May marks Mental Health Awareness Month. In years past, these four weeks might not have resonated with people as much as they do now. As mental health becomes more of a focus of holistic health, less stigmatized, and more normalized and conversed about, we are taking a step back to hear from Blue Shield of California clinicians on the current state of mental health and where the future might take. In addition, Blue Shield executives share what they do to take care of their own mental health.
What is the current state of mental health in California?
Dr. Jennifer Christian-Herman (PhD), vice president of Mind Body Medicine: When thinking about the current state of mental health in California, there are real challenges, and there is reason for optimism. Given the stresses of the past few years, there is increasing need for mental health care and greater openness to seek care. Unfortunately, many individuals face challenges with access, especially care that meets their needs and is evidence-based. Even when individuals have access through their health plan, we need to make it easier for them to navigate the ecosystem to find the care they need. For people needing specialized support options, we can’t just send them off on a quest to find the right type of treatment, whether it be for themselves or for their family members. This mix of access and navigation challenges can hold members back from the help that they need.
David Bond (LCSW), director of Behavioral Health for Blue Shield Promise: California simply doesn’t have enough mental health providers to meet the needs of every person. There are waiting lists everywhere and therapy takes time – healing is often slow and requires a lot of work for the person seeking help. Many mental health conditions call for weekly appointments and providers can only do so many hours of therapy in a week. And since the start of the Covid-19 pandemic, many providers have moved to telehealth-only care, further reducing the number of brick-and-mortar office visit opportunities. Additionally, numerous psychosocial stressors including the financial, social and political environment just don’t seem to be getting better for many communities, requiring the development or adaptation of all new coping mechanisms.
Dr. Nicole Stelter (PhD, LMFT), director of Behavioral Health for MindBody Medicine: As it did with other parts of our healthcare system, Covid and the Pandemic surfaced both new and neglected mental health needs while also helping to foment a “perfect storm” of population health and social/environmental issues:
Decreased stigma around mental health issues and seeking treatment has helped lead to increased demands for care. While stigma has decreased for some areas of mental health, it persists for other behavioral health concerns, like addiction so unmet treatment needs continue across diagnostic spectrum.
Social-political environmental factors - including war and conflict, gun violence, political polarization and violence, renewed legislative attacks on marginalized populations (e.g. LGBTQ+), economic instability, and growing environmental anxiety - all contribute as additional stressors in our post-pandemic communities.
Not enough mental health and addiction clinicians to meet demand. Mental health and addiction care has long been undervalued and the educational, training, and licensing career pathways are long and expensive. Neglecting this part of the medical field for so long has dug us a big labor-shortage hole that we’re not able to dig out of as quickly as the community needs.
What is Blue Shield doing to address these challenges?
Dr. Susan Fleischman (MD), senior vice president and chief medical officer: Blue Shield has expanded our offerings to include a wide range of virtual services and products. These range from meditation, lifestyle modification, and stress management, to direct referrals for treatment. It is crucial that we continue to build and optimize these new types of care within our network so that members and their families can feel supported with their specific health needs. We are also scaling an evidence-based model, Collaborative Care, that allows physical health providers to work collaboratively with behavioral health providers on shared, comprehensive care plans for patients.
Dr. Jennifer Christian-Herman: Creating an integrated and diverse ecosystem of care is key to building a better mental healthcare system. One of the ways we are doing that is integration with primary care, with the Collaborative Care model. This includes increased mental health screening in not only primary care, but pediatrics, maternal care, and specialty care (like oncology) – and supporting physicians to know what to do when these screens indicate a need for mental health treatment. The definition of mental health care is expanding – and we need to expand and evolve how mental health is perceived beyond the traditional models, including who provides it and where it happens. We need to meet people where they are, like at work and at school. Our BlueSky program offers resources for schools, as well as support for educators and parents. Lastly, engaging communities with support for mental health first aid and basics for community leaders can further expand access in those spaces. We're also exploring ways to improve navigation to both clinical services and emotional wellness resources to support members across levels of acuity.
Dr. Nicole Stelter: We’re approaching the need by developing and actualizing a strategy that crosses many fronts. We’re working to develop our network to include the right people, right skills, and right platforms - meeting the clinical needs of the population with choices and availability across levels of care and health equity. We’re also building out a portfolio of services, working with collaborators like Headspace and Ginger, to make the best use of available tele-behavioral health technology to ensure flexible access points. We’re evolving our clinical quality infrastructure to make sure our programs perform efficiently, are easy to access and navigate, and function as intended, with an emphasis on clinical outcomes and patient/caregiver satisfaction.
David Bond: We’re expanding our networks in as many ways as possible, including expanding access to telehealth options to help with care at scale. We are also welcoming the opportunity to bring any eligible provider into our networks to see our members. Additionally, care alternatives are also available for members who are interested in self-care or mental health coaching through our Wellvolution platform. And we are committed to our BlueSky program that empowers youths, parents and educators early with tools to support youth emotional well-being.
What do you do to de-stress and take care of your own mental health?
Sandy Clarke, chief financial officer: Recharging is an essential part of my overall well-being. Baking is one of my favorite ways to recharge. It allows me to try something new and delicious - while also enjoying a respite from day-to-day stress. The experience and process of completing a recipe is where I find joy, without stressing about how pretty the final product is!
Peter Long, executive vice president of Strategy and Health Solutions: Swimming is how I calm my mind. My barometer for stress is how many laps I swim each day. For me, swimming is a movement process – I’m not focused on mastering the sport or breaking any records.
Jackie Ejuwa, vice president of Health Transformation: I prioritize exercise and movement every day. Taking that time for myself each morning is what energizes me for the day to come, despite any stressors I may be facing. I encourage my colleagues to do the same. It doesn’t need to be movement – it’s so beneficial to take time for yourself, whether it be reading, yoga or self-reflection.