Forging a new frontier in

mental and behavioral health

Constructing the tools, teams and systems to move beyond crisis
For decades, the United States has lacked adequate screening, coverage, education and care pathways for
mental health, limiting access to and engagement in mental health care. At the same time, stigma, misaligned
financial incentives, rising inequity and unaddressed mental health have affected generations of families and
communities. The COVID-19 pandemic exacerbated the underlying issues of this mental health crisis, leaving
in its wake a vulnerable population. In fact, nearly 53 million Americans reported experiencing a mental health
condition in 2020, and that number is trending upward.1
Intense pressures are driving change and innovation
Somewhere between 30% and 50% of adults experience mental illness over their
lifetimes, resulting in more than $200 billion annually in health care usage and lost
work productivity. 2 Cost, access and stigma are top reasons many individuals are To help patients before they
not receiving services. experience a crisis, we need
a compassionate, connected
Even when consumers do engage with the health system, they may not be able to
connect to the care they need, or may have an unsettling, disjointed experience. ecosystem with informed teams
Pricing and reimbursement methodologies can be inconsistent and make it difficult that have the right insight, tools
for physical health providers to define consistent referral protocols. Too often, and support.”
mental health professionals don’t accept health insurance. This is due to a variety of
reasons, including restrictions, administrative burdens and low reimbursement rates. —R
 honda Robinson-Beale, MD
There is a cost to this disconnection for communities, families and the health system. Senior Vice President,
However, these pressures are also driving innovation and new discoveries. As Deputy Chief Medical
an industry we are focusing our research to understand how to better support Officer, Mental Health
mental and emotional well-being during different life stages and within different Services, UnitedHealth
populations. We know that emotional and mental well-being is a lifelong journey
Group
that builds positively or negatively on experiences, exposures and inherited
predispositions. We know we need a continuous, connected approach to mitigate
the onset of mental illness and sustain well-being across the lifespan. We are learning
more about the powerful link between physical and mental health and we understand
the impact of environmental events, systemic inequity, stigma and access.

Yet, our current system is not delivering healthy societal outcomes. Developing
an effective system of mental health care could remove mental illness as the
number-one cause of disability and reduce the risk of suicide. It could also lower the
expense related to high utilization, homelessness, incarceration and other
long-term health care and societal costs.

In today’s environment, how do we establish a compassionate, connected

behavioral health ecosystem with contributions from all stakeholders? How do we
develop fully prepared physical and mental health care teams that have seamless
access to the right insight, tools and support?

Read on to explore:
The cost of untreated mental health

Importance of aligning financial incentives

Required investments for a new experience

The profound effect of digital tools

New actions health leaders can take

2
The cost impacts every area of our society
The cost in human life and suffering is significant and growing.

Loss of life is the ultimate cost of advanced mental and behavioral health disorders.
Suicide rates increased 5% in 2021 and 2.6% in 2022, with some populations such as
veterans, rural populations and the economically disadvantaged facing extreme
risk. Middle-aged adults account for 46.8% of all suicides, and 41% of LGBTQ+ youth
considered and 14% attempted suicide in the past year.4 Suicide is a leading cause
of maternal death in the first year following childbirth, responsible for up to 20% of
postpartum deaths.5 1 in 4 clinicians want to leave health care due to burnout, with
300 to 400 physicians a year taking their own life.6

Opioid-related use continues to rise, with 9.2 million misusing opioids7 and the Trends in costs and services
National Center for Health Statistics predicted 82,998 opioid-related deaths in from 2020 to 202216
2022. 8 Of the nearly 600,000 people experiencing chronic homelessness, it is
estimated that 50% have behavioral health disorders.9

The full financial impact of untreated or undertreated mental and behavioral health
extends across the health system, throughout the criminal justice system, within
our workplaces, and amidst our families and communities.

Delayed diagnosis and treatment lead to more expensive medical care, poor
physical health outcomes and a perilous burden on health care providers. It
adds education expense, cuts into workplace productivity and pulls from the
pocketbooks of families and caregivers. It fuels criminal justice expenses, increases
disability costs and adds to our tax burden. Increased Spending on
use of mental mental health
Current estimates cite the cost to the U.S. economy at more than $1 trillion per year.
health services services has
In 2020, the government spent close to $280 billion on mental health services. 2
by 39% risen by 53%
The economics of mental health need to be reversed so that these dollars can be
redirected toward prevention, early intervention and ongoing support. As technology
improves and research validates the efficacy of various hybrid approaches, market
forces will likely drive down costs. Calculating the savings to rationalize a new
approach will require more complete data, include new concepts of mental health,
involve financial modeling and include metrics from across the community. How do
we begin to make the shift?

