Addressing the Youth Mental Health Crisis Requires an Urgent Shift in Focus

Behavioral health care requires significant reform and innovation to become more effective. Experiencing a problem like depression, anxiety, or self-harm during adolescence has high costs and can lead to negative long-term effects—not only on mental health but also on peer and family relationships, physical health, health-risking behaviors, and educational/occupational achievements¹. Despite this heavy burden, young people struggling with mental health challenges often remain untreated or face delayed detection, long waitlists, and multiple contacts with services before obtaining appropriate care². Recently, the US Senate Finance Committee held a second hearing on mental health care for America’s children. In the wake of the US Surgeon General’s Advisory on Protecting Youth Mental Health, the hearings highlighted the urgent need for bipartisan efforts to work toward real solutions.

Sen. Ron Wyden (D-OR) outlined a goal to produce a bill this summer to bring together work to accelerate efforts. He summed up the many challenges lawmakers are seeking to address, including building up the mental health workforce in light of shortages to meet current demands, making mental healthcare more seamless, advancing mental health parity, and improving access to care via telehealth. His bottom line was to underscore the consensus on advancing efforts to ensure everyone in America can get effective mental healthcare when they need it. As a clinical psychologist and director of the University of Oregon's Center for Digital Mental Health and cofounder of Ksana Health, a digital behavioral health company focused on transforming mental health care, I want to stress 3 crucial points:

Prevention and earlier intervention are key to “bending the curve.” Lawmakers’ commitment to addressing the youth mental health crisis is encouraging, however, there’s a fundamental need to shift from a crisis mindset to one of prevention and early intervention. Instead of addressing youth depression and mental health at the point of crisis (e.g., once a child or teenager has developed a severely disabling mental health problem or even become suicidal), we need to pivot to embrace a truly sustainable approach—one of prevention, early intervention, and ongoing care.

These approaches need to be data-driven, and emphasize improved quality and better health outcomes. This requires us to develop flexible modes of care that are matched to what a person needs at their stage of the journey. Not all people need a face-to-face consultation with a mental health professional at every stage. Sometimes support from a mental health coach or using a smartphone app for self-care will meet people where they are, and free up more intensive (and expensive) care resources for where they are needed.

The critical issue is to build a system that allows people to move up and down levels of care so that they can get the right amount of support for where they are without creating barriers to access. The wide adoption of mobile and wearable computing (particularly in the form of smartphones) provides opportunities for breakthrough innovations in behavioral health care that can help us to achieve this goal.

Increasing access won’t make a difference if it isn’t access to quality care. Data collected across the world where access to behavioral health services has dramatically increased over the past few decades (i.e., US, Canada, UK, Australia) has shown that increasing access to care does not, in and of itself, reduce the burden of disease associated with mental disorder. These findings have prompted some to suggest that along with addressing the accessibility gap in behavioral healthcare, we must also address the quality gap^3,4. In short, increased access to care must be combined with other innovations and system reforms if it is to have the desired impact of reducing the public health burden of youth mental disorders. Collecting data on the quality of care, and related outcomes, is much better than simply measuring the services people receive. Here again, a digital transformation of behavioral healthcare can provide these data so that we can ensure we are scaling up not just access, but also quality.

Parity is imperative. Solving this issue involves a rethinking of systems. Mental health needs to be funded and prioritized on the same level as physical health. While the move to telehealth is necessary to increase ease of access (particularly amongst underserved communities) and to address the shortage of practitioners, there are other important tools needed to truly modernize the system. There is an emerging class of digital behavioral measurement tools that can leverage data collected from smartphones and wearables to continuously monitor behaviors that may signal the early signs of mental distress. These kinds of data can provide new insights into how mental health is changing across places and across time. Continuous behavioral health monitoring is fundamental to measuring individual baselines and outcomes throughout the service user’s journey.

Measurement in behavioral health needs to be redefined as routine and essential in the same way remote patient monitoring is in physical health. Remote patient monitoring in behavioral healthcare should be reimbursable the same way that glucose monitoring for diabetes or monitoring of cardiac disease is reimbursable. Indeed, there are all kinds of health monitoring devices to help healthcare providers monitor physical health. Other than self-reporting surveys, there is currently no consistent measurement for mental health. We need consistent, objective, and scalable tools to measure behavioral health risk factors and outcomes.

We applaud bipartisan efforts to open up greater access to mental healthcare and to elevate mental health to the level of funding and focus that physical health receives. However, to ensure our youth get access to quality care, it’s vital to establish support for mechanisms of accountability. Requiring new models for measurement and delivery of behavioral health support will allow practitioners to implement assessment and intervention more effectively. Together these efforts will increase access to the effective care our youth desperately need.

Nick Allen, PhD, is co-founder and CEO of Ksana Health.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.

References

¹ Birmaher, B., Arbelaez, C., & Brent, D. (2002). Course and outcome of child and adolescent major depressive disorder. Child and Adolescent Psychiatric Clinics of North America, 11(3), 619–637, x. https://doi.org/10.1016/s1056-4993(02)00011-1

² MacDonald, K., Fainman-Adelman, N., Anderson, K. K., & Iyer, S. N. (2018). Pathways to mental health services for young people: a systematic review. Social psychiatry and psychiatric epidemiology, 53(10), 1005-1038.

³ Jorm, A. F. (2018). Australia’s “Better Access” scheme: Has it had an impact on population mental health? Australian & New Zealand Journal of Psychiatry, 44, 000486741880406–6. doi: 10.1177/0004867418804066

⁴ Jorm, A. F., Patten, S. B., Brugha, T. S., & Mojtabai, R. (2017). Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry, 16(1), 90–99. http://doi.org/10.1002/wps.20388