Editor's Note: Dr. David Wennberg is the CEO of Quartet Health, a mental health technology and services company. Dr. Ezekiel Emanuel is Vice Chancellor for Global Initiatives and Professor at the University of Pennsylvania. The opinions expressed in this comment are those of the authors. See more articles like this at cnne.com/opinion.
(CNN) - When the flu pandemic hit the United States in 1918, healthcare was a privilege reserved for an elite. But the widespread outbreak of a deadly virus does not include social hierarchies. It showed signs of an inadequate health system, which very few could access.
As a result, forward-thinking people built a public health infrastructure from scratch, one of which we can still highlight its vital importance.
More than a hundred years later, in the midst of the new coronavirus pandemic, we face the consequences of another inadequate and inaccessible system: mental health care. The psychological pressures that COVID-19 has brought - physical isolation and distancing, rapidly rising unemployment and economic losses - have triggered what amounts to a secondary pandemic for millions of Americans. We need a review of mental health care in the country.
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Help does not arrive on time. According to research published in the Journal of the American Medical Association, in April of this year, about three times more adults reported psychological distress than in 2018. That same month, text messages to the Disaster Emergency Help Line of the federal government increased by almost 1,000%.
As the pandemic continues to affect us, parents - especially mothers - have reported feelings of pain, fear, and loneliness as they balance their children's education and hold full-time jobs. Furthermore, reports of domestic violence and abuse are increasing around the world.
The murders of George Floyd, Breonna Taylor, Ahmaud Arbery, and so many others have increased anxiety and depression among the black community, compounding the experience of trauma and psychological violence caused by systemic racism.
We must address this huge mental health crisis. However, to make significant changes, we must first examine the failure of our current system.
Historically, society has denigrated mental health, perhaps because the condition of the mind seems less "real" or measurable by established standards. This notion largely segregates mental health from the medical system, undermining our investment in mental health treatment and care to this day.
Although nearly one in four American adults experiences a mental health condition each year, according to the National Institute of Mental Health, less than half receive the care they need.
One reason is that there are not enough professionals in the field. In 2012, there were only 34 psychologists for every 100,000 people in the United States, according to the American Psychological Association. There are even fewer psychiatrists, the mental health specialists who have the power to prescribe drugs. Just 13 per 100,000 people in the U.S., since 2018.
For those seeking care, finding the right treatment can be distressing. Too often, people with insurance receive a 1-800 number on the back of a card as their only solution to contact mental health services.
Outdated lists of psychologists and psychiatrists often include 'ghost networks', suggesting that they in fact do not purchase insurance, have retired or even died, which confuses and discourages patients from seeking them through this mechanism. .
One study found that, as of 2017, patients were five times more likely to need to go offline for mental health care than they were for physical health care. It's not hard to imagine the tremendous impact this has on patients' ability to get help.
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We need a mental health care system adequate for the challenges of the 21st century. The question is, how do we build it?
The first step is to recognize that mental health is a key component of overall health. This begins in the doctor's office, where mental health screenings should become as routine as taking blood pressure.
Such assessments as part of a standard checkup would help primary care physicians proactively identify mental health conditions, the first step in getting patients the care they need.
With an understanding of the clinical needs of patients and information on the clinical experience of professionals in the field, technology can help patients receive mental health care based on their needs and preferences. Some may want in-person care, others may opt for home teleconsultations or digital care through a secure platform.
This structure would begin to make more efficient use of limited specialists and bring people to that care more quickly.
By using a patient's baseline mental health assessment, physicians and health professionals in this field could set treatment goals and collaborate with the patient's care team, including their GP.
They could also keep track of the patient's progress and find out if they are getting healthier with treatment. This information would be kept secure, as with electronic medical records.
Still, knowledge and infrastructure alone won't fix a broken system. To truly support ubiquitous access to care, we need to build a system in which therapists are paid more to purchase insurance. In 2017, those involved in that health sector were reimbursed 24% less than primary care physicians.
It is no coincidence that, during the same year, patients found it increasingly difficult to find professionals who would accept their insurance. Due to low reimbursement rates, it can be more lucrative to work directly with patients who can pay out of pocket than to work with insurers.
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To address this disparity, health insurance companies must pay more to professionals to help patients recover. Through the same technology used to measure the health of patients and match them with appropriate care, insurers can begin to understand the quality of care provided by a professional in the field.
In the immediate term, health insurance companies can use aggregated non-identifiable patient data to pay psychologists and psychiatrists more money for providing excellent care. In the long run, they will save money.
Studies show that improving patients' access to mental health care reduces the overall costs of health plans, particularly with regard to chronic physical conditions.
This would be beneficial to health insurance plans, professionals, and most importantly, patients. People with mental health problems might be better off. Health insurance plans would save costs in the long run. And therapists would earn more money to practice patient-centered care.
We know that making these changes will not be easy, but they are critical. Mental health conditions are not unique experiences. They are often chronic conditions that present different needs at different times. We must ensure that patients can access the care they need, especially during the most difficult times, so that they can stay healthy throughout their lives.
Just as the 1918 flu showed us that access to health care cannot be limited to the few, the current pandemic confirms that we can no longer wait for a quality mental health care system. We have the knowledge. We have the technology. We have the capabilities. Now, we need the courage to act.
Mental health
