COVID-19 Contributed to a Crisis in Behavioral Health Equity… Here are Four Domains Where Health Care Stakeholders can Mitigate this Emergency | Deloitte US has been saved
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By Ralph Judah, managing director, and David Rabinowitz, senior manager, Deloitte Consulting LLP
The COVID-19 pandemic—combined with an economic recession, high unemployment, and a growing acknowledgement of systemic racism within society at large (the health care system in particular)—further exposed some of the gaps and inequities that have long plagued behavioral health. These issues are having a disproportionate effect on Black, Indigenous, and People of Color (BIPOC).
While COVID-19 inspired innovations in care delivery, the pandemic continues to highlight many challenges related to equity. For example, virtual health expanded significantly over the past year. Many of our clients, who are responsible for large employee groups, say they are being inundated with pitches for behavioral health technology solutions. These trends are helping to improve care access for many, but the digital-access gap has made care even less available to some lower-income individuals. The future of behavioral health we envision, where access to quality and affordable behavioral health care is equitable and widespread, may be unattainable if such challenges are not addressed.
Direct-to-consumer behavioral health services, widespread adoption of virtual health, and changes to the reimbursement landscape could give organizations new avenues for responding to consumers.1,2 However, these changes likely won’t be effective unless organizations have access to interoperable data, early identification and prevention capabilities, and scientifically validated approaches that empower consumers to take ownership of their behavioral health needs (including through the use of resources such as the World Economic Forum’s Global Governance Toolkit for Digital Mental Health).
COVID’s effect on mental and behavioral health is significant, disproportionate
Deloitte’s prior studies of the pandemic’s acceleration of behavioral health trends in the US and the racial etiology and implications of this public health crisis are compounded by the behavioral health crisis we face today. Overall, about 40% of US adults have reported symptoms of anxiety or depression since the pandemic began. That’s up significantly from just 10% in 2019.3 Mental and behavioral health issues appear to be disproportionately affecting vulnerable populations such as lower-income communities and Black Americans.4 Economic challenges have forced some families to forgo behavioral health services in order to pay for the basics, often resulting in higher medical costs down the road.5,6,7
The existing landscape of behavioral health has been further exacerbated by challenges across social, economic, and health care systems that should be addressed. These challenges include:
Organizations should try to leverage the existing momentum around virtual health (inclusive of telemedicine/teletherapy, wearables, apps, etc.) to break through these issues and improve equity in behavioral health.
Four domains where behavioral health can be made more equitable
Building upon Deloitte’s work to help health care organizations improve health equity, we have identified the following four domains that health care stakeholders (health systems, clinicians, health plans, employers, and government organizations) should consider:
1. In the organization
2. In offerings for the market
3. In the community
4. In the broader ecosystem
The COVID-19 pandemic and the country’s economic and sociopolitical crises have accelerated our trajectory toward the future of behavioral health. They have also exposed the inadequacies of a system that often fails to meet the needs of its most vulnerable people. Our hope is that stakeholders will consider some of these actions and use them to lean into the future and innovate without neglecting accessibility and equity.
Acknowledgements: Preethi Kannan, Charlotte Grimm
1. Telemedicine takes center stage in the era of COVID-19, Science, November 6, 2020
2. Digital health reimbursement: The transforming landscape, MedCity News, October 5, 2020
3. The implications of COVID-19 for mental health and substance use, Kaiser Family Foundation, February 10, 2021
4. Mental health disparities among Black Americans during the COVID-19 pandemic, Psychiatric Times, October 11, 2020
5. It could take 4 years to recover the 22 million jobs lost during the COVID-19 pandemic, Forbes, November 30, 2020
6. The impact of Coronavirus on food insecurity, feeding America, October 30, 2020
7. Why people are still avoiding the doctor (it’s not the virus), The New York Times, June 16, 2020
8. Understanding the role of past healthcare discrimination in help-seeking and shared decision-making for depression treatment preferences, Qualitative Health Research, July 25, 2020
9. Trends in racial-ethnic disparities in access to mental health care 2004-2012, Psychiatric Services, August 1, 2016
10. The impact of mental illness stigma on psychiatric emergencies, Frontiers in Psychiatry, June 19, 2020
11. Stigma still a major hurdle in getting people the mental healthcare they need, Healthline, October 20, 2018
12. APA to states, insurers: Provide access to mental health care during COVID-19 public health crisis, American Psychological Association, March 24, 2020