3
Financial incentives must align
A crucial tool in addressing mental and behavioral health is aligned incentives.
A preventive approach is integrated across a health system and factors in the
needs of a person along their mental health journey. This approach to care
requires financial models that can bend the cost curve by assuming full risk and
accountability for the outcomes over the long term.

Cost savings can be achieved through early, accurate diagnosis and referrals to
timely, effective care. A cost-effective care model will connect more patients
with care, but it will be to lower-cost, preventive care. To change to a new financial
model, the equations for investing more in mental health prevention in the short
term must demonstrate that cost savings can accrue over the long term.

Health systems are best positioned to implement new financial models for mental
health when they can:

• Implement risk arrangements for the total cost of care

• Include a comprehensive scope of services

• Transparently report outcomes

By having these 3 capabilities, health systems can use outcomes data to shift
services and interventions to personalize care for the populations they serve. These
risk arrangements reward swifter symptom recovery, chronic condition stabilization
and crisis prevention. They have the potential to increase the short- and long-term
savings that can further fund prevention and sustain needed community resources.

Measures of success: Growth in risk-bearing and accountable models, incentives and

funding for preventive approaches, reduced variability in payment models for providers.

4
Significant investment is required
A commitment to improving the effectiveness of mental and behavioral health
will require investment in a new data-driven approach. Effectively tracking
mental health costs and outcomes requires longitudinal data that follows the
long-term costs generated across different systems. Investment to upgrade the
data architecture, collection and interoperability is required for the industry to
advance the effectiveness of the behavioral health system and care at all levels
— the patients, providers, payers and community. Read “Addressing the great
information divide.”

Providers and health systems will also need the right health expertise and
management systems to build the architecture for precision diagnosis,
interventions, data-driven referrals and measuring whole-health outcomes.
As the model is developed, it must also be incorporated into an organization’s
information technology system.

Measures of success: Incentives for defining and evolving data system functionality and
measurement, speed to implementation, improved tracking of outcomes and quality.

Digital tools can have a profound effect

We’ve already seen the power of telehealth services throughout the COVID-19
pandemic. As more tools and data come to the fore, there is opportunity to adopt
telehealth services on a much broader scale and in a more personalized way. By precisely targeting the
right intervention for the right
Digital self-help tools are guiding consumers toward proper diagnosis and care.
Triage techniques are identifying those patients who are better served with digital
patient, we can get closer to this
and telehealth tools so that they can be more effectively and immediately treated. vision of a model where we’ve
This precision approach not only serves them quickly but also frees up limited got an answer for a hundred
in-person therapists for the higher-acuity patients who truly require them. percent of patients.”
These digital tools can also provide remote monitoring, real-time data collection
— Sam Nordberg, PhD
and intervention. Some are very precise. For example, precision treatment digital
tools may be targeted at trauma, such as post-traumatic stress disorder. Another Chief of Behavioral
may help women adjusting to menopause. Yet another can help a patient with Health, Reliant Medical
anxiety, offering diaphragmatic breathing, mindfulness and cognitive behavioral Group
therapy. These aids can benefit patients if they are aimed accurately — to treat the
specific mental or behavioral health issues a person is experiencing.

But simply adding more digital tools will not achieve the goals. The key is to have
the right leader and the appropriate investment to build, implement and measure
an integrated virtual mental health care model. Digital tools need to be validated
by quality research, vetted by your clinicians and then once implemented, prove
they can deliver measurable, evidence-based mechanisms of change in the patient.
Having a wide spectrum of these digital tools allows providers to choose the precise
approach needed.

Measures of success: Increased timely access, engagement in interventions, symptom

reduction, recovery rates and user satisfaction.

5
How health care stakeholders can take new action
It is going to take collaboration, investment and leadership from payers, providers,
employers and government organizations to integrate the processes, tools
and measures needed to proactively address mental and behavioral health. All
stakeholders have unique and specific contributions to make.

The role of the provider:

Providers are on the front lines of this crisis. They are coping with a rise in behavioral
concerns in all environments and they are seeing unprecedented numbers of
burnout, attrition and suicide in their workforce. The following strategies can
support consumers and clinicians alike.

