Mental Health

The pressure on Australian household budgets as inflation spirals upwards is the latest reminder of how important it is to ask our loved ones, “Are you okay?” R U OK Day is an Australian invention where we’re encouraged to ask questions proactively.

Perhaps because of this country’s history of stoicism, especially amongst older men, this day is critical to making sure people are given an opportunity to speak up when they’re not right.

Mental health is a crisis, no doubt about it. Suicide kills more than 3,000 Australians every year, leaving hundreds of thousands of secondary survivors. It is the number one cause of death for young Australians.

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Credits: RUOK.org

While there are many causes for mental health trouble, one reliable predictor is economic hardship. When you can’t pay your bills, you can’t keep the lights on, the fridge stocked, and the kids clothed.

You’ll find people who have held the levers of economic power, be they fiscal or monetary, will tell you of their responsibility regarding health outcomes. There’s a certain amount of data to suggest that with every interest rate hike, a certain number of people will die from suicide. This is a critical time for mental health.

It doesn’t have to be this way. We know from experience, especially as Australians who are also known for their generosity, that when someone puts their hand up and says they’re not right, the community rallies to them.

Suddenly the lights are on because someone’s covering the power bills for a while. The fridge is stocked because neighbouring families are expanding their Sunday night cookup to make sure there are some leftovers. And the kids are clothed because there’s a bag of donations on the front doorstep.

But none of this happens unless someone says, “I’m not okay.” And while some of us are blessed with the initiative to say so, many of us need to be given a nudge. There’s no one path to mental health happiness. For everyone, it is an individual journey, and like any journey has its twists and turns.

When offering help, saying ‘let me know if you need anything possibly isn’t as helpful as we might think because there are no boundaries to that. Instead, try saying, ‘I’m here for you and checking in periodically.

Don’t underestimate how much happiness an unexpected phone call to check in and say ‘hello’ brings to the recipient. Relationships need maintenance, and that means making time and making time means effort. And with a little bit of effort, you can deliver much happiness to the person you reach out to.

Make sure to ask someone, “are you okay” today and follow up with them in the weeks and months ahead. This economic uncertainty is going to continue for a while yet. We all have to look out for each other.

More here.

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In the early 1900’s, the foundations for what was to become Cognitive Behavioral Therapy (CBT) were spearheaded by psychology leaders like behaviorist John B. Watson. However, it wasn’t until the 1960’s that the first successful experiments using CBT were conducted by University of Pennsylvania’s Dr. Aaron Beck. CBT originates from a combination of behaviorism and cognitive therapy psychology practices, with a goal to help patients navigate negative thoughts and personal challenges, focusing on well-being and positive mental health. CBT is based on the concept that your thoughts, feelings, physical sensations, and actions are all interconnected, and that at times negative thoughts and feelings can trap you in a vicious cycle. CBT aims to help patients deal with overwhelming or large-scale problems in a more positive way by breaking them down into smaller parts. A CBT therapist often revolves treatment plans around each individual patient, where a patient reveals both their strengths and weaknesses, while also setting goals for the future. 6 to 12 sessions of CBT are usually the norm to maximize benefit in patients with anxiety and depression, but this can vary according to the patient and to the supporting clinician’s decisions on each case.

CBT is not only used to address and treat mental health struggles — research has also found evidence that it is effective in treating physical health issues such as diabetes, heart disease, chronic pain including joint pain and headaches, as well as insomnia. There is also much promise in terms of advancing the science of CBT to address the needs of specific population groups, such as young people and ethnic minorities, as well as focusing on specific emotions such as envy.

With recent traumatic events such as mass shootings, racial injustice and inequality, and the ongoing impact of the global pandemic, further light is now being shed on the growing mental health crisis in the U.S. In fact, recent data shows 19.86% of U.S. adults or nearly 50 million Americans are currently living with mental illness. That same data also found that of the U.S. adults struggling with mental illness, 56% are not receiving proper treatment. Furthermore, access to in-person mental health treatment is challenging due to clinician shortages and the rising cost of mental healthcare. In recent weeks, U.S. Surgeon General Dr. Vivek Murthy highlighted the urgent need to address healthcare worker burnout, which has resulted from this understaffing, as well as in longer wait times for in-person visits.

