Before the pandemic, access to mental healthcare was far from equal. Depending on insurance coverage, it could be difficult to find an in-network provider — let alone one that meets specific care needs.
Kevin Dedner, CEO of mental health startup Hurdle, remembered an experience seeing his primary care physician 15 years ago when he was struggling with depression.
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“He leaves and he comes back with a seven-page printout, with three columns of names on each page. From there it was for me to play a game of pick and choose, and I ultimately saw three therapists before I found a therapist that I made a strong connection to,” Dedner said during a panel at MedCity INVEST.
Later on, he learned that he was not the only person to experience this, as 53% of African Americans and 30% of the general population end therapy prematurely. He went on to start Hurdle, which trains its therapists to provide culturally competent care.
Recent data from the Centers for Disease Control and Prevention further clarifies these disparities. In the last week of March, 35% of the adult U.S. population reported experiencing symptoms of anxiety or depression. They were even more prevalent among women, Latinx and Black respondents. Youth have also been disproportionately affected; more than half of people ages 18 to 29 reported symptoms of anxiety or depression.
Now that the pandemic has laid bare some of these longstanding problems, the question is, what will change?
One silver lining is that more people are talking about their mental health, and more people are recognizing mental health conditions in the same way that they would seek care for any physical health condition.
“I think one of the things that we will fundamentally talk about is this growing awareness of the disparities that already existed in our communities have been amplified by this collective trauma experience that everyone had,” said Daniele Fallin, Chair of the Department of Mental Health at Johns Hopkins Bloomberg School of Public Health. “It’s important to point out, the pandemic happened — at least in this country — in an intersectional time with a racial reckoning and a political event that was the election of 2020.”
Dedner said his company has seen more people seeking out mental healthcare, especially African Americans and Asian Americans. While in one sense, this is encouraging, it’s also sobering.
“It tells how impactful this pandemic period has been on certain populations,” he said. “I’m convinced this is going to be one of the legacy issues we’re going to have to deal with in the aftermath of the pandemic.”
In the last year, there’s also been a significant shift as more people accessed care through virtual visits, especially for mental healthcare. Although this made it easier for some people to seek out therapy or other services, it didn’t solve the challenges many patients encounter in dialing through a list of phone numbers, looking for someone who is available and takes their insurance.
“There’s a disconnect between supply and demand,” said Stacia Cohen, executive vice president of health services at CareFirst BlueCross BlueShield.
Right now, she’s prioritizing finding characteristics and practice patterns for mental health providers to be able to “match” them more effectively with patients who need care. But in the future, she sees a need to look upstream to address social determinants of health — economic, social, and environmental factors that can affect people’s mental health. She also would like to see more mental healthcare covered through value-based models, which could help alleviate some of the access challenges patients encounter.
“As a carrier, I shouldn’t care if care is delivered face-to-face, via televideo, phone call, email, chat, carrier pigeon or smoke signals … Rapidly accelerating value and outcomes-based models, rather than volume-based models, can eliminate that barrier,” she said. “While we continue to be on a fee-for-service chassis, ‘pay per click’ for all of these modalities is problematic.”
Photo credit: Benjavisa, Getty Images
Correction: This article has been updated to correct a paraphrased quote from Cohen about addressing mental health care upstream. She was referring to social determinants of health, not providing care in schools and workplaces.