1. Diagnosis

Earlier diagnosis is an essential area for advancement. The following technologies

are now being added to the diagnosis toolbox:

Screening tools that identify the appropriate resources for more in-depth
assessment

Self-help tools that track important characteristics, symptoms and

monitor progress

Natural language processing (NLP) and artificial intelligence (AI) aids that
detect changes in speech patterns, indicating a change in an individual’s
mental health status

Remote monitoring that recognizes and tracks biomarker changes such as

activity, sleep or mood

Accurately diagnosing mental and behavioral health disorders can be a complex

process. There may be multiple contributing factors, co-occurring conditions or
symptoms that come and go.

Screenings are a first step but are not enough by themselves. Multiple screenings
by qualified professionals are needed to build a complete and more accurate
diagnosis. They combine with interviews, assessments and medical history to
create a comprehensive profile and nuanced view of an individual. Screenings can
take place in-person, through a mobile app, using chat bots, during health plan
sign-ups, at the pharmacy and at customer service points. Screenings can also
assist providers by more efficiently revealing what type of care an individual prefers
and is able to access.

Self-help tools are not currently intended for self-diagnosis but can lead to earlier,
personalized intervention. They also engage a person in their care by putting
an element of control for managing their condition back into their hands. NLP
and AI show promise for identifying changes in facial or vocal expressions that
indicate shifts in mental health conditions. Remote monitoring can shorten clinical
decision-making time by reducing alarm delays for adverse events or alerting for
device failures between office visits.

6
Insurers at the state, federal and commercial levels are now covering depression
and anxiety screenings. Normalizing these scales as part of routine clinical care can
destigmatize conversations and assist health professionals in addressing mental or
behavioral issues people may be dealing with, much like asking about smoking or
any other physical health risk factor.

The challenges of securing and accepting a proper diagnosis include stigma, health
literacy, mistrust in the health system, costs, access and other barriers. And it is
important to recognize that data is still emerging, so evidence-based indicators do
not yet exist for every mental health disorder.

Measures of success: Number of completed screenings and referrals. A whole-health

approach that includes mental and behavioral health data and/or diagnostics at
every touch point.

2. Referrals

Making an immediate and appropriate referral is essential to a patient’s mental

health journey. The best-case scenarios occur when care professionals work 50%
shoulder-to-shoulder with mental and behavioral health specialists and can of patients triaged can be
immediately connect patients to the best tool, therapy and/or prescription. Too immediately served by precision
many patients today identify a need but are left in limbo waiting for a specialist or
digital behavioral health. 2
having their referrals rejected. Too often, they end up abandoning their effort or
reemerging in emergency rooms (ERs) or hospitals.

We need to move from a random, unsystematic referral process to a data-driven,

evidence-based, precise, referral management approach.

The major challenges are poor alliances, a lack of coordination and not enough
specialists to meet the need. This is where innovative triage strategies can be
employed to identify not only the condition(s) the patient has but the precise tools
and care pathways that can most immediately and effectively serve them.

7
Recognizing the unique needs of each person

Innovative ecosystems work to integrate in-person and virtual care, creating

a hybrid approach that incorporates a multitude of elements. These elements
include digital tools, in-person visits, prescription services, and mental and physical As a leader, you can set the stage
care touch points. Part of a precision approach is matching the care pathway to the for an open dialogue to say ‘What
patient based on their needs and preferences. For example:
are the opportunities I can use to
Patient A can be treated with a self-guided digital solution. better support you?’ ”

Patient B may benefit from digital tools and a virtual therapist. — Mary Jo Jerde, RN
Patient C requires in-person therapy, digital tools and medication.
Senior Vice President,
Center for Clinician
Patient D requires multiple levels of integration such as digital tools, in-person
Advancement,
therapy, medication, coordinated mental and physical health care, and more.
UnitedHealth Group

Patient A

Patient B

Patient C

Patient D

Self-guided digital tools

Virtual therapists

In-person therapy

Medication

Digital tip: When prescribing digital tools, consider an immediate visit with
a digital care navigator, who can support the patient and add accountability
for using the digital tools. Then include follow-up with a mental health
specialist to check in on their progress.

8
Another consideration is how patients enter the system and begin their mental
health journey. Older generations or families may begin with their PCPs while PCPs prescribe

59%
younger generations such as Gen Z and millennials prefer digital health or walk-in
clinics. In fact, more than 100 million Americans do not see a primary care provider
(PCP) for numerous reasons.10 Providers need screenings and referral pathways
that match the preferences and touch points of the populations they serve. of antidepressant medications
and see 60% of people being
Coverage is a significant referral challenge. Patients are referred — or not — based
on their coverage rather than on their specific need for mental and behavioral
treated for depression in the
health services. And often, PCPs receive higher reimbursement rates than mental United States.17, 18
and behavioral health specialists. While PCPs play a crucial role in addressing
anxiety and depression in low-acuity patients, they are not trained in more complex
areas of mental and behavioral health or in managing the side effects of all
medications. And yet, because PCPs are covered, they are the largest prescribers
of psychotropic drugs. This has serious, if unintended, consequences for patients
and underscores the need for PCPs to be well-supported with a referral network of
mental and behavioral health partners that can diagnose and treat more serious or
co-occurring conditions.

