Since the pandemic, the shortage of behavioral health professionals has become more dire as the need for more comprehensive mental health care has increased. As of March 2023, 160 million Americans lived in areas with mental health professional shortages. 55% of counties in the U.S. have no psychiatrists, and 77% report a severe shortage.
In some states, such as Maine, there was a 50% drop in the number of psychiatrists from 2015 to 2020, leading to wait times of up to 18 months to access psychiatric care. Moreover, 70% of psychiatrists are 50 years old or older. By 2025, demand for psychiatrists will outstrip supply by 25%.
The toll that psychiatric illness takes is substantial. Depression is the leading cause of disability in the world. Medical costs for treating patients with chronic medical disorders and co-occurring psychiatric disorders such as depression are two to four times higher than in those without psychiatric disorders.
Nearly half the population in the U.S. report recent symptoms of anxiety and depression. The annual number of deaths by suicide is 48,000, and overdose deaths exceed 100,000. Among the 20% of the U.S. population that are the highest utilizers of medical care – accounting for 80% of all health care costs – 60% to 80% have an underlying psychiatric disorder that drives increased utilization. Despite the high prevalence of psychiatric illness and costs associated with untreated psychiatric illness, 60% of those with a psychiatric disorder and 90% of those with substance use do not receive any psychiatric treatment. It’s not only the stigma of receiving treatment or a lack of resources available but an unreliable intake system to identify and support those who need the most help.
We live in an era where physical health providers are overwhelmed with requests from patients, lacking many of the tools and training needed to address the surge. And simply collecting written questionnaires on a patient’s mental health is not enough. Integrated behavioral health care models, where behavioral and physical health providers work together to treat patients, can address this growing issue. But with limited resources and high demand, delivering effective, integrated behavioral health care at such a large scale is challenging.
In response to this growing need, measurement-based, population-focused models of care combined with the thoughtful utilization of digital solutions has emerged as an effective approach that can help deliver integrated care at scale despite limited resources.
What is measurement-based, population-focused care?
Measurement-based and population-focused care, a critical part of integrated care models like collaborative care, is an evidence-based health care approach where treatment decisions are guided by systematic measurement of patient-reported symptoms, functioning, and overall well-being.
Typically, measurement-based care (MBC) includes standardized questionnaires (to assess symptom severity, progress, etc.), data collection, and provider analysis of the data to make informed treatment decisions and continuously adjust a treatment plan based on the patient’s evolving needs. This health care approach allows providers to offer more effective and personalized care based on objective information collection and assessment.
MBC, traditionally used to collect and assess physical health metrics (blood sugar, weight, etc.), is essential for treating patients holistically — taking into account both their physical and behavioral health. For patients needing behavioral health support, MBC can help objectively track and assess a patient’s symptoms, which can often be subjective and highly variable over long periods. With MBC, health care providers can monitor a patient’s mental health status — whether it’s stable, improving, or declining — and address it accordingly.
Aside from the efficiency that MBC can provide, this type of clinical approach can also help bridge other, more interpersonal gaps in the health care system. If executed well, ongoing patient monitoring can inform highly personalized treatment plans and improve patient and provider communication, allowing patients a structured channel for sharing their experiences with mental health without stigma or shame. Likewise, MBC can be used to help bolster patient engagement. The self-reported methods of MBC can encourage patients to take a more active role in their treatment plan and diagnosis, which can be empowering.
Integrated care models are focused on treating large populations while relying on fewer resources. Psychiatrists that participate in these integrated care models will not consult with patients directly. Instead, they provide oversight of large caseloads of patients managed by behavioral health clinicians working in the practices alongside the non-psychiatric attending physicians (e.g., primary care physicians).
MBC and population-focused integrated care models can bring an actionable, data-driven approach to supporting behavioral health while substantially increasing access to behavioral care holistically interwoven with patients’ overarching medical needs. However, it’s incredibly challenging to execute this strategy successfully without the right technology.
How can technology advance measurement-based care?
One of the biggest hurdles to using measurement-based care is having the right technology to deploy and scale it. Without technology, health care providers can struggle with administering routine assessments, or receiving unbiased patient information (due to the lessened but still present stigma around mental health) among other administrative burdens. With technology, health care providers can work more efficiently and more cost-effectively by sending remote questionnaires – clinical assessments like PHQ-9 and GAD-7 – via desktop or mobile, so providers and patients aren’t limited to in-person assessments, which can take up valuable appointment time.
Providers can set up custom notifications that alert health care providers, directly in the EHR, when a patient’s data indicates a significant change or deterioration to help ensure timely intervention if necessary. Technology helps health providers make the most out of MBC — helping to risk-stratify populations, deliver timely interventions, and even allow health care providers to be proactive in their care, saving costs and preventing behavioral health crises.
Measurement-based care — with the help of technology — embodies a commitment to evidence-based, patient-centered care, and it holds the potential to revolutionize how we understand, manage, and treat behavioral health conditions. The deployment of MBC using robust, secure technology has the power to create a brighter, healthier future for everyone.
Tom Zaubler is a psychiatrist and physician executive.