To tackle these ongoing struggles, more people are turning to health solutions like CBT and Internet-based Cognitive Behavioral Therapy (iCBT) to help minimize the negative mental health impact many are currently facing. iCBT follows the same principles as CBT but through an easily accessible, digital format. In fact, we saw in our recent research that most patients are continuing to seek virtual care for their mental health needs, a trend accelerated by the pandemic. Through its 24/7 flexibility, users can access iCBT resources from anywhere using a smart phone, tablet, or desktop. For people who might live in rural settings, lack transportation, have unpredictable schedules, or face other challenges accessing healthcare, iCBT provides a continuous support system which allows patients to return to the psychoeducational materials and tools any time they need to.

When it comes to iCBT effectiveness, the data is very clear. One study showed anxiety and depression symptoms in participants were cut in half and remained so even 12 months after the start of iCBT treatment. Additionally, one of our studies found recovery rates in participants were high and in line with face-to-face therapy. These findings are encouraging and provide one solution to the current mental health crisis people in all age groups are facing. By exposing more people in need of mental health treatment to solutions like CBT and iCBT, we can improve overall health outcomes and see rates of mental health conditions decline.

The evolution of CBT has helped pave the way for the growth of digital solutions like iCBT, and as we look toward the future these therapeutic approaches show no sign of slowing down. Market research predicts the digital therapeutics market will be worth nearly $36 billion by 2030. By continuing to prioritize research in the mental health field, digital interventions will only become increasingly accessible. As this type of growth continues, we can ensure people everywhere have access to evidence-based mental healthcare to combat our growing mental health crisis in the U.S.

Photo: SIphotography, Getty Images

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A major concern during the Covid-19 pandemic has been that Americans, especially those with underlying conditions, will delay necessary care. New survey results show this concern is not unfounded.

As of last September, about 40% of Americans with one or more chronic health conditions reported delaying or avoiding care, according to a new report from the Urban Institute and Robert Wood Johnson Foundation.

Report authors analyzed data from the second wave of the Urban Institute’s Coronavirus Tracking Survey, a nationally representative survey conducted Sept. 11-28, 2020. The survey polled 4,007 adults, ages 18 to 64 years.

About 36% of Americans said they delayed or did not receive healthcare due to a fear of exposure to the coronavirus or because a provider limited services during the pandemic, the report states. Black adults (39.7%) were more likely than white (34.3%) or Hispanic/Latinx (35.5%) adults to report delaying or forgoing care because of concerns about virus exposure.

About four in 10 adults with one or more chronic health conditions (40.7%) said they delayed or avoided care because of the pandemic, as compared with 26.4% of adults with no chronic conditions.

In addition, more than half of adults with both a physical and mental health condition (56.3%) reported delaying or avoiding healthcare due to the pandemic. About 43% of this group also reported delayed or forgoing multiple types of care.

The impacts of delaying or avoiding care were acutely felt by those with chronic conditions, the report shows. An estimated 23.2% of these adults reported that going without or delaying care worsened a health condition, 21% said it limited their ability to perform daily activities and 15.2% said it limited their ability to work.

Further, the report shows the kinds of care that Americans were avoiding. Dental care was the most common type of care adults delayed or did not receive because of the pandemic (25.3%), followed by seeing a general doctor or specialist (20.6%) and receiving preventive health screenings or medical tests (15.5%).

“Tackling unmet healthcare needs requires effectively assuaging fears about exposure to the coronavirus,” report authors concluded. Providers need to reassure patients that they are following public health guidelines and that these precautions can effectively prevent virus transmission.

“More data showing healthcare settings are not common sources of transmission and better communication with the public to promote the importance of seeking needed and routine care are also needed,” the authors wrote.

Photo: YinYang, Getty Images

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Digital therapy startup Talkspace plans to go public in a blank-check deal that would value the company at $1.4 billion. The company, founded in 2012 by husband-and-wife team Oren and Roni Frank, lets users text or video chat with therapists.

The company will go public through a merger with a subsidiary of Hudson Executive Capital, the firm founded by former J.P. Morgan CFO Doug Braunstein. It will be listed on Nasdaq under ‘TALK’.