Connecting PCPs to a consistent, effective referral process that includes a

continual feedback loop with the mental and behavioral health specialist can
reduce burnout. It can also illuminate their decisions for managing a patient’s
physical well-being.

9
 Success in forging new frontiers
Consider these connected care model success stories when building an infrastructure for whole-health integration.

A holistic-care, pharmacy-led mental health model

Innovation in health care models is also happening within the pharmacy sphere.
Genoa pharmacies are located within community behavioral health centers, similar
to clinic settings. The pharmacies are designed to support patients with severe
behavioral health challenges or other chronic conditions who need a higher level of
daily support for their medications.

Genoa’s location inside the clinic provides unique support to providers and
patients alike:

• An integrated part of each clinic’s care team. Direct, in-person access to a

pharmacist who knows the needs of their patient population.

• Help developing the right care plan. A pharmacist on the care team helps
doctors address issues like insurance coverage, drug side effects and complex
medicine schedules.

• A pharmacist who knows each patient. Patients build relationships with the
pharmacist who gets to know them and their unique needs.

• Services designed to make it easy for patients to get and stay on their
medications. Filling all prescriptions from any doctor, free prescription mailing
or delivery, no-cost adherence packaging, help with prior authorizations and
administration of medications and immunizations, where allowed by the state.

Genoa’s pharmacies foster relationships with group homes, residential programs

and outpatient facilities that may not have an onsite pharmacy but can benefit
from their services.

Genoa also offers telephonic Comprehensive Medication Management (CMM)

to optimize a patient’s medication therapy. A pharmacist works one to one with a
patient to ensure all of their medications are appropriate, effective, not causing
harm, and the patient is able to adhere to their regimen.

Leaders report the proactive approach to pharmacy care leads to medication

adherence rates of around 90%. The model also decreases emergency room visits,
hospitalizations, disease severity and death, by keeping people on their medicines.
Explore more connected care success stories.

Measures of success: The consumer is properly engaged in a care pathway that’s right
for them. They have access to a network that can address the full range of their needs
and is included in their health care coverage.

10
A digital-first mental health care model

Reliant Medical Group has a primary care integrated behavioral health department.
It’s staffed with over 80 full-time licensed mental health clinicians including clinical
psychologists, master’s level clinicians, medical doctors and nurse practitioner It’s about removing barriers and
prescribers who consult, triage and offer intervention delivery. having people understand how
The medical group is using practice-oriented research to enhance the integration they can access these resources
of Precision Behavioral Health (PBH). This digital-first care model includes an more effectively.”
ecosystem of evidence-based digital interventions as a primary treatment for the
people they serve. By focusing on their multilevel needs, health professionals can —M
 ichael Consuelos, MD
rapidly evaluate outcomes and monitor the successful integration of PBH into an Vice President, Strategy
already existing clinical care process.11 and Growth, Optum
By doing so, the organization moved into a space that historically belonged Advisory
to employers, offering care that delivers a lower-cost intervention at a scale
appropriate for people experiencing mental illness. Over a period of 15 months,
they piloted triaging approximately 50% of their patients to participate in the PBH
program. The participants became highly engaged in their care and the treatment
outcomes were superior to an average seen in outpatient psychotherapy.

3. Access

One of the largest barriers for solving the mental health crisis is providing timely,
guided access to effective diagnosis and treatment. Unfortunately, even if consumers
do manage to connect to the health system and get a referral, they find themselves
waiting too long for services, unable to physically connect or unable to pay for care.

Virtual visits have proven effective and central to what some patients desire in terms
of cost and convenience. Telepsychiatry and teletherapy fit into this category. They’re
also especially needed in rural pockets or other areas where there are shortages
in specialists available to adequately serve a population. Payers are already seeing
the value of including more telehealth in their plans, and providers are beginning to
establish integrated physical and virtual mental health care pathways. There’s a wide
array of virtual health tools arriving on the market every day. They include virtual
coaching, remote monitoring, instant chat and texting services, and self-help aids.
While each tool must be vetted by clinicians, these digital interventions can expand a
physician’s capacity and allow providers to serve more patients.

