Mental health is a difficult topic to discuss even at the best of times. But when a patient is already suffering from a disease or illness, or when they're recovering from surgery, they're in a particularly vulnerable state of mind. It's during this time — at the complicated intersection between physical impairment and compromised mental health — that we pay some of the heaviest social prices.
Whether it's health care costs spiraling out of control or the palpable frustration of watching a loved one struggle with their well-being, an emerging body of research and a host of advocacy groups are challenging the health care status quo. Their mission is to help the public and our institutions better understand why bodily health care should include care for mental health as a matter of course — and coming up with practical ways to pursue "bundled care" to look after both at the same time.
Why Is Mental Health Care an Unmet Need?
In the United States, at least, which hasn't seen its way forward to a truly public health care system, commitments to good public health come with huge expenses attached. The private insurance apparatus is wasteful, it leaves millions unprotected, and it doesn't, generally speaking, take mental health seriously enough to include it in the average insurance plan's benefits.
At the present time, there is no federal-level mandate for insurers to include mental health.
Unpacking the reasons why this is so would take a considerable amount of time. One of the major factors is the stubborn social stigma attached to mental health. But our collective squeamishness about the human brain means we're ignoring the long-known and still under-appreciated fact that mental health is actually far more central to sound bodily health than previous generations understood or believed.
But now, several research and hospital groups are attempting to change the conversation. They're doing this by putting together pilot programs at major hospitals to test the effectiveness of bundling "standard" and mental health care. Why? To ensure a holistic approach to disease treatment, surgery recovery, and generally getting patients back on their feet — and back into a healthy state of mind — more quickly than current approaches allow.
How Does Bundling Mental and Physical Health Benefit Us?
Over the course of thousands of patient studies across hundreds of hospitals, a 2013 program called the "Bundled Payments for Care Initiative" launched a deliberate effort to study whether, and to what extent, treating patients for mental and physical health simultaneously, and throughout recovery, was beneficial.
This nationwide program set out with the goal of improving health care efficiency and bringing costs down. What they found satisfied that goal and more. They pulled back the curtain on what is one of the major missing pieces in the United States' health care system: the understanding that compromised mental health care is inextricably linked to bodily health and treatment recovery in many ways. Here are some of them:
- Patients with chronic conditions, or who are worried about their health or their death, are more likely to suffer from compromised mental health, including suicidal ideation.
- Patients being treated for medical conditions who have a co-occurring mental illness pay higher prices for health care on average than those who do not.
- Patients with mental health disorders are less likely than their counterparts to take their full medication courses, take their medication on time, or fully comply with their doctors' instructions.
Leaving mental health care "off the table" when discussing health care policy is a form of institutionalized discrimination, according to some. But just as important as the moral argument, in this and in any other political climate, is the cost-benefit analysis.
Shawn Bishop, a vice president at The Commonwealth Fund, sheds some light on the efforts being conducted to study this question and raise public consciousness about the results they've found:
"We know that mental health care is not always at the top of the agenda for patients with other chronic diseases ... we also know that better treatment of mental health conditions can assist patients to benefit from treatments for their medical conditions and can reduce the costs of care. It follows that if organizations are willing to make an investment in mental health treatment, they might be able to recoup some of that investment in a bundled payment system."
So far, attempts to prove the merits of this type of "bundled payment system" have been promising.
Proof, One Study at a Time
A landmark study conducted at Massachusetts General Hospital was precisely the demonstration this concept needed, and exactly at the right time. The hospital's psychiatrist-in-chief, Dr. Jerry Rosenbaum, effectively summed up the experience this way:
"The success of that project was in large part due to "care" rather than "treatment" — especially care management and psychosocial and behavioral health care."
To be more specific, the hospital studied the health outcomes of Medicare patients who received simultaneous treatment for "standard" health concerns as well as for their mental health. The results confirmed researchers' suspicions: costs for patients dropped and recovery times and outcomes improved. Making the study even more impressive, these results reflect the real-world experiences of some of the most chronically ill — and most expensive to insure — patients in the country.
"Treatment" vs. "care" is an extremely illuminative way to look at this conversation. "Treatment" means considering one problem at a time in isolation and "fixing" it. But virtually all of the available medical research says this is only half the job. "Care" goes several steps further than treatment by considering the whole patient, including their all-important mental health history and present state of mind.
Nobody is certain at present where the future of American health care is headed — but studies like these demonstrate the importance of revising what real value looks like in the world of medicine. It's business as usual to incentivize hospitals and health systems based on their health outcomes — but we've been undermining those outcomes, and spending far more money than we need to, by leaving mental health off the table.
With both body and mind accounted for in their treatment courses, patients are more likely to recover successfully and avoid future hospitalizations.
In turn, this brings down costs for everybody — whether in a private insurance setting or within a single-payer social health system.
Ultimately, more study is needed to better understand how mental health treatment impacts the full range of diagnosable and treatable conditions — but these studies and observations are encouraging signs already. If every hospital began treating the mind as well as the body, beginning with making basic mental health screenings a part of general medicine, the benefits for the country as a whole would be dramatic.
