I recently had the opportunity to chat with Dr. Edward F. Lawlor who is both a Distinguished Professor and Dean Emeritus at The Brown School (of Social Work and Public Health) at Washington University in St. Louis. He also serves as Board Chair at Provident Behavioral Health.
Dr. Lawlor, thank you so much for sitting down and talking with us today about this incredibly important topic - what are your views on the current state of mental health?
In the tailwinds of the COVID pandemic it has become commonplace to describe population mental health and the mental health system as “in crisis.” The New York Times1 recently published an extensive series on the mental health crisis, the Surgeon General has declared child and adolescent mental health to be a national emergency, and specialty societies, such as the American Psychological Association have “sound[ed] the alarm on a growing mental health crisis that could yield serious health and social consequences for years to come.”
Unfortunately, this rhetoric is not all hyperbole. Virtually all the indicators of mental health status have shown dramatic increases, trending up even before the COVID pandemic. According to the Centers for Disease Control and Prevention, rates of depression, anxiety disorders, and drug and alcohol induced deaths are all up steeply, and experts worry that reporting and data have not yet caught up to the real underlying increases in the population. So called “deaths of despair” are increasing, especially in regions experiencing both substance use and mental health challenges. Increases in adolescent suicides have raised particular concerns for policymakers during this period.
You talk about COVID and its’ growing impact on our mental health - how has the mental health system also been impacted by the pandemic?
As a result of the pandemic and the growing mental health demand, the entire mental health system has undergone rapid and dramatic change. Most important has been the sudden pivot to telemental health. A large volume of mental health is now provided virtually, either online or telephonically. Providers and consumers report that this transition has significantly eased access to services and increased the efficiency of scheduling. The widespread advertising of new virtual counseling and mental health services is a signal of the market and desirability of these new options.
Public policy has also adapted, most notably with the implementation of the new 988 crisis line, providing 24/7 professional response for individuals in crisis or at risk of suicide. Provident Behavioral Health is one of the major national and state providers of this service and has received much needed and timely support from the RGA Foundation.
In your view, what major gaps remain in the current mental health care landscape that you can share with our readers?
Despite the innovations we’re seeing, the shortfall between available services and demand has grown in the COVID era. Mental health providers report significant waiting lists, emergency rooms are facing too many mental health cases, and more individuals are reporting barriers to accessing needed services. While the emphasis on rapid response and crisis intervention represented by the 988 initiative has been necessary and effective, it is now important to take stock of how we can adjust to the new normal in mental health, and how we can construct a delivery system that has the potential to respond to this growing need.
The public policy agenda is daunting. To provide access to mental health services for those most in need, both public and private benefits and coverage will need reform. To provide appropriate and professional services there must be massive change in the delivery system – especially with an emphasis on community-based services. Major investments in the workforce will also be necessary in all modes of mental health services: psychiatry, psychology, nursing, social work, and counseling.
How does technology play a role in addressing these mental health needs?
The role of technology in mental health needs to be further embraced but in an evidence-based and thoughtful way. Telehealth has provided dramatic opportunities to increase access, particularly for rural and disadvantaged clients, but we are still learning about when they are most appropriate, and how they should be integrated with more traditional face-to-face therapies. More cutting-edge technologies for mental health are in the pipeline – including digital apps and artificial intelligence, digital analytics, new pharmaceuticals, implants, sensors, and monitors.
As in other sectors of social services, fragmentation and lack of governance of mental health are huge impediments to overall progress. Funding for mental health is a patchwork of public and private coverage, governmental programs, philanthropy, and charity care. No agency or system is in charge. Adjacent services, such as treatment for substance use disorders and psychiatric care, are separate worlds. Inpatient care does not connect to outpatient services. Handoffs from schools, child welfare, the criminal justice system, and medical care are almost nonexistent. Providers of services for children and youth are different than providers for families. Community, economic, and racial disparities in the availability of mental health services are enormous. The mental health “system” is really an array of well-intentioned and quality organizations cobbled together.
Where do you see an opportunity for partnership and support by the insurance industry?
Insurance industry influence is essential to move beyond crisis. First, the project of reducing stigma and promoting open and easy discussion of mental health is not finished. Creating workplaces that embrace and discuss positive mental health is necessary for the larger societal project to normalize mental health. Engaging in advocacy to organize and fund a delivery system that is responsive to the magnitude of demand is a proper and needed role for firms and their participants. At a more micro level, the design of coverage – including in insurance products – to achieve the vision of parity and promotion of mental health will require continued industry leadership.
Excellence and access in mental health services is the sine qua non for lives well-lived, hope, and a long life. It will also yield important and tangible benefits in the economy, the workforce, and civic life. It is worth the investment of time and treasure.
Thank you to Dr. Lawlor for taking the time to share these important insights – and also, thank you to Provident Behavioral Health for continuing to keep these vital conversations front and center. I recently had the privilege, alongside a few of my RGA colleagues, to work with the International Insurance Society (IIS) on a webinar around the topic of suicide. We invite all of our readers to click on the link below to learn more and to watch this powerful video:
We also want to hear from you: how, as an industry, can we continue to heighten awareness and drive purposeful conversations and importance around the topic of mental health and suicide prevention?