Providers can speed access by expanding their network, extending their digital
reach and ensuring more warm handoffs. Too often, even after a consumer has
been referred, there is no one responsible to make sure they connect to the
specialist or services they need. This rarely happens in other clinical areas such
as cardiology, neurology or orthopedic medicine, and it should not happen when
addressing mental health.

Mental health should not be managed as an add-on satellite service that operates
independently of the rest of the health system. The brain is not separate from the body.
Physical and emotional experiences intertwine and continually influence the overall
health of a person. That is as true for the health workforce as it is for the consumer.

Measures of success: 24-hour or shorter response times from referral to therapy,

measurable symptom reduction, reduced emergency room visits, reduced suicide and death.

11
Health leaders can innovate by starting with their own workforce. Leaders can ask
themselves “Is our coverage adequate?” and “Do we understand the propensity for
mental and behavioral health needs in our employee population and are we able to
make warm handoffs to the types of care they need?” Making these advancements
in access requires broad networks, strong partnerships, risk-based financial models,
and the data and operational infrastructure that can support integrated whole
health. The employee population is a focused starting point. Read “7 Strategies for
expanding access.”

4. Emotional connectivity and coordinated care

When navigating a behavioral health crisis, emotional connectivity with the provider
is a critical factor for achieving stabilization. Individuals in crisis need to feel, hear
and trust that their provider is knowledgeable and in their corner. Today, most people
are already in some level of crisis when they reach out for services and support. If the
individual has a trusted doctor, they can be guided to the appropriate avenue for care
services. If not, too often they end up in the ER and admitted to the hospital.

Managing crisis and complex cases is best done by a coordinated care team. This
helps the patient and also avoids the high-stress situations that lead to the burnout
Health organizations need to
of front-line workers.
have mechanisms that help
Coordinating a full care team helps foster a good therapeutic alliance. A full mental patients develop a therapeutic
and behavioral health care team can include physicians, mental health specialists,
alliance with their system of care.
pharmacists, case managers, social workers, community health workers, family
members and/or personal advocates. To be successful, these teams need time The system must facilitate trust
for case conferencing, cross-team communication and access to a centralized between the individual and those
electronic medical record (EMR). When documented through the EMR, mental and on their care team. People need
behavioral health services can be coordinated with the patient’s PCP. to feel heard and respected.”
The case manager is the central team coordinator and a vital part of the equation. They
— Rhonda Robinson-Beale, MD
can help the consumer navigate through their mental and behavioral health journey
from start to finish of a crisis and/or continuously through chronic or complex cases. Senior Vice President,
Deputy Chief Medical
Team access to an interoperable, centralized data system is essential to the
Officer, Mental Health
effective management of acute and chronic mental health situations. Collecting
data from multiple places can help the care team grasp the patient’s complete Services, UnitedHealth
story and understand what barriers they face. Access to evidence-based Group
guidelines for whole health and appropriate, secure data collection and sharing
are central to implementing holistic care.

As accountable, risk- and population-based systems mature, therapists may migrate

away from being generalists and toward more specific expertise, which may lead
to higher-quality outcomes. Thus, the natural evolution in behavioral health will
concentrate on freeing up therapy resources by enacting precision behavioral health.
For example, health systems may develop a team specialized in treating trauma
disorders, a team for maternal mental health, or a chronic pain mental health team.

These collaborative care models include multiple layers of community behavioral

health workers, peer coaches, psychiatry and psychotherapy specialists, case
managers and health navigators. PCPs can be empowered to join the team and take
the lead at certain times within a patient’s mental health care journey.

Measures of success: Higher patient satisfaction.

Increased engagement rates. Data and interoperability
that allows effective tracking of outcomes and quality.

12
The role of the payer
Payers have been historically defined as health insurance companies. But today,
that has expanded to include managed behavioral health care organizations
(MBHOs), accountable care organizations (ACOs), subspeciality provider groups,
state municipalities and self-funded employers.

These organizations play a multifaceted role in addressing the mental health crisis.
They have their hands on many levers including setting up financial incentives,
providing logistical support, advocating for policy changes, and helping community
stakeholders adopt a whole-health approach. You have to make the right thing
These groups are adept at collaborating across industry stakeholders. They have the easy thing.”
insight into the financial challenges and motivations of employers, communities,
government agencies, providers and consumers. They also have a unique capacity —S
 am Nordberg, PhD
to bring forward the vision and economic rationale for a preventive, personalized Chief of Behavioral
approach to mental and behavioral health. Health, Reliant Medical
They are in a strong position to guide investments, play a role in the data Group
advancements, and support the human resources and infrastructure required
to develop and implement an evidence-based mental health care ecosystem.
They can use their existing data to quantify the long-tail costs for individuals who
become long-term dependents on the system when their mental and behavioral
health needs are not properly addressed. They can work with local governments
to calculate the value that could be achieved with more investment in early
identification and prevention.

