America's youth are experiencing a mental health crisis. One in five people ages 13-18 currently suffer from a mental illness, and suicide is the second leading cause of death for people ages 10-17.
Despite this, 96 percent of counties in the United States have an unmet need for psychiatrists, meaning that patients — including teens and children — often travel far, wait long or face other barriers before receiving care. Healthcare leaders need to make a commitment to treat the whole child, from head to toe. This requires two things: (1) earlier mental health screening and intervention and (2) telemedicine to fill the gaps of behavioral health specialists throughout much of the country.
Well-visits are a missed opportunity for mental health screenings
Well-child visits are critical to tracking children's growth and development. These visits are a time to review and discuss children's development, including physical, cognitive, emotional and social development milestones, as well as physical examination such as vision, hearing, checking blood pressure and measuring weight gain. But today's well-child visits barely scratch the surface of mental health.
Traditionally, mental health is not addressed by healthcare providers in a primary care setting until a child reaches adolescence. Yet, research shows that, mental, behavioral and developmental disorders actually develop in early childhood. A CDC study that screened U.S. children ages 2-8 years found that one in six had a detectable mental, behavioral or developmental disorder. Expanding mental health screening for pediatric patients is an essential step to ensuring that youth receive appropriate mental health treatment.
Value-based care can open the door to more behavioral health screenings
As more healthcare organizations shift to value-based care (where they are reimbursed for achieving specific health outcomes, rather than charging a fee for specific services) mental healthcare has shown tremendous potential to improve long-term patient outcomes and lower the overall cost of care. The life expectancy of a patient with severe mental illness is 25 years shorter on average, and when chronic diseases are accompanied by a mental health condition, the cost of care increases by 200-300 percent.
Across Atrium Health's 50+ primary care practices, we've found that early behavioral health intervention achieves the best population health outcomes. This includes catching early signs of a childhood mental health disorder, before it progresses and becomes severe. The right behavioral health intervention at an early age can transform a patient's entire life and may also reduce the overall cost of healthcare over a person's lifetime.
Expanded screening is not enough — we also need to expand access to treatment
Even when a child is identified as having behavioral or mental health concerns, the wait time to receive treatment can take months. This is primarily due to the lack of child psychiatrists currently practicing in the U.S. Here in North Carolina, the psychiatrist shortage that affects much of the country is particularly severe. Nearly one in three counties currently have no practicing psychiatrist. When providers are in short supply, patients who live far away from urban centers — approximately 40 percent of our state's population — experiences transportation as an additional barrier to care.
Virtual health meets behavioral health
How can hospitals and healthcare organizations meet the enormous behavioral health needs of the present moment? There are two critical components: virtual technology and a team-based approach. Across our large healthcare system, we have seen firsthand how telemedicine can expand services, even with providers in short supply. Since 2015, we have integrated virtual behavioral healthcare into several of our pediatric clinics. If a child or parent expresses mental health concerns at a pediatrician well-visit, or a pediatrician would like to incorporate additional mental healthcare with his or her patient, a virtual consultation — via video connection or phone call with a behavioral health specialist — can bring a team of experts right to them, regardless of where the patient is.
After the appointment, the Behavioral Health Integration team will reach out to the family with regular phone calls to learn how treatment is working, answer questions that arise, and provide ongoing support to their pediatrician. Since our Pediatric Virtual Behavioral Health Integration program began, the 915 youths who have taken part in the program have shown dramatic improvements in their mental health:
- 65 percent have shown a significant reduction in depressive scores
- 68 percent have achieved significant reduction in anxiety
- 47 percent have achieved remission of their depressive symptoms
- Most significantly, 83 percent of children who entered the program with suicidal thoughts no longer had suicidal thoughts when they completed the program
Meeting pediatric patients where they are
Ultimately, virtual behavioral health enables providers to reach more patients in a single day, bringing much-needed behavioral health services to communities that would otherwise go without them. Virtual behavioral health also saves time, reduces travel burdens, lowers the costs of care and fights the stigma associated with asking for mental health support. With mental health disorders in the U.S. increasing at an alarming rate, healthcare organizations must be more proactive in addressing emotional health at the point of care. If healthcare leaders invest dollars in behavioral healthcare technology now, millions of dollars — and lives — could be saved.
Author Bios
Ruth Krystopolski serves as senior vice president of population health at Atrium Health, which operates a network of more than 40 hospitals and 900 care locations, providing a full spectrum of healthcare and wellness programs throughout the Southeast region. Prior to joining Atrium Health, Ms. Krystopolski coordinated population health initiatives at CHRISTUS Health, a Catholic health system that provides care to patients in the southeastern United States and internationally. She also worked as executive vice president of care innovation and president of Sanford Health Plan at Sanford Health of Northern Minnesota.
Manuel Castro, MD, serves as the Medical Director of Behavioral Health Integration at Atrium Health. He leads the Behavioral Health Integration team in servicing primary and pediatric care practices across the healthcare system through a virtual platform. In 2016 Dr. Castro was honored to become a Fellow for the American Psychiatric Association. He is the recipient of the Brian R. Nagy MD teaching award at CMC-Randolph and is an adjunct associate professor of psychiatry with UNC-Chapel Hill.