Last year, special-purpose acquisition company Hudson Executive Investment Corp. raised $360 million in an IPO. Private investors also poured $300 million into the deal, including Federated Hermes Kaufmann Funds, Jennison Associates, Woodline Partners and Deerfield.

Talkspace will get $250 million in growth capital after the merger closes. The deal is expected to close in the first or second quarter of 2021.

Here are four takeaways from the company’s IPO plans:

Employers were a big source of growth during the pandemic

Like other mental health startups, Talkspace saw a surge in users during the pandemic. In the last year, it saw the number of cash-paying users increase from 20,000 to 28,000.

But partnerships with companies like Blackstone and Google, and insurers such as Humana and Cigna, have been an even bigger source of business for Talkspace.

“Large employers are aware of the gap in the market that needs to be filled to allow more people to access behavioral health care,” CEO Oren Frank said in an investor presentation on Wednesday.

Companies had started to take notice of the shortage of mental healthcare providers before the pandemic. But the problem became even more pressing in the last year.

This led to a number of companies looking for ways to offer more mental health services—including those provided by Talkspace. In the last year, the company saw the number of covered lives increase from 2 million in the first quarter of last year to 39 million.

Talkspace CFO Mark Hirschhorn said Covid-19 had driven “tremendous unsolicited inbound interest in our commercial offerings.”

The startup forecasts its profit will double

Talkspace appears to enjoy large margins from its text-based therapy business. In 2019, the startup brought in $20 million in profit at a 51% margin, according to a slide shared with investors. For 2020, the company expects $47 million in profit with a 63% margin.

The startup also expects its revenue to nearly double, from $38 million in 2019 to $74 million in 2020.

Talkspace’s users currently pay $65 per week to be able to text a therapist or for audio messaging. For live video, the cost rises to $79 per week.

At the same time, the business model used by on-demand therapy platforms has come under fire as therapists report low pay. Therapists also are required to respond within a certain timeframe, or face docked pay, according to the New York Times.

Data about text-based therapy is limited

Although users have flocked to text-based therapy, it’s not clear whether it’s as effective as talking to a therapist face-to-face.

A small study published in 2015, funded by Talkspace, indicated an improvement in patients’ well being after four months of text therapy. But there is still little peer-reviewed research on the subject.

On one hand, a text-based approach makes therapy available to more people. Frank said more than 60% of the company’s users have never been to any form of therapy before.

On the other hand, a text message misses many important visual cues, such as a person’s body language or expression. From a convenience perspective, however, the model is likely here to stay.

“People will reasonably have a lot of questions. It is disruptive and part of a broader approach to telehealth,” Enrico Picozza, a partner at HLM Venture Partners, wrote in an email. “We were one of the first investors in Teladoc at a time when other investors were running from the company because of many challenges preventing early-adoption.  It was unclear if telehealth would work at that time but we saw the long term potential. Patients as well as physicians need to get comfortable with new technologies and modalities. Once that occurs and reimbursement is clarified, it is off to the races. We see that happening with text-based care in the near future.”

Other mental health startups see growth

Though Talkspace is a well-recognized brand, with celebrity backers like Demi Lovato and Michael Phelps, other therapy startups have seen a boom in activity over the last year. One of its competitors, Lyra Health, recently was valued at $1.1 billion, and has brought on clients including Starbucks and Morgan Stanley in the last year. Ginger, another startup that offers text-based therapy and coaching, also recently raised a large funding round.

Telehealth companies have also seen more patients seeking out therapy. Earlier this year, MDLive said behavioral health visits were its fastest-growing segment.

Photo credit: Microne, Getty Images

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Over the past two years, managed care organization Kaiser Permanente has been testing how to give its members access to digital health tools. The company picked six apps that it would cover for its members, and trained clinicians on how to include the use of digital health apps in their workflow.

One of the challenges is making these tools easy to find, and getting patients to use them. In a recently published paper in NEJM Catalyst, Kaiser found that patients were more likely to use health apps after being referred. So far, its clinicians have made 115,000 referrals.

“We think we’ve cracked the code and figured out how to get people to use these, in the context of treatment so that they might have their biggest effect,” Dr. Don Mordecai, national leader for mental health and wellness at Kaiser Permanente, said in a phone interview.