Payers can collaborate with providers to align incentives so that when a health
care system effectively treats a patient for their mental health symptoms
and conditions, the system is rewarded accordingly. With more consistent,
alternative payment approaches from payers, provider organizations can be
motivated to lean into a preventive care model.

Payers can make the financial case for a consistent, value-based approach to
mental and behavioral health. There is a significant cost to not intervening early or
to taking a “toe-in-the-water” approach. This is especially the case with high-acuity
patients, as the organization may not see a clinical or financial result in a way that
makes any real difference. On the other hand, by implementing programs across
a significant patient base, systems can generate the savings to fund the shift to
a proactive approach. In a capitated environment, a greater investment will yield
greater returns for delivering better care and will show gains in several other quality
and satisfaction measures.

Payers can lead us down the path to mental wellness and fitness. They can support
research into mental health treatment and promote innovative approaches to care
delivery. These investments can guide and test the viability of new models, and
when they show promise, they can be adopted at the public level and funding can
transfer to the state.

13
Payers can also help by expanding what their plans include. Consumers need
affordable coverage for outpatient therapy, inpatient psychiatric care, medication
management and crisis intervention. They need access to specialists who can treat
their specific disorder and coverage for teletherapy, psychiatric medication and the
newly evolving preventive mental health services. Some may also need community
support services such as food, transportation and housing. Read “Addressing the
root causes of mental health disparities.”

Payers can increase mental health service access by expanding coverage for
telehealth mental health services at parity with face-to-face services. They
can invest in preventive and early intervention programs such as mental health
screenings, Employee assistance programs (EAPs) and programs that target specific
concerns such as maternal mental health, youth mental health, chronic care-related
mental health, social isolation and loneliness, and other indicators of early risk
conditions. By expanding mental health education and awareness to reduce stigma,
payers can help their partners make great strides in tempering the current crisis.

Measures of success: Consistent payment models, a data-driven, evidence-based

mental health approach, networks aligned with population need, coverage for
preventive services.

The role of the employer

Employers invest so that they can sustain a healthy workforce and seek ways to
curtail any increase in total health and disability costs. There is a growing array of
strategies, resources and tools that employers are putting into practice to achieve One of the most powerful forces
this in mental and behavioral health. has been the recognition of a
problem with mental health
Eliminating stigma through a culture of safety and advocacy
care. Removing all stigma is
Any workplace — especially health organizations — needs to support the mental another huge problem that we’re
health of their own employee base and a mandatory first step is eliminating stigma.
continuing to face.”
Eliminating stigma starts by developing a culture of psychological safety, advocacy
and allyship. — Michael Consuelos, MD
Leaders can help set a cultural tone — leading by example and sharing their own Vice President, Strategy
stories — so that mental and behavioral health challenges are more easily brought and Growth, Optum
to light. Training leaders, managers and board members helps to ensure that Advisory
there is enough psychological safety running through an organization so that
mental health is not stigmatized. When employees feel they need to hide who
they are, it often leads to performance issues, misunderstandings and eventually
absenteeism or attrition.

Clinicians often resist sharing that they are struggling, as they are hardwired to
assist others first. This is a well-established phenomenon and puts the health care
workforce at heightened risk. In fact, the American Hospital Association and the
U.S. Centers for Disease Control and Prevention have created a suicide prevention
guide to address this crisis.12 It is vital for all clinician leaders to receive specific
training on how to create psychologically safe environments that support more
open conversations.

14
It is also important for managers to be sensitive to cultural, gender-based and
generational attitudes about mental health. These attitudes can make it even more
difficult for certain employee populations or subgroups to share how they feel.

One way to predict the needs that are generally likely to exist in your health care
workforce is to review de-identified data. This can uncover the disorders that may
be prevalent in your communities, as many of the challenges can be mirrored in the
workforce. When paired with employee surveys, leaders can understand both the
need and the perceived value of the benefits and programs being put into practice.

Applying a wider range of tools and resources

Workforce resources and tools are expanding and now include mobile apps, chat
supports, peer groups and digital education platforms.

