Kaiser Permanente’s Anthony A. Barrueta on Policy Therapy To Improve US Mental Health Care

Originally published at about.kaiserpermanente.org. Anthony A. Barrueta is Kaiser Permanente’s Senior Vice President of Government Relations. Kaiser Permanente is a Fair360, formerly DiversityInc Hall of Fame company.


All of us who live with mental health conditions, including me, share a common goal in treatment — to feel better. Ideally, treatment and therapy enable us to understand ourselves more clearly, live fuller lives, and better manage fear, anxiety, sadness, and troubled thoughts. There may be many paths to healing, but unlike a wandering, beautiful hike, the destination is the goal.

Along the way, we greatly benefit from skilled guides, and access to good mental health care is key. Without support and clinical guidance from health care providers, it can be difficult to help patients improve and become empowered to better manage our conditions.

Thanks to decades of exceptional advocacy by organizations like Mental Health America — founder of Mental Health Awareness Month, observed in May — federal and many state laws now require equal coverage for treatment of mental and physical health conditions.

While work remains to implement and enforce these parity laws, it is a mistake to blame lack of availability and access to mental health services solely, or even mostly, on inadequate insurance coverage. Larger systemic problems have for too long contributed to our failure to achieve the goal of comprehensive availability of quality mental health services. As a nation, we’ve been too slow to embrace innovative models of care focused on improved patient outcomes and have not allocated resources to the systems that have proven to have maximum impact. And a strained and unequally distributed mental health workforce compounds the problem.

Cognitive behavioral therapy uses a framework and set of exercises to help individuals actively challenge their faulty or unhelpful thought patterns and reevaluate them in light of the reality of their circumstances. I’d like to apply this tool to policy discussions. Can we overcome our barriers to progress by refocusing our thinking on the realities we confront? If we look at the problems of the mental health care system a little differently, can we get closer to remedying them through effective public policy?


Redesigning systems of care

At Kaiser Permanente, we have concentrated extensively on the research and innovation required to redesign systems of care that broaden the focus from how mental health care benefits are covered to how treatment can be best provided. The emphasis is on evidence-based, patient-centered care that embraces telehealth and technology. It also means focusing on measuring patient outcomes and identifying the care models that work.

Even before the pandemic sparked a broad deployment of technological innovation in mental health care, Kaiser Permanente clinicians were assessing treatment progress through patient feedback. This approach to mental health and addiction care and services advances the main goal of the patient — to feel and function better.

Over the past 2 decades, Medicare has successfully applied quality incentive systems to promote evidence-based, outcome-directed health care. Applying that same incentive model to mental health care delivery, by investing more in researching the effectiveness of various care models would encourage innovation in care.


Transforming the workforce

Many studies from the end of the last decade demonstrate most states face substantial shortages of skilled, well-trained, and culturally competent mental health professionals who can meet the needs of diverse populations. Worse, despite our growing need, we are not training enough new entrants in certain mental health professions to even replace those who are retiring.

With the proper investments, our country can boost the mental health workforce pipeline by increasing the number of psychiatry residency positions and clinical training programs. We need to make sure we’re using our resources optimally to train new mental health practitioners, potentially in specific modalities of care with shorter training programs. This would allow us to use current training resources to bring many more practitioners online sooner. Scholarships and loan forgiveness programs would encourage early career professionals to pursue mental health vocations and serve patients in need.  As we grow the workforce, policies allowing doctors and therapists to practice telehealth across state lines could meet the demand for services in areas with shortages.


More funding for education, prevention, and early intervention

We know that preventing adverse childhood experiences, or ACEs, is foundational for long-term physical health and emotional wellness. Early intervention is key to preventing suicide and improving outcomes for serious mental illness. Preventing ACEs requires continued expansion and funding of education, prevention, and early intervention in community settings, such as in the home, child care, school, recreational settings, and places of worship.

Policies to enable the deployment of mental health professionals in these settings not linked to Medicaid reimbursement or otherwise bound to coverage of individual patients would allow broader access to mental health tools. A great example of this is universal school-based cognitive behavioral therapy programs to provide all children with the tools to manage symptoms of depression and anxiety, as recommended by the U.S. Community Preventive Services Task Force.


Promoting understanding, compassion, and confidence to seek care

After more than a year of uncertainty, isolation, and social deprivation, we are experiencing unprecedented levels of anxiety, depression, and related conditions in ourselves or those we love. But there may be a silver lining in this very dark cloud because the pandemic experience has increased empathy and prioritized mental health as one of our top economic, social, and political concerns.

If we continue to talk about mental health and learn how to respond when we encounter people in distress, we can continue to reduce the stigma that surround mental illness. Kaiser Permanente’s Find Your Words public health awareness effort is intended to help end the silence around mental health, and empower conversations that spread hope and promote reaching out to help ourselves and others. It offers the tools to give people more confidence to seek care for mental health conditions and addiction. And, it helps individuals understand how to build resilience and continue to normalize the conversation about mental health.

We know what we want — to feel like ourselves again. We want our friends and our families struggling with mental health conditions to have relief. Through mental health parity, we’ve laid a public policy foundation for improving access to mental health services. Now it’s time to pursue policies to reinvent stale models of care, support and rebuild a stressed and strained workforce, and invest in preventive services and evidence-based care innovations.