Why don't we treat mental health like we do physical health?

This article was first published by Mercer here.


One impact of the pandemic has been the increase in behavioral health conditions across the US population. In 2019 between 10-20% of adults were suffering from depression, anxiety or other condition; by 2021 that number had reached 40%. This makes behavioral health issues about as common as high blood pressure. With the broadening of our collective experience of these conditions, we’ve seen some of the barriers to getting help start to fall: There is greater recognition of the behavioral health conditions, more openness about discussing them, and less stigma attached to seeking care. We can hope this will be a permanent change.

Nearly every encounter with the healthcare system includes a blood pressure check. This makes sense because high blood pressure is common and there are steps to take to help protect people from consequences like heart disease and stroke. Like untreated hypertension, untreated behavioral health conditions have a negative impact on people’s health and ability to participate fully in their home and work life. And, again as with hypertension, there are effective ways to treat behavioral health conditions and improve the health of the people suffering with them. That’s why it is so important to integrate a behavioral health screening into routine medical encounters. For too long, behavioral health has been treated as a separate category of care, resulting in countless missed opportunities to identify behavioral health conditions and get people the care that they need. Given the general lack of understanding and stigma surrounding behavioral health conditions, people struggling with behavioral health problems may not know to seek care directly from a behavioral health care provider. To really tackle our current behavioral health crisis, screening for behavioral health must become as common as checking a person’s blood pressure.

report from Johns Hopkins underscored the importance of this approach. People with diabetes were found to be 2-3 times more likely to have depression than those without diabetes, but only a quarter to a half of them were diagnosed with depression. The study also found that if a person had both diabetes and depression they had a 46% higher likelihood of dying. Other studies have shown that healthcare costs for those with chronic conditions and behavioral health diagnoses are 3 times that of those who do not have the behavioral health conditions.

Benefit professionals can support the shift to this broader view of behavioral health conditions and their impact. First, any analysis of the cost of this disease burden must look beyond expenses that fall strictly in the behavioral health category to include a view of both chronic disease and leave utilization. This more comprehensive analysis will provide a better picture of what is going on in a population and also establish a better baseline to measure the impact of targeted programs or resources that are put in place. Next, any program you offer that is intended to improve health should include an integrated behavioral health screening protocol and be able to refer people to behavioral health resources (including other programs available to members). For example, if you provide vendor services to support your members with chronic conditions it is important to include behavioral health screening as part of quality standards for that vendor. It is also important that these vendors are linked to resources to address behavioral health needs that are identified. For example a diabetes vendor should screen everyone they serve for depression and anxiety. Anyone who is identified as having a behavioral health condition should be referred automatically to an employee assistance program or other clinical resource that provides care. Performance guarantees can be based on successful referral of people needing behavioral health services.

A silver lining in the cloud of the COVID-19 pandemic has been greater awareness of how common – and treatable – behavioral health conditions are. It’s time to stop missing important opportunities to improve the health and wellbeing of your workforce.