By Ralph Judah, managing director, health care global markets, and David Rabinowitz, senior manager, Deloitte Consulting LLP
The COVID-19 pandemic has both highlighted and worsened the world’s underlying mental and behavioral-health challenges. Social isolation, loss of income and health coverage, anxiety about acquiring COVID-19, and concern about loved ones falling ill have placed a tremendous strain on all of us.1 Government agencies around the world have warned that a wave of depression, substance abuse, post-traumatic stress disorder, suicide, and other behavioral-health issues could be on the horizon as a result of the pandemic.2, 3 Prior to COVID-19, an estimated 1 in 4 people experienced significant mental illness at some point in life,4 and about 1 in 5 working-age adults were affected by mild-to-moderate disorders at any given moment.5 These challenges are now being exacerbated. Mental distress during the pandemic is three times higher than it was in 2018.6
Prior to COVID-19, we had projected that by 2040, there would be far more emphasis on early detection and prevention of mental and behavioral health issues compared to today. The recent health crisis, however, likely accelerated that timeline by 10 years or more. A convergence of social, political, and technological disruptions is pushing this change forward. While this transforming landscape will look different for health plans, health providers, and major employer groups, we expect that some of the same six drivers of change will help shape mental and behavioral health in the post-pandemic era:
- Cultural and behavioral change: Mental- and behavioral-health disorders are often under-reported due to long-held social stigmas. An openness about such illnesses could make it easier for people to confront and manage their challenges. This change appeared to be underway before COVID-19—particularly among members of Generation Z. A study from the American Anxiety and Depression Association found that 60 percent of young Americans (between the ages of 18 and 25) consider seeing a mental-health professional as a sign of strength—compared to only 35 percent for adults over the age of 26.7 As stigmas fade, maintaining and treating mental and behavioral health will likely become an ingrained part of our daily health dialog, including at work. Employers are already growing increasingly interested in the physical and mental health of their employees. There is an understanding that healthy employees are more productive, and we expect more employers will be held accountable for helping their employees maintain a level of mental and behavioral health over time. As a result of lowering stigmas—and an increased emphasis on mental and behavioral health from employers—the paradigm can shift to a focus on prevention vs. treatment.
- Scientific and technological advancement: Scientists and researchers are learning more about the role genetics, neuroscience, endocrinology, and other factors might play in mental and behavioral health. Some studies have even uncovered connections between the gut microbiome and the brain.8 An increased understanding about what drives mental and behavioral illness could lead to new therapeutic breakthroughs and treatments. Such tools could include genomic testing and screenings for mental and behavioral conditions, mass-customized diagnosis and treatment modalities (e.g., psychedelics, neuromodulation, and virtual-reality treatment and diagnosis), and machine-learning-enabled systems that improve diagnostics by leveraging patient histories to improve triaging and tailor treatment.
- Increased access: The reduction in stigma, combined with scientific breakthroughs, could help drive low-cost access to mental and behavioral health services. The expansion of telehealth—which accelerated during the COVID-19 pandemic—will be one path to expanded access. Federal regulators have temporarily removed barriers to ensure that health providers are paid for virtual visits. In turn, many physicians, therapists, and other providers turned to tele-visits to help ensure patients continue to receive needed care. Meanwhile, startups including Talkspace and Care.Coach are now offering direct-to-consumer virtual treatment choices. But the emphasis on virtual health is only one mechanism by which access can increase. We also anticipate that mental and behavioral health will become more tightly integrated into primary care, and that targeted testing and screenings for mental and behavioral conditions will become accessible to everyone. This could help ensure that issues can be addressed early. All of this will likely be enabled by accessible insurance coverages. Increased availability of virtual mental health care can lead to higher use, which could create a feedback loop that further reduces stigmas.
- Data sharing: Smart phones, wearable technology, and always-on sensors have given consumers an opportunity to collect, analyze, and share sensitive mental and behavioral health data, such as stress and anxiety levels. While consumers have become accustomed to capturing information about their physical health, data sharing could also make it possible for mental and behavioral health-related data to be passively collected via sensing technologies connected to both physiological and social-sharing data. This data-sharing could enable tracking of early warning signs about the state of individuals’ mental and behavioral health and give providers a clearer picture of their patients’ needs. We could also see employers begin to aggregate and compete on the overall mental and behavioral health of their employee population. Healthier employees tend to be more productive, engaged, and positive, which has a downstream financial impact to the employer. This also could be used as a recruitment tactic if employers can demonstrate their commitment to mental and behavioral health.
- Interoperable data: As data is increasingly shared by consumers, it is also likely to be increasingly interoperable. Individual health records will be able to travel easily across data systems as a result of shared data standards and access to secure and centralized databases. In early March, the US Department of Health and Human Services (HHS) released final rules for interoperability. The rules establish standards and requirements for application programming interfaces (APIs) to support patient access and control of electronic health information (EHI). In turn, we expect data will be more easily aggregated into data lakes, which can allow for effective development of analytics. This process is already underway: Four of the largest tech giants have all recently committed to supporting data interoperability in health care by publishing open-source, cloud-based software solutions to allow for greater interoperability, according to Deloitte’s recent report on Radical Interoperability. The interoperability of the data could combine with improved data collection to make it possible for health organizations to more effectively screen, model, and forecast potential mental and behavioral health issues and to help address them before they emerge.
- Empowered consumers: Consumers are already taking advantage of personalized well-being tools to practice self-help and sustain health independently, while efficient pricing and robust access to high quality services can help ensure that everyone can pursue the help they need. This has become even more apparent during the COVID-19 crisis. While choices have become more limited, people are finding ways (like the utilization of apps for meditation and exercise) to maintain their well-being through self-care. Social media platforms are beginning to offer mental and behavioral care support, disrupting traditional care modalities and increasingly shifting power into hands of consumers.9 This transition is happening as the medical system is also adapting: Payers and provider systems are placing increased importance on consumer-centricity to be successful.
Hospitals and health systems, health plans, and employers have different perspectives about where behavioral health is headed, and how it will get there. Providers, for example, are seeing more care shift from the inpatient setting to the outpatient setting, and now toward more virtual care. Health plans are changing how physicians are reimbursed for those virtual services, and employers are beginning to consider mental and behavioral health as essential to maintaining the health and productivity of their employees.10 Over the long run, we anticipate that stakeholders will work with state and federal regulators to address mental and behavioral health needs.
May is Mental Health Awareness month, and the COVID-19 pandemic has shined a spotlight on mental and behavioral health. As it does so, it also may be accelerating the process of change toward a world in which prevention, early detection, and effective treatment help far more people to maintain their health while reducing stigmas.
- COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially for Loved Ones; Older Adults are Less Anxious, American Psychiatric Association, May 25, 2020
- What We Must Do to Prevent a Global COVID-19 Depression, Time, April 9, 2020
- The coronavirus pandemic is pushing America into a mental health crisis, The Washington Post, May 4, 2020
- Mental disorders affect one in four people, World Health Report, World Health Organization
- Making Mental Health Count, OECD Publishing, 2014
- COVID-19's Psychological Toll: Mental Distress Among Americans Has Tripled During the Pandemic Compared to 2018, Time, May 7, 2020
- A Survey about Mental Health and Suicide in the United States, Anxiety and Depression Association of America, 2015
- Evidence mounts that gut bacteria can influence mood, prevent depression, Science, February 4, 2019
- Snapchat Is Ready to Disrupt the Health Care Conversation, American Hospital Association
- Employers are planning to grow their virtual mental health services, Business Insider, May 12, 2020