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Behavioral Healthcare’s Metaphorical Cockpit Has Blinking Red Lights
We work in an evidence-based healthcare field. Our commitment to following the evidence means we stay alert for warning signs connected to key metrics. Behavioral health leaders should use these metrics to guide the field in the right direction. This is often analogized to airplane pilots being guided by lights and gauges in the cockpit. Two of our field’s guiding lights are blinking warnings.
Lights are flashing red for rates of effectiveness and rates of access. The flashing red effectiveness light signifies that measurement-based care (MBC) utilization is dangerously low. Existing MBC systems show good results, so this light should go green by widely implementing MBC. The flashing red access light signals very low rates of care access for those with behavioral problems. Easy solutions are lacking here.
Grounded in a Spirit of Innovative and Core Values
Research evidence helps determine the clinical value of each service. Successful clinical trials must be followed by studies in the field. Consider psychotherapy, where randomized studies find several approaches efficacious. These positive results mean little if the practitioners are not effective in daily practice. Evidence needs to move from the lab to the field to ensure real-world effectiveness.
Another way of thinking about this is that MBC completes the process of validation. We train clinicians in validated approaches and license them to work independently. Delivery systems must then ensure the care delivered is effective. The pinnacle of being guided by evidence is producing a system of care with effective clinicians. Executives utilize MBC to reach this pinnacle.
While therapeutic evidence resides at the client level, an equally important type of evidence lives at the population level. It begins with epidemiology, which, by definition, collects evidence on “the incidence, distribution, and control of disease in a population.” This evidence is a critical part of ensuring appropriate access to care. Our access rates are as important as our rates of therapeutic effectiveness.
Sadly, access rates for behavioral health are among the worst in healthcare, and so this must spur us to action on many fronts. We must explore workforce expansion, the use of new modalities (e.g., virtual and digital), and the development of brief interventions for reaching more people. While our field has varying levels of control over the many drivers of access, we can create new, scalable interventions.
Psychotherapy sessions scale poorly, but we know that much of the effectiveness of therapy rests with the person delivering it. The evidence of poor access should push us to find more scalable services that real-world evidence finds to be effective. This might include brief visits over an extended period of time in the primary care setting, more use of group sessions, and new single-session clinical models.
Access solutions must balance innovation with our core values. Some hesitate at deviating from traditional therapy, but our dismal access rates demand breaking with the status quo. However, innovative and scalable tech solutions must not lead us to compromise our values. Any tech solution must embed clinical oversight, and empirical results (not a tech bias) should guide our problem-solving.
Driven by a Sense of Urgency
Our field has many planes flying diverse clinical missions, but all are pursuing a common goal: we provide effective care for those in need. We are all impacted by a failure to achieve our field’s common goal. It may be imperceptible day to day, but our field is ultimately endangered by these persistent red lights. Let us not become accustomed to the blinking. They demand a sense of urgency.
Executives can make a difference by fostering a culture where we focus as much on results as on care processes, where we care as much about those with unmet needs as those gaining access. Important goals are not achieved by just attending to everyday business—focusing on them as an explicit priority is essential. We also will never succeed by doing the same thing and expecting different results.
How long will we accept delays in implementing MBC across our industry? When will frustration about access rates lead to ambitious, multi-faceted plans to move the numbers? Waiting for governmental solutions is a poor bet since they are likely to be inadequate. Waiting until a major crisis pushes tech leaders into the driver’s seat to fix access may be a regrettable non-decision.
No single leader controls all the levers that must be pulled to achieve these goals. Yet every leader can call out the blinking lights and support collaborative action to move forward. We should not let the vast sums invested in our field recently create a sense of complacency. Investors tend to prioritize profits over improving a field, and our lights will still be blinking when investors move to the next opportunity.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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