US and UK

Behavioral Health – Learnings from Across the Atlantic

Mental health is a difficult subject to unpack. Still steeped in stigma and misunderstanding, it’s a daunting topic to approach, to say the least. Add the complexities, regulations, and financial burdens of caring for those with behavioral health issues, and you may find the stress of trying to research behavioral health is bad for your physical health!

Until recently, US healthcare has looked at mental health separately from physical well-being. In many cases, we still do. We talk about the social determinants of health and the impact of mental wellness on physical care, but when the rubber meets the road, we connect mental and physical health to each other much like we connect with our in-laws: infrequently and begrudgingly.

It was helpful for me to spend a bit of time talking to Jeremy Goff, our head of international research. Recently, he’s spent quite a bit of time working with the UK on their upcoming interoperability study. As a byproduct of that work, Jeremy has become acquainted with how the UK looks at healthcare.

He explained that across the Atlantic, people take pains to view the whole health of a patient. “I often hear them talk about the four main areas of healthcare: social, mental and community, acute care, and primary care.” I think that of all the lessons we can learn from our UK neighbors, this may be one of the most important.

Severe mental illness has been correlated to a 10- to 20-year reduction in life expectancy. It may be hard to overstate the need to marry mental and physical care in US healthcare. As with most worthwhile tasks, this is easier said than done.

Jeremy at least partially attributes the holistic view of the UK to the single-payer system of the NHS. It makes sense that if an organization is going to be picking up the tab for all forms of care, that group might as well bring disparate areas of care together.

I am not about to be the one who opens the single-payer debate up yet again, so I appreciated that Jeremy also mentioned the cultural aspect associated with the UK’s view on mental health. The UK’s citizens tend to support and buy into the intertwined nature of mental and physical care. Mental health organizations in the UK seem to have adopted digital care. While we haven’t validated adoption in the US, our behavioral healthcare organizations have anecdotally been slower to move off of paper than their physical care counterparts.

But this directly highlights the main issue at hand: Why are the physical care sites “ahead” digitally? Well, it helps that meaningful use came along and pushed advancement forward. But meaningful use focused mainly on physical care; the US has separated patient wellness from physical wellness even at the regulatory level.

I’m not advocating for throwing more regulation at the problem, but I do think that as regulations and other factors continue to shift, we should make a conscious effort to include the voice of behavioral health providers in the overall discussion of where healthcare is headed.