The mental health crisis in the United States is a pressing concern. In June of 2023, the U.S. Preventive Services Task Force recommended that all adults under the age of 65 be screened for anxiety disorders. While screening can help identify who needs help (and the true magnitude of the problem), disparities in access to and affordability of care continue to exacerbate the issue. A recent study published in JAMA1 highlighted the stark reality of this divide, revealing that nearly one in five U.S. counties, encompassing a staggering 10.5 million people, lacked both a psychiatrist and broadband access in 2020. Such counties, often rural and economically challenged, witnessed an alarming eightfold increase in suicides and a nearly fourfold surge in drug overdoses compared to counties with either psychiatrists or broadband. Dr. Tom Insel, former Director of the NIMH, underscored the gravity of this situation in a LinkedIn post, emphasizing the digital divide's role in the mental health crisis. In his comments, Insel pointed out that while these adverse outcomes can be attributed in part to factors like rural settings and higher poverty rates, the dearth of psychiatrists combined with the absence of broadband means that over 10 million individuals might be deprived of mental health care, both on- and offline. The findings from the JAMA study and Insel's insights underscore the urgent need to bridge this divide and prioritize mental health care access for all. And while mental health is hugely important (and often overlooked), it is also a synecdoche for all of healthcare. Some of the same problems (and potentially, solutions) are certainly true of chronic illnesses, a point driven home by a team of writers at the Washington Post.
Access to mental health is driven in part by the disparity between the need for services and the number of clinicians (particularly psychiatrists) and, in some areas, in-patient facilities. Citing data from the Health Resources & Services Administration, The Commonwealth Fund estimates that more than 8,000 additional mental health professionals are needed in 2023 to meet the needs of those requiring services. This shortage not only hampers immediate care but also leads to longer waiting times, reduced follow-up care, and in some cases, patients going without any treatment at all. Such a deficit in mental health care provision can have cascading effects on communities, leading to increased emergency room visits, higher rates of incarceration for untreated individuals, and a general decline in public health and safety.
The widening gap in mental health care provision has paved the way for innovative solutions, especially in the realm of technology. As traditional healthcare systems grapple with the challenges of clinician shortages and facility inadequacies, the digital health sector is stepping up to bridge the divide. Companies like Talkspace and BetterHelp offer platforms that connect patients to licensed therapists via video, voice, or through text-based sessions. Such platforms are a first (technological) step towards democratizing access to quality mental health care. User-friendly interfaces and the promise of confidentiality have particularly resonated with the younger generation, who often prefer digital interactions. The growing list of states that have signed the interstate Counseling Compact has provided a legislative first step, which, when combined with telehealth platforms and offerings, moves us towards circumventing geographical barriers and societal stigmas associated with seeking help. As the demand for mental health services continues to surge, these digital platforms are poised to play a pivotal role in reshaping the future of mental health care in the U.S.
In addition to telehealth platforms, the rise of mobile apps tailored for mental health has been noteworthy. Apps like Headspace and Calm provide guided meditations, sleep aids, and stress-relief exercises, catering to users looking for self-help tools to manage anxiety, stress, and other mental health challenges. Meanwhile, integrating AI and chatbots in mental health care has gained traction to the point where they are almost de riguer. Woebot, for instance, is an AI-driven chatbot designed to offer real-time responses, helping users navigate their emotions and offering coping strategies based on principles of cognitive behavioral therapy (CBT).
As the definition of health has become more holistic and is now inclusive of physical and mental health, several companies are championing the cause of integrated healthcare. Lyra Health offers a platform that seamlessly connects employees to therapists, coaches, and tailored care plans, underscoring the importance of a holistic approach to health and well-being. Hims & Hers has also expanded its offerings to include mental health services, providing access to licensed therapists and psychiatric professionals, seeking to ensure that clients receive comprehensive care. Recognizing the interconnectedness of mental and physical health, Hims & Hers' recent foray into cardiac care dovetails perfectly with their existing clientele seeking treatment for erectile dysfunction. Given that erectile dysfunction can be an early indicator of cardiovascular issues, their cardiac care offering is strategically positioned to serve a demographic whose gender and age make them prime candidates for enhanced preventative care. By addressing both mental health and physical conditions like erectile dysfunction and cardiac health under one umbrella, Hims & Hers is effectively catering to a population that stands to benefit immensely from integrated and preventative healthcare solutions.
While factors like location and socio-economic challenges clearly play a role in the disparity of access to mental health services, the lack of broadband access, crucial for telehealth services, stands out as a significant barrier. So while these digital solutions are making strides, the underlying infrastructure must be robust enough to support and deliver these services to the most vulnerable populations. The Infrastructure Investment and Jobs Act passed in November 2021 includes some tangible provisions for doing just that. With a budget of $1.2 trillion, it aims to rectify the "functional" infrastructure deficits, particularly in broadband. The COVID-19 pandemic underscored the urgent need for reliable broadband access, especially in rural and economically challenged areas. The legislation's provisions, which include a significant $65 million allocation for digital infrastructure, are designed to enhance broadband deployment in these areas and establish a minimum download/upload build standard. Furthermore, to make broadband access affordable, the legislation introduces the Affordable Connectivity Benefit, offering a monthly $30 voucher towards an internet service plan for low-income families. By bolstering the digital infrastructure, the legislation ensures that innovative mental health solutions, like telehealth platforms and AI-driven chatbots, can reach those who need them the most, bridging the gap between technology and care.
Health systems, with their inherent advantage of being integrated care systems, are uniquely positioned to address the unmet needs in mental health care. Drawing inspiration from new entrants, they can leverage their trusted relationship with patients and a suite of new technologies to offer holistic and comprehensive care solutions. Unlike some of the new competition that focuses narrowly on "microefficient" services, health systems can provide a broad spectrum of care that encompasses both mental and physical health. By doing so, they can ensure continuity of care, reduce fragmentation, and offer a seamless patient experience. The digital innovations showcased by these new entrants, from telehealth platforms to AI-driven chatbots, can be integrated into the existing infrastructure of hospital systems, enhancing their capability to deliver care. Moreover, the emphasis on user-friendly interfaces, confidentiality, and digital literacy can be adopted to make these solutions more accessible and acceptable to a wider demographic. In essence, by synthesizing the best practices of both traditional and innovative healthcare models, hospital systems can lead the way in addressing the mental health crisis, ensuring that care is not only available but also accessible, affordable, and of the highest quality.
1 Ramesh T, McBain RK, Cantor JH, Stein BD, Yu H. Mental Health Outcomes Among Patients Living in US Counties Lacking Broadband Access and Psychiatrists. JAMA Netw Open. 2023;6(9):e2333781. doi:10.1001/jamanetworkopen.2023.33781