By: Lisa Tyndall, PhD, LMFT
Associate Director, Center of Excellence for Integrated Care | Foundation for Health Leadership & Innovation
Yes, there has been a shift in the conversation around mental health. We are fortunate that folks have started sharing more about their experiences with anxiety, depression, bipolar and stress overall. Listen to Pandora, NPR, or many other media channels and you will likely hear a commercial for BetterHelp or other services offering talk therapy. And yet, it is still true that we often don’t seek that help until things feel pretty darn crummy. In fact, insurance companies will often not reimburse for talk therapy unless the service is deemed “medically necessary” meaning that there must be evidence in the notes and a diagnosis that makes it bad enough for them to see it as important. Our question at the Center of Excellence for Integrated Care is, “Why would we want to let it get bad enough?” Do we let patient’s blood pressure get “bad enough” with rates at an elevated level for multiple years before a medical provider offers interventions to help improve the potential negative outcomes? The answer is no. So why is mental health not treated the same?
Over the past several years, the Center of Excellence for Integrated Care has joined several states in the effort to ask insurers to create a reimbursable service that would empower licensed clinicians to have conversations about preserving mental health and wellness with children, youth, and their caregivers. In the current clinical context, children receive a well child check that is technically required to cover a long list of topics often leaving little to no time to comprehensively discuss a child or youth’s mental health. Of course, when a child is suffering from anxiety or depression or some other mental health challenge, these medical providers are often the first stop and are helpful at connecting them to resources. There is often not time, however, to have a more thorough conversation when a child or youth is doing well about how to maintain that degree of mental wellness.
In talking to a myriad of stakeholders over the last several years, it is clear that the providers, parents, and kids we spoke with would welcome an opportunity to focus on health from this preventive perspective. Especially in primary care, providers shared that if they have a lengthier conversation regarding mental wellness these days, they are often doing so at the expense of their schedule and other demands creating a strain on themselves, their offices, and their patients. Behavioral health clinicians were excited to have the opportunity to have mental wellness conversations with kids and youth. While some expressed concerns about the workforce available to provide the service, it is our contention that we must not let that be a roadblock or the need for in-patient and more intensive levels of care will likely never diminish.
We were slated to contract for a pilot implementation of this type of service in early winter of 2025, however due to federal funding challenges that pilot is delayed. However, we are grateful for the opportunity to support students at Duke University—through the Duke Business Behind Health: Incubator Program—who have volunteered to write a report on the business case and implementation of this service. We are hopeful this project will help us catch a glimpse of the benefits this type of service provides when it is reimbursable.
Other great work also continues around youth behavioral health through the efforts of CaroNova. For example, highlighting the voice of the youth, they recently held a Youth Design Day with over 40 youth coming together to share their vision for supporting youth mental health and wellness to inform the direction of the Youth Behavioral Health Action Plan. In an effort to continue lifting the voices of the youth, they will also be strategizing ways to hold similar sessions in the future across the state. Additionally, the NCIOM recently published a follow up to their “Building Resilience and Promoting Well-Being: An Updated Action Plan for North Carolina’s Children and Families.” As Positive Childhood Alliance NC noted in a recent report, legislators are aware of the importance of prevention and the necessity of implementing changes on the systemic level. We have an opportunity to make some significant changes in these systems that positively impact our children’s lives and futures. From the community level, with a decrease in mental health stigma to a provider and payor level with building a sustainable prevention infrastructure, we must begin to consider prevention and wellness as a critical part of the health and mental health conversation.
Posted in Mental Health Awareness