EAP mental health programs can do more to center awareness around

stress, anxiety, loneliness, social isolation and depression. EAPs and
stronger outreach can also help close the gap from education and
awareness to helping people understand what’s available in their coverage
and benefits.

Digital applications are available to let employees check in on their feelings

and offer up exercises to help them reflect, refocus and take new action to
reduce stress.

Peer groups can be organized around specific needs such as cancer

support, relief for parents dealing with teens and substance abuse, and the
stress of caregiving or chronic disease. These can be digital or in-person
sessions depending on the needs of the individuals.

Digital content such as educational videos, guides and podcasts can help
health care employees learn more about mental health and explore mental
health issues common to their role.

Employers can also do more to promote helplines such as 988 — the

national suicide and crisis lifeline that provides free and confidential
support for people in distress. Today, only about 1 in 8 people know about
the hotline.13

15
Addressing systemic workplace issues

Another consideration for employers is recognizing systemic issues within the

workplace that can amplify mental and behavioral health risks. Systemic issues in
health care, for example, include administrative burdens, technology challenges, Many clinicians will not share that
compassion fatigue, long work hours, workplace violence, ethical dilemmas, they’re struggling. That is their
exposure to human suffering and leadership behavior. No amount of coaching,
nature of helping others. They
counseling or medication can overcome the impact of daily exposure to continuous
stressors. While it is no doubt challenging to solve these types of issues, leaders
don’t help themselves first.”
can identify, prioritize and address them through problem-solving structures that
— Mary Jo Jerde, RN
work from the grassroots up.14 Organizational facilitators can guide conversations
with workers. They can encourage staff to raise their hand and voice what they are Senior Vice President,
feeling and seeing in the workplace. Center for Clinician
Advancement,
Health care workers in particular face higher levels of distress, mental health
concerns, absenteeism and even suicide rates than non-health care workers.15 UnitedHealth Group
Employers can also advocate for regulations and policies that protect workers from
exposure to workplace violence and other systemic issues. A company’s board of
directors can also offer support and help the organization stay accountable to
improve the mental and behavioral health of employees and the community in a
broader sense.

Expanding access to mental health services and support

With good data in hand, human resource departments are better equipped to
ensure that the benefits they offer effectively align with what their workforce
needs.

If your organization employs clinicians, an assessment with follow-up conversations

about stress, anxiety and burnout can lead to new action that can help bring joy
back into the workplace — and reduce attrition and early retirement rates.

Mental health benefits are evolving, and employers have led the way in adding digital
screenings, virtual coaches and virtual visits with licensed therapists across a range
of expertise. All employees benefit from education about what new resources are
available and how to access them. Orientation, onboarding, training, workshops,
promotions, EAPs and online tutorials are all opportunities to spread the word.

Taking a whole-health approach

Employers are in a strong position to promote whole-person care and to encourage

their payer and provider partners to build the data integration and coordinated care
teams that understand the interplay between physical and mental health. Employer
organizations can create a pathway to holistic health for their team members.

Using these strategies, tools and resources, employers can create a space where
everyone is welcome, employees feel safe expressing a mental health concern, and
they have the support they need to bring their best selves to work.

Measures of success: Reduced attrition, reduced cost, higher eNPS scores and the
generally improved health of employees.

16
The role of the government and community
The entire community must connect to provide relief to those who are affected
by mental health conditions, meeting them where they are when they need
services and support.

State and local governments are the tissue that connects a comprehensive
approach to mental health. They drive policy, funding, service delivery and
coordination of services. They also have insight into our most vulnerable
populations, and social drivers of health that can affect health outcomes.

They can track innovative pilots in their community and work with payers and
providers to determine which ones make sense to be funded at a state or local level.
They can also track mental and behavioral health-related costs and activities in
foster care, criminal justice, homelessness, public education and public health.

Local municipalities can consider hiring a part-time contracting manager who

interacts with the community and builds relationships with partners who are best
equipped to fill mental health care and support gaps. Medicaid has successfully
established this practice to connect members with clubhouses, volunteer
organizations, housing, employment opportunities and healthy food access within
communities across the nation.

Influencing policies for change

Policymakers can advocate at the local, state and national levels to support
mental health access, research and a comprehensive approach to mental
health care.

To this end, new mental health regulations have been put into place. Most recently,
the Dr. Lorna Breen Health Care Provider Protection Act was enacted to address the
high rate of suicide for physicians and unreasonable staffing ratios. Mental health
parity laws, telemedicine expansion, suicide prevention policies, anti-bullying and
anti-harassment laws, and workplace policy and regulations have all had an impact.

