experts argued on a virtual panel, sponsored by Big Health, mid-January.
Among the suspected drivers of the worsening crisis are social media and COVID-era isolation, which have led to a lack of socialization and coping mechanisms in young children and teens, mental health experts said during the panel.*
“We have had a mental health crisis for adults and youth probably as long as there’s any historical record,” Big Health’s chief medical officer Jenna Carl, Ph.D., said. “It’s just that we’ve become better at actually acknowledging and diagnosing.”
Many teens also identify gun violence and climate change as significant sources of stress. “While we all live in an uncertain world, I think that adolescents and children these days live not just in an uncertain present, but a very uncertain future,” Vaile Wright, Ph.D., the American Psychological Association's senior director of healthcare innovation, said. That leads to a lack of agency and, in some cases, hopelessness.
Many therapists also use a generic form of treatment that is not evidence-based, the panelists said. Most evidence-based psychotherapies are cognitive-behavioral. An essential part of such approaches is training, both initial and ongoing. Thus, solutions to the crisis should include reeducating current providers and building up a pipeline of new professionals entering the workforce, particularly minorities, the panelists agreed.
Digital tools can help augment clinicians’ skills and provide increasing levels of personalization, Carl explained. There is strong evidence to support newer, clinical-grade therapies like prescription digital therapeutics.
Yet noise from an overcrowded digital health space and lacking reimbursement for such interventions remain barriers to adoption. “We’re sitting here with tools that we could offer but we can’t,” Carl said.
“I don’t think it’s a lack of evidence, I think it’s a lack of understanding and hesitancy to try something new, particularly in the digital space,” Wright added. The American Psychological Association is working on educating providers, parents and, importantly, lawmakers on this, she said.
There is an appetite for innovative approaches to treatment among parents, Google’s head of global well-being and mental health Rebecca Whiting-Holliday, said.
“Our employees and their families, they want to feel better, they want to see their kids get better. Innovation in this space, when there’s evidence to back it up, is exciting,” she said.
Google wants to support caregivers by offering a range of holistic options, prioritizing an integrated approach to mental health. The company also invests in resource and affinity groups to help employees make informed decisions that are best tailored to their needs and preferences.
“Knowing what our employees need, what their challenges are, helps us design that package that can speak to a vast array of employees and a vast array of needs,” Whiting-Holliday said. Staying flexible also helps reach people “across this whole continuum of experience.”
To encourage reimbursement, providers must have the data to prove good outcomes. But that isn’t possible without the necessary tech infrastructure to collect such data, Wright noted.
Behavioral health providers were left out of the 2009 HITECH Act, which incentivized the meaningful use of electronic health record software, meaning many still rely on paper and pencil to track outcomes today.
“I think a lot of providers out there are doing great work, but payers can’t tell which providers in their panel are the ones getting the right outcomes and which ones aren't, because we just don’t ask people to measure,” Wright said.
Having patient data digitized can also enable measurement-based care, a systematic way of tracking outcomes with powerful results. Today, fewer than 20% of practitioners employ this method, which is supported by the American Psychiatric Association and the American Psychological Association.
From focusing on the social determinants of health to fixing reimbursement for providers, panelists agreed that a value-based approach was the right way forward.
“We pay for a medical system, and what we really need is a holistic system that looks at the outcomes that we can get,” Patrick Kennedy, founder of the Kennedy Forum, said during the event. The first step toward that is fixing parity, so payers cover mental health on par with medical care.
Last summer, the Biden administration proposed a rule to strengthen mental and physical health parity requirements and improve mental healthcare access for more than 150 million Americans.
Kennedy also emphasized the importance of supporting social needs, such as through social services and access to recreation programs. Instead, the current system often responds to mental health concerns with more doctor’s appointments and medications without holistic solutions.
“Why don’t we intervene much earlier upstream?” Kennedy questioned. “That's not part of our DNA, because the medical system only works in a reactive way.”
Payment reform that emphasizes a preventive public health approach is critical, Kennedy said. One potential avenue is for local governments to share in payment for premiums to expand mental healthcare. The entire system will see upstream savings through reduced incarceration, Kennedy said. Another potential solution is having school-based services reimbursed under Medicaid.
Earlier this week, the Centers for Medicare & Medicaid Services announced $50 million in grants to deliver school-based health services for children through Medicaid and the Children’s Health Insurance Program.
*The virtual panel was moderated by Anastassia Gliadkovskaya.