3 Ways to Improve Behavioral Healthcare Access for Vulnerable Populations

With the need for mental health treatment increasing—and a shortage of behavioral health specialists to fill this need—healthcare organizations must seek ways to expand the reach of virtual behavioral care especially for vulnerable populations.

The need for behavioral health solutions is especially acute among children and teens, where we have seen rising rates of depression, anxiety, suicidal ideation, and hospitalizations during the pandemic. The upward trend even caused Children’s Hospital of Colorado to declare a state of emergency for children’s health this past May. The worsening crisis, combined with the fact that mental health services were severely disrupted by the pandemic, resulted in an increasing number of kids struggling to access care. As a result, emergency departments (EDs) saw a 24% increase in mental health-related ED visits among children ages 5 to 11 and a 31% spike in these visits among teens, Centers for Disease Control & Prevention (CDC) data show.

“Even though we've spent the past decade expanding our pediatric mental health services, it's not nearly enough. We're running out of beds for kids seeking psychiatric help,” Jena Hausmann, president and CEO, Children’s Hospital Colorado, wrote in an op-ed for US News.

With mental health outcomes dependent on access to the appropriate services in the right settings at the right time, how can healthcare providers most effectively pair vulnerable populations with the care they need? Here are three approaches to consider.

No. 1: Seek ways to redistribute mental health resources virtually to reach those in rural areas. More than 60% of rural adults believe lack of access to behavioral health resources would be a barrier to treatment. States like Utah, Wyoming, Idaho, Alaska, and Mississippi rank lowest in the United States for mental health access. Not only do these states suffer from a lack of behavioral health specialists, but factors such as long travel times, poverty, and lack of insurance create barriers to treatment. In rural areas, poor penetration of broadband services also prevents some populations from connecting with mental health services via telehealth.

Some healthcare providers are exploring ways to more tightly integrate behavioral health services with primary care to ensure that those in need receive the appropriate treatment and support. For example, Indiana University Health set up telehealth kiosks for behavioral health in 100 primary care clinics across the state. This approach helps patients avoid turning to the ED as an entry point for behavioral health services. IU Health also ensures that EDs in its system have 24-hour access to remote psychiatric consults when patients require evaluation in real time. When patients need follow-up behavioral care, a telebehavioral health specialist will facilitate connections to specialists nearby.

No. 2: Encourage primary care physicians to screen for mental health challenges. The U.S. Preventive Services Task Force recommends screening all adult patients for depression. This is especially critical during the COVID-19 pandemic, when 42% of adults report recent symptoms of anxiety or a depressive disorder, according to the CDC. In fact, a University of Michigan study reveals that individuals over the age of 50—especially women—are more likely to report that their mental health had worsened during the pandemic.

When screening results suggest individuals would benefit from mental health treatment, processes should be in place to support a seamless referral to behavioral health providers—virtually or in person. Doing so can appeal to some patients’ desire for private, convenient care from their home. It can also provide members with a better experience in finding the right specialist when local or near-local resources are limited. Some health plans also offer emotional support and resources for stress, anxiety and depression—including online therapy—via a mobile app or by phone.

No. 3: Make it easy to connect children and teens with telebehavioral health services. An Amwell and Nemours Children’s Health survey found 61% of parents are more willing to use telehealth now than prior to the pandemic, including 29% of parents who previously did not use telehealth. Further, families with social determinants of health challenges were more likely to use telehealth than those who did not, and 37% of these families would use telehealth regularly, according to the survey.

These results point to increasing acceptance of the use of pediatric telehealth among families—and the potential to connect children and teens with mental health services when they are offered virtually.

Nemours staff began to provide tablets to teens to complete mental health screenings in the ED, resulting in a 62.3% mental health screening rate, up from 1.77% of patients prior to the initiative. When the need for behavioral health services is identified, staff offers recommendations for counseling via both virtual and in-person resources, increasing the chances that families will find an option that works best for them.

More than 1 in 5 teens seen in the ED of Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware, during the first year of the pandemic reported severe depression, while nearly 8% said they experienced suicidal thoughts. Most surprising: the high number of positive screens for mental health concerns among teens who presented with health complaints other than behavioral health. Yet ED screenings for mental health issues among children and teens are not standard components of ED care.

Mental health issues in children and teens are not obvious. Even parents may not recognize the prevalence and scope of mental health concerns among their children. By connecting children and teens with telebehavioral health screenings and resources, healthcare providers can more effectively pair children and teens with the virtual support needed to manage the mental weight of the pandemic and adolescence.  

Designing the Right Approach

Today, one 1 out of 4 telehealth visits delivered via Amwell are mental health-related, a trend that emerged almost immediately after COVID-19 emerged in the United States. By working with primary care practices, pediatricians, Eds, and health plans to extend the reach of telebehavioral health to vulnerable populations, healthcare providers can close gaps in mental health care for those who need it most. Such an approach helps eliminate health disparities, improving delivery of vital services as well as quality of life.

Anthony Sossong, MD, is chief medical director, behavioral health for Amwell.