Invent Health: bringing mental healthcare closer to the patient

If any practitioner can recognize mental health problems, patients won't wait years to get help

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During the latest salon from Vator, HP and UCSF Healthhub, which was centered around mental and behavioral health, Dr. Nina Vasan, Chair of the Committee on Innovation at the American Psychiatric Association and Executive Director of Brainstorm: The Stanford Lab for Mental Health Innovation, mentioned one startling statistic: it takes, on average, 11 years from the onset of symptoms for someone to actually see a medical provider.

"That’s the best-case scenario, in the U.S., with insurance; think about the rest of the world, it’s even worse," she said.

The question is then, how to cut that down, a topic which was broached by Vasan and the rest of the panel, which included Alon Matas (Founder and president of Betterhelp), Brian Garrett (Co-founder & Managing Director, Crosscut Ventures), and David Bond (Director of Behavioral Health, Blue Shield of California – Promise Health Plan), along with co-moderators Bambi Francisco Roizen (Founder and CEO, Vator), and Dr. Archana Dubey (Global Medical Director, HP Health Centers, HP), mentioned some of the ways that such a huge amount of time could be shortened.

For Bond and Blue Shield, the best way to get people the mental healthcare they need is by arming all physicians and practitioners with the tools to recognize potential mental health problems and so they can then refer those patients. 

"Behavioral health and treatment is not just the responsibility of behavioral health professionals. One thing that we really are looking to do at Blue Shield is engage non-behavioral health practitioners to be a more holistically integrated practitioner that includes behavioral health," he said. 

For example, Bond mentioned that OBGYNs should be screening pregnant women for maternal mental health conditions, while pediatricians can also screen new moms for postpartum depression. This is a more effective way of getting people care because it brings mental health closet to where the patient is, as it's coming from the doctor each patient is most likely to actually see.

"You’re much more like to see a PCP than a mental health provider, and for a pregnant woman she’s much more likely to see an OBGYN than a primary care provider. You want to get where these folks, who might be more susceptible to behavioral health conditions or episodes of challenges, can get the appropriate screening, get an early detection and intervention and linkage to services that are necessary and appropriate," Bond said.

"The issue is where you access healthcare, whether it’s a culturally bound type of healthcare, like with a doula, or whoever it is that you feel comfortable with and that’s your health home. We want to integrate approaching behavioral health or mental health, social relationship, at that point of entry, where you have comfort accessing, where many people don't have a level of comfort accessing other levels of healthcare."

As of last summer, Blue Shield began requiring everyone who treats a pregnant woman to screen for maternal mental health conditions, in part to counteract advice people might be getting from non-medical professional that could be harmful to them and their baby.

"You’ve also got folks who are saying, ‘If you are pregnant, so off your antipsychotic during the course of your pregnancy,’ which can have awful outcomes. I’m in no way licensed to give any kind of medical advice, so I want to put that at the forefront of this, but if you’ve got someone who has bipolar disorder, and is subject to manic episodes, it can very damaging for a fetus, and particularly for a young child in their first year of infancy. We can reduce the likelihood or their exposure to adverse childhood experiences when we treat mom. Or give mom the treatment that she needs, and the family."

Dubey agreed with Bond, noting that what has happened in healthcare is that specialists exist in a silo, "and the point of entry for the patient has been now restricted to primary care only," something which she believes has to change. 

"The problem that we’re treating is more important than the provider that we are picking to treat that problem. So, when we are designing our operating system for healthcare, it has to be fluid enough for each of the providers to come in in order to serve the patient. It has to be very, very patient-centric and any door of entry, every provider, needs to know when to flag this patient so they don’t have to wait 11 years," she said, noting that postpartum depression, in particular, is often neglected.

"It’s not genetic transfer, it’s the environmental transfer to that child from day one if you do not treat the mom who is the core provider to that child. It’s quite impactful if we train our healthcare providers, whether it’s nurses, doulas, whoever is providing, to be able to flag this patient and get to care really quickly."

Vasan noted that mental health does need to be addressed in the medical system, especially in areas like orthopedics, which she said has a huge amount of mental health issues because of the pain that patients are in. She also brought it back to something that had been discussed earlier in the conversation, though: the role of the community and how those groups can also be used to help diagnose potential problems. 

"If we look from the community perspective, the two or three biggest groups that are able to recognize mental health struggles across the whole family are faith-based communities as well as schools, and employers at times for adults as well," she said.

"What are those other community resources, schools, faiths and other groups where we can better train those folks to be able to identify mental health struggles and then have a good pathway for them to be able to make those referrals?"

Vasan also touched on what Bond had mentioned about children being affected by mental health problems, and brought up what she believes can be done within the education system to make mental health something that can be self-diagnosed and then potentially self-treated. 

"Cognitive behavioral therapy, some schools are teaching that now, and mindfulness, some schools are teaching that now, and that’s amazing. But, really, if that was a policy initiative of some senator's who decided to take up, what that would do, by getting that curriculum and that education in at an early age, would really, really change the ability for people to understand that they’re struggling deal in some way, and then have the tools and skill set and resilience to actually deal with it themselves," she said.

"We just need to focus on educating people, and educating them as early as possible, so that the skill sets and the tools are being delivered. Because that’s what a lot of therapy is: it’s learning these tools, but sometimes you can do it in an app, and sometimes you can do it in a workbook, and sometimes you can do it in fifth grade."

Later on in the talk, Francisco took a question from the audience about how the adolescent population is being served.

"Schools are doing check-in calls and teachers are struggling to teach remotely, who feels responsible to serve this segment of the population?” the audience member asked, to which Francisco mentioned some of the ways her own children's school is helping them cope with a program called Zones For Life.

"I really am grateful for my school to be able to step in and teach the kids, the elementary school students, coping skills. So, there’s different colors and green is, ‘You’re ready to go, you’re at a good level.’ Red, maybe you’re kind of angry, not at a great level. And they really teach the kids, ‘How are you feeling and where are you?’" she said.

"Those are the types of programs that need to be adopted. More of those programs should be adopted in all schools. They go to parochial school, so they might have a little bit more money than a public school, but I think those are the types of programs that I would like to see more ubiquitously."

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(Image source: aspiringgentleman.com)