Mental healthcare: One of the greatest tests for today's health system leaders

Today and over the next several years, mental health will challenge hospital and health system executives in how they communicate, prioritize, respond and invest. 

The intricate nature of mental health issues places unique demands on leaders, compounded by the enduring stigma and troubled history of mental healthcare in the United States. Historically, mental health treatment was marked by "moral treatment of the insane," substandard asylum conditions, and an overreliance on institutionalization. These regrettable practices only perpetuated the misconception that mental health is somehow separate from physical health and overall well-being — a notion that still lingers today. 

While awareness of youth mental health crises, serious mental illnesses and substance use disorders is greater than it once was, attitudes and perceptions toward these needs remain complex and fraught. Only 3 in 10 U.S. adults say they would be only somewhat comfortable talking with a close friend about their mental health, and an additional 12% would be not too or not at all comfortable with this, a survey published in 2024 from Pew Research found.

This context only elevates the importance of how healthcare leaders respond. Elizabeth Wako, MD, president and CEO of Swedish Health Services, is one example of credible leadership.

Dr. Wako was appointed to the top position of Swedish, a five-hospital system based in Seattle, in 2023. A closer look at her 30-year career shows why her communication about mental healthcare stands apart. 

Dr. Wako began working as a registered nurse caring for psychiatric patients, an experience that left her with a firsthand understanding of the needs, care gaps and judgments endured in the specialty. She spent time in the home health setting, inpatient involuntary hospital medicine, and the group home setting with patients who had behavioral health needs and were experiencing homelessness.

"What I learned is that mental health is very much something that every single one of us experienced. It's not somebody else's problem, it's our problem," Dr. Wako shared with Becker's at its 14th Annual Meeting. "The more we pretend like mental health is its own special disease, the more we'll be unable to treat mental health." 

As a leader with a large platform, Dr. Wako is intentional in how she discusses mental health and strongly rejects the notion that it exists in isolation. She employs the metaphor of a wave when describing mental health needs. Whether a sine wave or an ocean wave, mental health exists on a continuum, she insists.

"You could be at the top of the wave or sit at the bottom of the wave, but there's always a wave," she said in a Becker's Healthcare podcast. "Sometimes you are drawn back deep into the ocean — kind of the dark depth of the oceans. Sometimes you're resting in the sunlight on the white sands. The wave, however, is always moving. It's always coming in and it's always going out. So I would say accepting that mental health is normal and it's our human plight — that's half the battle of managing mental health. It's normal."

At Swedish Health Services, Dr. Wako sees access as the first priority for mental and behavioral healthcare. "As a health system, I think we need to be able to ensure that mental health services are easily accessible regardless of where you live, your race, your background or your financial situation," she told Becker's. "We should all have access to it." 

She advocates for expanded access points, increased reimbursement for services, and the integration of mental health resources within primary care settings. Currently, Swedish is looking at ways to increase mental healthcare capacity by expanding primary care and embedding mental health resources within all primary care clinics. Dr. Wako sees the integration of mental and primary care as critical to address needs in a manageable way. 

"That's a goal that I think all of us should have: you should be able to see your primary care provider have an assessment done, an evaluation made, and then a direct transfer to a mental health professional to be able to start having that conversation with you," Dr. Wako said. 

Another area of focus for the system is its digital front door and hospital infrastructure. Nationwide, there is vast potential for improvement here. Entry points to quality healthcare for mental health needs are not easy for patients to find, as numerous studies have shown. 

In 2021, roughly two-thirds of insured Americans with a diagnosed mental health condition were unable to access treatment and only a third of insured people who visited an emergency department or hospital during a mental health crisis received follow-up care within a month of being discharged, according to Milliman. Between 2011 and 2020, emergency department visits among children, adolescents and young adults for mental health reasons approximately doubled, according to a study published in JAMA.

"We can't expect to always walk in the front door of our primary care office anymore. We should be able to access primary care through our phones, through our computers, through other devices," Dr. Wako said. "We have to use all the resources that we have, and tapping into all those resources will really broaden the support for this community." 

In terms of infrastructure, Swedish is undergoing a transformation at its flagship hospital. Its new 12-story tower, expected to open in fall 2027, will contain an emergency department partially devoted and specialized for behavioral health patients. The improvement is important, given that even as recently as 2018, more than 50% of emergency departments and general hospitals lacked psychiatric services. 

Finally, Dr. Wako maintains that meaningful improvements to mental and behavioral healthcare access requires diversity, equity and inclusion thinking. This is where partnerships, community engagement, investments and creativity are especially paramount. 

"You can't address health without addressing food insecurity, without addressing lack of education, without addressing lack of housing," Dr. Wako said. "These are not compartmentalized issues; these all go together and they create a whole human being. Until we put a package together for a whole human being, we're not going to be able to provide health for our community." 

Hear Dr. Wako's remarks directly about her philosophy and Swedish's strategy in response to mental health needs in the communities it serves on the Becker's Healthcare podcast.

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