Defragmenting Behavioral Health | David Guth with Shelley DuBoise | Centerstone

The Future of Health Podcast

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What happens when individuals needing medical help don’t fully acknowledge the problem, much less know where to go to get treatment? It can be a problem in any area of healthcare — “No, my heart is fine, I’m just tired.” In behavioral health, though, the problem is compounded by a confusing system and the still-present social stigma around mental health issues.

That, in a nutshell, is what Centerstone is trying to solve. Co-founder and CEO David Guth sees the behavioral health system as needing a restructure to get there:

This has been a very fragmented industry. So you don’t have large, high-profile comprehensive behavioral health organizations that the public trusts and looks at as the gold standard.

Add to that the changing but still-present social stigma around mental health issues, and people looking for treatment are left with a very difficult process to get help and recover.

The health care consumer is getting more savvy there are more tools to kind of look at what’s possible. But in mental healthcare the traditional consumer thinks that their options are seeing an outpatient therapist or going into the hospital.

[…But] as people become more aware, as they as they begin to see there are other options for care, I think we’re going to see the consumer make some choices that are different.

The consequences of a deficient behavioral health system are wide ranging, playing out at every level of the continuum of care.

First and most obvious is described above: lack of options or, often, lack of knowledge about where to turn, means we have people missing out on much-needed treatment.

It goes deeper, though. Mental health issues tend to coincide with other, physical issues. Cause and effect can go both ways. For example, Guth notes,

It’s hard to go through chemo without some sort of mental health problem either as a direct result of the drug or [as a result of] the situation.

Going in the other direction:

When you look at people who are not progressing well in treatment the overlying identifying feature of that population is the co-occurring condition of mental illness and addiction. […]We did a study for a large practice looking at their their health outliers — the individuals that were consuming a lot of resources and not getting well. And we found a staggering percentage of that particular population had diagnosed but untreated bipolar illness.

Therefore, from both a cost and outcomes perspective, it makes sense to work on better integration of mental/behavioral health care with the rest of the system.

Fortunately, barrriers are coming down. The science around behavioral health is improving and the body of research growing. Education is becoming more commonplace, so people have a greater understanding of the physiological, pathological underpinning of so many mental health conditions. Additionally, people are starting to speak out about their own struggles and recoveries. This has an enormous positive effect in terms of breaking down the social stigma around mental and behavioral health.

And, organizations like Centerstone are working to provide personalized treatment based on each patient’s needs, not based on the organization’s specialty:

You have to have organizations that can navigate people through the type of service that they need.

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You have to know what the individual circumstances are and get them into the right service for them, not just because that happens to be the one service that you provide.

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You have to have somebody that a team of folks are used to looking at the complexity of somebody’s presentation and knowing that they’ve got multiple options.

There is a lot to be accomplished to have a fully consolidated behavioral health system in place in the US. While various organizations, provider, mental health professionals, and others are working out the structural details, Guth points to the one thing that any individual can do to help:

The one thing that virtually every family has in common is there is somebody in that family dealing with one of the serious issues. And we can all make a difference by beginning to encourage those people to tell their story. […] We see how empowering it is for individuals to come forward and tell their story because the fact is if you’ve overcome a mental illness or an addiction you’ve had a journey through some serious pain and you have gotten to a place that that needs to be celebrated […] So I just encourage you, if you’ve got a family member that is suffering with this or has overcome this, we must not keep them in the closet.