In early testing, a group of 562 clinicians in Kaiser’s mental heath and depression care programs referred 16,438 patients to mental health apps. Of that group, 58% downloaded an app, 40% used it at least once and 27% used an app more than three times.

Mordecai said digital health tools could serve as an adjunct to treatment, such as in between therapy sessions. Or, people could choose to access them on their own time.

Kaiser Permanente selected six apps for this program:

  • Headspace, a popular meditation app that has raised more than $200 million to date
  • Calm, another well-known sleep and meditation app that recently raised $75 million
  • Whil, an app that offers courses on stress resilience and mindfulness for businesses
  • Cognitive behavioral therapy app myStrength, which was acquired by Livongo last year
  • SilverCloud, a startup that offers mental health programs paired with coaching. It has raised more than $26 million to date.
  • Thrive, an app with cognitive behavioral therapy tools and mood tracking.

To narrow down the list of possibilities, Kaiser Permanente brought in hundreds of patients and clinicians to help assess and test these apps. It also considered whether they were based on clinical evidence and were HIPAA-compliant.

“Absolutely, issues like privacy came into the question,” Mordecai said. “There are apps out there where their business model is to gather and sell your data. That was of zero interest to us.”

There was also an emphasis on user experience — whether the apps were actually enjoyable and easy to use.

“We’ve been having conversations with digital companies for years, but I think it needed to reach a certain level of maturity,” Mordecai said.  “The first round of these kinds of things, like computerized CBT, one of the reasons that people didn’t use them that much was that they were kind of clunky. … What we’ve seen over the past five years or so is a real evolution of these apps in terms of a compelling user experience and in terms of people’s willingness to engage with them.”

Building an ecosystem

Kaiser Permanente set out to begin building this digital health “ecosystem” in 2018.  The idea was to build a platform where clinicians could refer patients to a curated portfolio of apps and document it in a patient’s health record. It began more broadly rolling this out to its members in 2020.

In recent years, the managed care organization has faced its own challenges with mental health treatment. Three year ago, Kaiser Permanente faced state sanctions after patients reported long wait times for mental health treatment. Last year, the company touted hiring more than 1,000 therapists, but mental health workers and patients said they still struggled with timely access to care.

The Covid-19 pandemic was expected to exacerbate existing problems with accessing mental healthcare across the U.S. Telehealth visits have helped bridge what would otherwise be drop-off in care, but still haven’t solved some of the root issues.

Initially, like other healthcare providers, Kaiser saw demand for visits drop as people sheltered in place, but it quickly recovered as more people turned to telehealth appointments.

“I think, in some sense, the wave is still coming,” Mordecai said. “I think we’re going to be grappling with the impact of this for a while after the virus threat is diminished.”

Photo Credit: Saimon Sailent, Getty Images

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I’ve worked in health care for more than 30 years, serving in various roles in and outside of finance. I’m not proud to say that in the past, I’ve played a role in cutting behavioral health programs in an effort to navigate budget constraints and mitigate financial losses. I’ve seen other health executives and systems do the same.

It wasn’t until about 10 years ago, when my own niece needed these programs, that I discovered the lack of an adequate care infrastructure. I’ve been living with that personal guilt for a decade.

Florida, our family’s home state, ranks 48/50 in access to care by Mental Health America. My organization, AdventHealth, regularly conducts Community Health Needs Assessments (CHNAs) in Florida and the other states in which we operate. In terms of identified needs in the CHNAs from across the system, mental and behavioral health are chosen 70 percent of the time as an area to address in our communities.

Add this to existing issues negatively impacting Americans and people around the world (e.g., a global pandemic, racial unrest and political division), resulting in a major crisis on our hands. If there was ever a time that we should see the need for behavioral health resources, it’s now.

We All Know Someone Who Struggles with It
Behavioral health is an umbrella term for a variety of conditions, including anxiety, personality disorders, learning and developmental disorders, trauma, addiction and more. Each one of these components breaks out into subcomponents. In some cases, these conditions may manifest themselves in alcoholism or bulimia; in others, in panic attacks or depression.

