How medical practices are adapting to the surge in demand for behavioral health services

A Sept. 27, 2022, MGMA Stat poll reveals that about 3 in 10 medical practices (30%) are looking at adding or expanding behavioral health services in the coming year.

The poll, which had 460 applicable responses, points to medical practice leaders putting their efforts toward areas such as:

• Partnering with independent counselors and allowing psychologists and therapists to use space in the office multiple times a week for patient care
• Fully integrating primary care and behavioral health so providers in both specialties establish patient care
• Adding behavioral health within an existing pain practice
• Using a trained nurse practitioner (NP) assisting as a physician extender, allowing for easier ADHD, anxiety and depression testing, as well as medicine management
• Bringing on new licensed clinical social workers (LCSWs).

Among medical practices that signaled no such changes, only 10% said they were considering adding or expanding services in the next two years, as some expressed concerns with the financial feasibility of such a move or a lack of office space to add new providers.

The decision to invest more in this space comes as the behavioral health needs of patients remain significantly elevated more than two and a half years since the start of the COVID-19 pandemic.

• An athenahealth study from January 2019 to February 2022 found that 21% of patients saw a mental health provider for the first time during the pandemic, and another 17% re-engaged with past mental health treatment.
• A 2021 American Psychological Association report found that more than 8 in 10 (84%) of psychologists treating anxiety disorders reported an increase in demand for treatment since the start of the pandemic.
• At one point this past year, Geisinger Health had a backlog of behavioral health patients of 18,000.
• A recent study from the Harvard T.H. Chan School of Public Health points to an increasing use of psychiatric mental health nurse practitioners to help meet the needs of Medicare patients.

As COVID-19 case numbers have come down from their peak, a new Ipsos survey this month found that mental health is now the top health concern among Americans, supplanting COVID-19.

Integration of behavioral health

Editor’s note: The following is excerpted from “Post-COVID-19 trend watch: Implications for practices,” in the October 2022 issue of MGMA Connection magazine.

The demand for behavioral and mental healthcare services continues to increase, exacerbated by the effects of the COVID-19 pandemic.1 Nearly a third of Americans exhibit depression or anxiety,2 and demand for treatment of anxiety, depression, and substance-related and addictive disorders has increased.3 College students have shown an increase in depression and alcohol use disorder;4 alarmingly, 68% of Millennial and 81% of Gen Z workers have left a job due to mental health reasons.5

Contributing to this problem is that nearly 40% of Americans live in an area designated with a mental health professional shortage.6 The lack of mental healthcare professionals means Americans are increasingly looking outside traditional care delivery models to obtain mental and behavioral healthcare, including from services provided by their schools or employers, or from more novel solutions such as mobile apps or virtual therapy.

As demand increases and the access gap widens, many universities struggle to enhance their programs to meet the growing need.7 Some universities are prioritizing changes to foster an inclusive and supportive educational environment, increasing the volume and diversity of behavioral health staff, reducing the stigma associated with seeking care, and offering mental health screenings for students.

Similarly, many employers are improving resources to support their employees’ mental and behavioral health needs — nearly 23% of workers say their employer introduced new mental health services during the pandemic,8 but a third of employees say their employer program does not go far enough.9 Employers that want to retain high-quality staff will have an increased interest in investing in their employees’ mental health, particularly in reducing absenteeism, lost productivity, increased healthcare costs, and decreased quality of work.

An influx in non-traditional mental healthcare services has occurred in recent years, particularly because of the pandemic. Year-over-year investment has more than doubled for mental health tech startups, reaching more than $5 billion in funding in 2021.10 Non-traditional mental health services, such as virtual therapy or mobile health applications such as LiveHealth Online or Talkspace, may provide more immediate access to help, but their success in sustained management of care will depend on how well they are integrated within the patient-physician relationship.

While universities, employers, and virtual care options can help fill the mental healthcare gap for many individuals, a critical juncture for patients accessing mental health care is still their primary care or non-primary care specialist physician. Physicians and practices will need to be vigilant about communication and continuity of care when alternative mental and behavioral health services become part of a patient’s care. Practices that can sustainably integrate behavioral and mental healthcare with their patients’ regular care will be poised to better compete in the market and improve care for their patients.

Additional resources

• “Integrated behavioral health in a clinical primary care setting” (Insight article)
• “Behavioral health professionals embracing telehealth as patients social distance” (Podcast)
• “Valuing access to behavioral healthcare over ‘transformation’” (Insight article)
• “Integrating behavioral health models in practice” (Insight article)

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Notes:

1. “Demand for mental health treatment continues to increase, say psychologists.” American Psychological Association. Washington, D.C., Oct. 19, 2021. Available from: bit.ly/3PxmDsK.
2. USA Facts. “Over one-third of Americans live in areas lacking mental health professionals.” June 9, 2021. Available from: bit.ly/3Pk6GXk.
3. American Psychological Association. 2021 COVID-19 Practitioner Survey. Oct. 19, 2021. Available from: bit.ly/3RFB2oG.
4. Kim H, Rackoff GN, Fitzsimmons-Craft EE, et al. “College Mental Health Before and During the COVID-19 Pandemic: Results From a Nationwide Survey.” Cognitive Therapy and Research. 2022;46(1):1-10. Available from: bit.ly/3odtlZf.
5. Greenwood K, Anas J. “It’s a New Era for Mental Health at Work.” Harvard Business Review. Oct. 4, 2021. Available from: bit.ly/3ofXYxn.
6. Bureau of Health Workforce. “Designated Health Professional Shortage Areas Statistics.” HRSA, HHS. As of June 30, 2022. Available from: bit.ly/3RHWpWp.
7. Aslanian S, Roth A. “Under Pressure: Inside the college mental health crisis.” APM Reports. Aug. 19, 2021. Available from: bit.ly/3AZIWDh.
8. Leonhardt M. “23% of workers say employers are offering new mental health benefits. But is it enough?” Fortune. April 22, 2022. Available from: bit.ly/3zfurKl.
9. Constantz J, Boyle M. “Employers Struggle With Mental Health Help as Traumas Pile Up.” Bloomberg. June 13, 2022. Available from: bloom.bg/3ObJ4CM.
10. CB Reports. State of Mental Health Tech 2021 Report. Feb. 24, 2022. Available from: bit.ly/3OgPrVt.