Behavioral Health: The Red-Headed Step Child of Healthcare

The widespread acceptance of behavioral health treatment in the world of healthcare is still relatively new. In the eyes of many, it’s necessity is still questionable compared to other disciplines. The heavy stigma around the issues it tries to address may be partially to blame. It has been under-appreciated for decades. Despite being the underdog of healthcare, its acceptance is growing as studies turn up that show it is more important than was publicly accepted.

Numerous recent studies indicate that behavioral health is important for whole-body wellness. The holistic initiatives entering the healthcare arena stress the importance of a healthy mental state as a part of being a healthy person and maintaining good physical health. A 2012 study of 30-day readmissions found that 79 percent of readmitted patients had a behavioral disorder complicating their physical conditions. As clinicians intervened earlier to address those behavioral issues, and the readmission rate fell 8% in just two months. Jenifer Nolan, head of the behavioral health enterprise KentuckyOne Health says, “When you’re depressed, by nature you become hopeless and you don’t think anything is going to help, no matter what you do.” This means that these patients are less likely to follow through with regimens and recovery instructions when they leave care. Behavioral healthcare administered early could significantly cut not only these patients’ suffering, but also health care costs.

The impact of mental illness and substance abuse on medical outcomes is not to be underestimated, according to experts. You may say behavioral health is not as exciting as cardiology, but it does play a critical role in heart disease, cancer, and all physical diseases according to David Deopere, vice president at Unity Pont Health-Trinity, a regional health system that serves the Quad Cities area of Illinois and Iowa. He said we already know that behavioral health issues exacerbate physical disease. Physical disease also exacerbates behavioral problems. A 2008 scholarly study says depressed people have a 37% greater chance of developing diabetes and a 2001 study concluded that having diabetes doubles the odds of developing depression. In order to tackle the physical disease, treatment has to integrate both aspects.

There are many examples of the effectiveness of mental healthcare in reducing physical health issues. Intermountain Healthcare in Utah conducted a study and found that when treated in primary care clinics comprised of both medical and behavioral professionals, patients went to the emergency room 54% less than patients not using behavioral care. This integrated approach saved that health plan $700 per year per patient.

Historically, mental health and physical health have been fragmented. Having two separate systems, however, is less effective and more costly. Patients who depend mostly on their primary care and need behavioral health care a well rarely get it. Even when they are referred, they only make their appointment about 50% of the time. This could be due to the stigma associated with behavioral and mental health labels or due to proximity to care or cost. 96% of counties in the United States are underserved when it comes to having enough psychiatric prescribers. For people in these areas who need help, the nearest psychiatrist could be miles away.

The mainstream is beginning to accept the need for behavioral health integration more  and more as more research comes to light about the benefits it would bring. For one, it would reap better results for patients dealing with serious chronic illnesses. The diseases are difficult enough to manage even without having to worry about depression and substance abuse. Alcohol or drug abuse may develop as a way to cope with a chronic illness or traumatic life event. The abuse can worsen conditions for a diabetic, for example. Social support, education, or information may not be available to the person. They may be isolated, or too exhausted to even follow up with different appointments. A more convenient one-stop shop would be much more helpful.

Medical and behavioral health care clearly can’t address the mind-body relationship if done separately. Work is being done around the country to figure out effective ways to create integrated systems like this. Much of the physical self-neglect medical professionals encounter with chronically ill patients becomes more understandable when their behavioral health issues are unearthed. Taking a look at the bigger picture really helps understand and treat a person.

Reference

1. Holmes, Emily A., Michelle G. Craske, and Ann M. Graybiel. “Psychological Treatments: A Call for Mental-health Science.” Nature.com. Nature Publishing Group, 16 July 2014. Web. 20 Jan. 2015.

2. Morrissey, John. “The Evolution of Mental Health Care.” Trustee. Trustee Magazine, 1 Oct. 2013. Web. 20 Jan. 2015.

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