As a member of AdventHealth’s Behavioral Health Steering Committee and chair of its employee workgroup, I recently shared a presentation with our executive leadership team that included an eye-opening statistic from our short-term disability provider: 42 percent of mental illness disability claims are related to depression.

And yet, at times it seems like we’re not openly talking about this. Whenever we suffer from other ailments, we’re very likely to ask colleagues or friends for recommendations on specialists like cardiologists. Unfortunately, that doesn’t seem to be the case for psychiatrists or therapists. The truth is, it doesn’t matter who you are – what gender, race or socioeconomic status you come from ­­– we all know someone who struggles with behavioral health, and sometimes it’s ourselves.

It takes real courage to be in a position of leadership and admit that you struggle. If you happen to be one of those individuals, show that courage.

For the Good of Our Health and Our Communities
The science is very clear: Depression exacerbates other medical issues. That’s because the components of our health – body, mind and spirit – are interconnected.

How can we address this? We need to be better at using our primary care network to meet the behavioral health needs of our communities, as well as the behavioral health resources we provide to our health system team members.

The health care industry needs to be thinking about behavioral health more “wholistically”, which is why I like the idea of utilizing primary care. A study several years ago revealed that 45 percent of suicide victims had seen their primary care physician (PCP) within 30 days of taking their life. The Collaborative Care Model allows PCPs to manage mild to moderate severity behavioral health patients with the assistance of a care manager and consultation of a psychiatrist. It surrounds PCPs with a team so they don’t have to do it all themselves.

It’s important that we also engage community partners to see how we can get them to lean into these issues. No single organization should be tackling this on its own. We should partner with other health systems and city and county governments to put a comprehensive network in place.

And clearly, there needs to be more sources of funding, whether it’s the state, private insurance or employers. There has to be an increase in funding for these issues so those who provide this type of care can be compensated for it.

I can tell you that my perspective as a finance executive is not what it used to be. Today, I tend to intervene when people start talking about reductions in their behavioral health programs. Instead of hitting the “easy button,” I believe we’re going to have to do the hard work of figuring out how we reduce losses.

The good thing is, I’m finding I have colleagues of like mind who are committed to doing the same – the right thing.

Picture: Benjavisa, Getty Images

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Headway’s platform lets users search for in-network therapists. The company manages back-end paperwork and billing, and hires therapists as independent contractors.

When Andrew Adams moved to New York five years ago, he struggled to find a therapist that would take his insurance. He’s not alone — a little over one in four people struggled to find a therapist in their network, according to a survey conducted by the National Alliance on Mental Illness in 2015.

A shortage of healthcare professionals, coupled with a crippling pandemic, has exacerbated a longstanding problem with access to mental healthcare. Another challenge is that many therapists have independent practices, which can make processing claims and negotiating with insurers more difficult.

Adams started Headway with the idea of building his own network of therapists by creating a system to manage the administrative burden, such as claims and insurance credentialing. In turn, they become independent contractors of Headway, which is paid by insurers every time they see a patient.

“Pre-pandemic, there was a crippling access shortage. There’s a real shortage of therapists accepting insurance,” he said in a phone interview. “We’re proud to be radically growing that.”

Since March, the company has seen a surge of patient demand. Visits nearly quadrupled, Adams said. But Headway also saw increased interest from providers. Many of them referenced a “call to arms feeling,” he added.

Headway claims to have more than 1,600 therapists and psychiatrists on its platform. Roughly two-thirds of them didn’t accept insurance beforehand.

Users can search on Headway’s platform to see if a therapist is covered in-network. Its services are covered by several major insurers, including Aetna, UnitedHealthcare, Cigna, and startup Oscar.

The company recently raised a $26 million series A round led by Thrive and GV (formerly known as Google Ventures). Accel, which led Headway’s seed round, as well as GFC and IA Ventures also participated in the round. To date, it has raised a total of $32 million.

Adams plans to use the funds to expand Headway’s services into other states. Although many patients are currently seeing mental health providers of telehealth visits, they might want to see them in-person in the future.

“We do see our patients typically want to go in person when they can, which is why we’re building a large, geographically dense network,” he said. “We’re really excited to use this capital to expand across the U.S. and do what we’re doing now, not just in the market of New York.”

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