4 Parameters Will Drive Our Field's Future

Four major parameters will shape our field in the coming years. Change within each will drive our clinical contributions and economic growth. It is vital that we seize opportunities where they exist today because our control is time-limited. Preserving the status quo is not an option. The best direction forward for our field is not apparent in each case. Now is the time for debate and planning.

How?

The first determinant is how services will be accessed. The rise of digital health services can no longer be considered a mere trend. Healthcare will be digital in major ways. Digital access will be standard for any quality healthcare system. When were you last surprised someone had an email address or a company had a web page? Digital health will be like that, a core component of every system.

Digital health is a service and not just a means of access. We have digital therapeutic tools modeled on therapies like CBT. Their use will soar, like that of virtual portals to clinicians. We may see new behavioral products built on established tools (e.g., video gaming or AI) and new technical capabilities developed specifically to support our field’s goals for changing one’s thoughts, feelings and behaviors.

Where?

The second key factor is where services are received. Services may increasingly be received outside professional settings for the convenience of patients and clinicians. Therapists who practiced via Skype, Zoom or other platforms during the pandemic can attest to this reality. Travel to visits will soon need justification. Other location changes for our field will be driven by the general healthcare field.

We are headed to becoming a subsidiary of the healthcare industry. As our services are acquired by healthcare entities, we may practice within those settings. We could be proactive here. Many believe our work is better provided within the primary care setting. There are several visions for such integration. One model has our clinicians transforming that setting with a focus on behavior change.

What?

The third factor to shape our field is what services are provided. Pharma will keep producing valuable medicines. Digital and virtual services will be pervasive. Innovators will design brief psychosocial services to fit various care settings. For example, primary care needs brief interventions to impact health behaviors, early behavioral disorders and non-adherence to physician recommendations.

Brief interventions could be modeled after formal psychotherapies, much as digital services mimic therapist interventions. Yet clinical innovators must take us further. How might a therapist best use 10 minutes or less in a primary care exam room?  Such interventions are potentiated in primary care. Visits recur over many years. We need to advance beyond the existing contours of psychotherapy.

Who?

The fourth factor is who provides services, and this includes a sub-category of the quality of providers. We start from a baseline where many healthcare networks offer poor access to psychiatry and psychotherapy. Current strategies include growing the number of professionals, enhancing PCP skills managing psychotropics, and training peers for non-professional coaching and counseling.

Healthcare’s focus on quality will likely grow. Big data may have arrived, but data-driven decisions are still absent in many settings. Data reporting on clinical outcomes for individual clinicians and treatment programs will be so routine one day that our current state will be unimaginable. We will then need solutions for the reality of bell curves. Some excel, most are good, but some providers are failing.

Searching for innovators before the new boss arrives

We have people working today to replicate the mold of psychotherapy in digital formats. Others are seeking to perfect aspects of therapy for uniformly better results. We need some therapy disruptors willing to break the mold. We need it reshaped for new settings. Therapy is a gem, but its origins are in the 19th century. Tomorrow’s psychosocial solutions could look different to address new circumstances.

Care access will remain a critical problem in our field, lacking a single solution. We may need a larger workforce, but provider growth will not change the alienating effect of stigma. If we remain an isolated specialty for advanced clinical conditions, many will avoid us. Emotional problems will be normalized only when therapists working in primary care seem as essential as PCPs to its success.

Innovation may not be what is asked of us as the healthcare industry steadily assumes ownership of our field. We may be asked to limit our work to solutions with robust validation or focus only on high-cost patients. Research may be focused mainly on biomedical cures. The future is unknown. Yet we have the time and ability to act now. Let us start debating issues that may seal our collective fate for generations.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.