Measures of success: A quantified cost of untreated mental health across the

community ecosystem, partnerships with community advocates, protective policies,
laws and community programs.

17
Closing
A preventive, whole-health approach that can be sustained across the life of an
individual is the path forward to quality outcomes and bending the curve on the
cost per patient.

Attributes of a whole-health approach

How many of these attributes does your organization possess?

Reimbursement policies that reward a preventive approach

Commitment to making the investment in time, technologies and

resources needed to transition to evidence-based, precision mental
health care

Electronic medical records that build longitudinal views and connect

physical, mental and behavioral health services

A complete network of behavioral health providers that can meet the

needs of the populations they serve

Integration of in-person and virtual mental health care pathways

Case managers or other resources that can help the patient navigate

Connections to the community that match the patient’s culture and

social drivers of health

Communities and leaders must come together to help people experiencing mental
health problems early, and well before they fall into crisis. With aligned incentives,
appropriate tools and clear processes in place, health professionals can overcome
current barriers to prevention, therapy and treatment.

Building informed, empowered teams starts with a compassionate, connected

ecosystem designed with the right insight, tools and support targeted toward every
person’s physical and mental health, so everyone can do more than just survive,
they can thrive.

18
Sources Contributing experts
1. Mental Health America. The state of mental health in America: 2023 key findings.
Sam Nordberg, PhD
2. Penev T, Zhao S, Lee JL et al. The impact of a workforce mental health program on employer medical plan spend: An application of Chief of Behavioral Health,
cost efficiency measurement for mental health care. Popul Health Manag. Feb. 14, 2023; 26(1): 60–71.
Reliant Medical Group
3. Ibid.
Rhonda Robinson-Beale, MD
4. Centers for Disease Control and Prevention (CDC). Provisional suicide deaths in the United States, 2022 [Press release]. Aug. 10, Senior Vice President, Deputy
2023.
Chief Medical Officer, Mental
5. Policy Center for Maternal Mental Health. Maternal suicide in the U.S.: Opportunities for improved data collection and health care Health Services, UnitedHealth
system change [Issue brief]. Sept. 2023.
Group
6. Matheson J. Physician suicide. American College of Emergency Physicians. Jan. 20, 2016.
Michael Consuelos, MD
7. Substance Abuse and Mental Health Services Administration. SAMHSA announces National Survey on Drug Use and Health
(NSDUH) results detailing mental illness substance use levels in 2021. Jan. 4, 2023. Vice President, Strategy and
Growth, Optum Advisory
8. CDC. Provisional data shows U.S. drug overdose deaths top 100,000 in 2022. May 18, 2023.

9. National Alliance to End Homelessness. State of Homelessness: 2023 Edition. Mary Jo Jerde, RN
Senior Vice President,
10. Hassanein N. A third of Americans don’t have a primary care provider, report finds. USA Today. Feb. 28, 2023.
Leader of the Center for
11. Youn SJ, Jaso B, Eyllon M et al. Leveraging implementation science to integrate digital mental health interventions as part of Clinician Advancement,
routine care in a practice research network. Adm Policy Ment Health. Aug. 24, 2023.
UnitedHealth Group
12. American Hospital Association. Suicide prevention: Evidence-informed interventions for the health care workforce. 2022.

13. Velázquez T. Most U.S. adults remain unaware of 988 suicide and crisis lifeline. Pew Trusts. May 23, 2023.

14. Asfaw S, Pennock K, Preble S et al. C-suite check-in: The health care workforce crisis. Optum. 2022.

15. Olfson M, Cosgrove CM, Wall MM et al. Suicide risks of health care workers in the U.S. JAMA Network. Sept. 26, 2023.

16. RAND Corporation. Spending on Mental Health Services Has Risen by More Than Half Since Beginning of Pandemic [Press Release].
Aug. 25, 2023.

17. Ohayon M, McCue M, Krystal A, Selzler K et al. Longitudinal study to assess antidepressant treatment patterns and outcomes in
individuals with depression in the general population. Journal of Affective Disorders. Oct. 21, 2023.

18. Association of American Medical Colleges. A growing psychiatrist shortage and an enormous demand for mental health services.
Aug. 9, 2022.

optum.com
Optum is a registered trademark of Optum, Inc. in the U.S. and other jurisdictions. All other brand or product names are the property
of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change
specifications without prior notice. Optum is an equal opportunity employer.
© 2023 Optum, Inc. All rights reserved. WF11789698 12/23