HOSPITALS & PROVIDERS
Members lack benefit understanding, quality information, and a segue into treatment programs
MORE AMERICANS than ever before are using mental health services, yet more than a third of those who need treatment are not getting it. These are among the key findings of a new study, 'Therapy in America 2004,' the first to examine emerging consumer trends and attitudes in mental healthcare.
The nationwide study consisted of a telephone survey of 500 adults and an online survey of 1,730 adults who have needed or have received treatment for a mental health problem within the past two years.
The results of the study have important implications for MCOs as they search for the best strategies to manage mental illness. Depression is the No. 1 cause of disability in the United States and worldwide, and second only to heart disease as a cause of disability. Chief findings from the study show that:
* A surprising number of Americans receive help for mental health conditions;
* More than one-third of those who need treatment do not receive it;
* Prescription medication is the predominant type of mental health treatment; and
* Consumers lack key information for selecting a therapist.
PART OF AMERICAN LIFE
A substantial number of Americans are either in treatment themselves or have friends or family members who have received talk therapy or medication. The good news is that mental health treatment is widespread and widely accepted, and most people are overwhelmingly satisfied with their treatment. More than one in four adults, or an estimated 59 million people, have received treatment for a mental health problem in the past two years via talk therapy, medication, or a combination of the two, according to the study. Of these, the majority (80%) report high levels of efficacy and satisfaction, regardless of the type of treatment received.
However, increased utilization of mental health treatment represents a challenge for MCOs that need to find cost-effective ways to provide behavioral health benefits, which can significantly improve healthcare outcomes. MCOs should choose a behavioral health partner that: 1) has the providers and facilities necessary to ensure its members receive timely and appropriate care; and 2) uses an evidencebased approach to identify issues, manage serious cases, and measure results of treatment to document significant medical outcomes. Outpatient treatment programs using an evidence-based approach can reduce worker impairment, help employers avoid prolonged losses in worker productivity, and reduce unnecessary absenteeism.
The study uncovered the top barriers to receiving care as: cost, lack of coverage, the belief that one's problems are not serious enough, and the lack of confidence that treatment helps. About 37% of those who report having experienced sufficient distress to warrant treatment have not received it. These people-estimated to number 24 million-represent just one in 10 people in the general U.S. adult population.
While the stigma of therapy is less than in the past, it has not disappeared entirely. The fear that therapy would go on their 'record' is mentioned by 22% of respondents, and the concern that friends or family could find out is mentioned by 19%; Women are far more likely to seek mental health treatment than men (63% vs. 37%).
MCOs need to bridge the 'access gap' or void where consumers are caught between what they don't know and what they need to know. Because many consumers are unfamiliar with their mental health coverage, MCOs must do a better job of educating their members about the availability of that coverage. They also must help remove the stigma of receiving psychotherapy or mental health services that still exists and keeps people from seeking treatment. In particular, service organizations need to reach out to men, who are more reluctant than women to seek help. Progressive, managed behavioral healthcare organizations are beginning to embrace tele-Web technology to make psychotherapy accessible to more people.
And lastly, MCOs need a behavioral health partner that has the ability to cost-effectively manage and measure outcomes, to identify people at risk and facilitate an intervention if needed, and to keep at-risk people involved in therapy until they improve.
TALK THERAPY VS. MEDICATION
Talk therapy, particularly goal-focused cognitive therapy, has been shown in numerous studies to be effective alone, or in concert with medication, for many patients. Nonetheless, the study found that 81% of those with a treatment history-an estimated 48 million people-report taking or having taken a prescription medication for a personal, emotional or mental health problem in the past two years. In contrast, only 53% report undergoing psychotherapy.
With recent concerns over the use of antidepressants and possible increased incidence of suicide, it is more important than ever that drug use be monitored. MCOs need a clinical feedback system to identify patients at high risk for suicide, chemical dependency or premature treatment termination and a system to help monitor patient use of antidepressants and other drugs. An effective behavioral health partner should provide a tool that measures a patient's progress and determines how much therapy is needed, and for how long it is needed, for the patient to get better.
The practical factors most people consider when choosing a therapist, such as geographic proximity and cost, fail to address the most important elements of a successful therapist-client match-the therapist's personal style and listening skills. The most common factors cited in the choice of a mental health professional include: recommendation from a doctor, whether the therapist is part of the individual's health plan network, proximity to home or work, and cost.
In contrast, the factors ranked as most important in making therapy successful include: the therapist's listening skills, the therapist's personality, the personal connection with the therapist, the therapist's being active in the session, and the cost.
Since the therapist is such an important factor in getting patients better, MCOs need to supply members with quality rankings so they can select a therapist based on the clinician's quality and capability for general or specific areas of therapy.
[Author Affiliation]
BY JERRY VACCARO, MD
[Author Affiliation]
Jerry Vaccaro, MD, is president and CEO of PacifiCare Behavioral Health, Santa Ana, Calif.
