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Valuable Behavioral Model Attracts and Activates Consumers
Our field must do a better job of attracting consumers to use our services. Simplifying the logistics of accessing care would help, but people also need basic help understanding their problems and the solutions available.
We need consumers using services to be less passive. Approaching healthcare in a more active and informed way has been called health “activation.” Activated consumers take ownership of their health status, attempt to stay healthy, and use healthcare services wisely.
Attracting and activating consumers depends heavily on communication. Healthcare is complicated, and we need clear ways of communicating the who, what, and why of care. High-level templates depicting key elements of healthcare are often called clinical models. Are some clinical models better at attracting and activating consumers? Let us consider 2 of them: the disease (or medical) model and the recovery model.
The Superiority of the Recovery Model for Increasing Access
Diagnosis is the foundation of the medical model, and effective treatments are rarely possible until symptoms are framed diagnostically. Yet healthcare’s emphasis on diagnosis as the first step in care misses the actual first step: accessing services. Access is a problem in itself, and our field will fail to attract and engage people in care if we think everything starts with knowing and owning one’s diagnosis.
Our field is grounded in diagnosis like other areas of healthcare, but we have 2 unique problems. There are no physical or lab tests to verify behavioral diagnoses, and few people want one since they are laden with stigma. Once a long-delayed diagnosis is confirmed, people want something (e.g., pills, technology) to remove their disease or disorder. The passive patient role is common across healthcare.
We should set a low bar for consumers to use our services. General distress is enough reason to ask for help. Questions about diagnosis are premature, unsettling, and reliant on professional assessment. How might our field be more welcoming to consumers? We should normalize their experience, convey that any type of distress merits getting help, and instill hope about learning critical health improvement skills.
A good alternative to the disease model is the recovery model, showcased every September during National Recovery Month. Recovery is nearly universal in scope because it applies to numerous conditions. Beyond mental health and substance use disorders, the recovery model includes people with medical conditions like diabetes and heart disease. It stresses improvement rather than cure.
Recovery is hopeful, pragmatic, and social. It validates not just professional care, but the support of family, friends, and peers who have experienced recovery. Recovery is an ideal entry point to our field because it is welcoming and activating. It opposes stigma by appealing to everyone’s common humanity. A desire for wellness or wellbeing, rather than having a specific diagnosis, is all that is required.
Consider how Mental Health Awareness Month each May differs from September’s recovery focus. May addresses mental illness and excludes substance use disorders. Unlike recovery month, May avoids all reference to behavioral health. While it is vital that we advocate for the unique solutions connected with mental illness, the population we serve is covered by the expansive term “behavioral health.”
Stigma is a major obstacle to treatment access. We have relied on the medical model for defeating it. The argument that behavioral illnesses are “like any other” has had a limited impact. People are a bit more willing to think medical services are warranted, but stigma’s social rejection remains firm. An attraction model focusing on our common humanity might be a better tool against the forces of social exclusion.
Making Self-Efficacy a Goal for Healthcare Consumers
All of us face recovery at one time or another. The recovery model speaks to everyone. Life presents stressors at every stage. One need not have an illness to need recovery tools. We recover from loss and disappointment in life as much as illness. People fail to get engaged in care for many reasons we cannot control. Yet we can control how highly we prioritize attracting people to care.
Care access is driven by conflicting currents. Due to pent-up demand, attracting consumers may bring more people into care than can be helped at first. This is why health activation is an important corollary. We need to replace the passive patient role with an image of resilient people owning their health status. Let us imagine people enjoying a sense of self-efficacy in managing their health and healthcare.
A businessperson might find this too ethereal. Self-efficacy is not on the curriculum in most business schools. Yet increased access to services is possibly our field’s primary problem. We will never fix our low rates of care access unless we focus on the problem squarely, and the norm today is little more than bemoaning the problem and waiting for technologists to swoop in with easy solutions.
Attraction and activation may seem like odd ideas for most executives, but we need both structural and communication solutions to help millions of people in need. The status quo is certainly not the answer.
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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