There’s no turning away from the physical and emotional suffering caused by the COVID-19 pandemic. We’ve experienced every type of upheaval — in some cases losing loved ones, employment and a way of life. This anguish has culminated in a parallel mental health pandemic that has itself taken a profound toll.
Staggering data from the Centers for Disease Control and Prevention show that drug overdose deaths in the U.S. rose 29.4% in 2020, an estimated 93,331 people; that’s a 5% increase over 2019. And other heartbreaking statistics show an increase of suicides and suicide ideation amongst our nation’s youths. As life starts to reopen, a question looms: Will the lessons learned from the pandemic fundamentally change how we provide health care in this country, or will we return to the old “normal”?
The pandemic has laid bare the disparities in health care delivery. Both the public outcry against structural racism and discrimination sparked by George Floyd’s murder and the health care inequities exposed by the pandemic present us with the challenge of not only improving mental health access, but doing so in a way that can improve the health and well-being for all communities.
Past attempts to improve mental health outcomes for historically marginalized communities helped identify multiple barriers to care, including stigma, transportation, insurance and finances, as well as providers’ failures to adequately identify and address these and other health issues. The removal of these barriers is among the foundations of today’s integrated care models, which seek to reduce stigma and facilitate access.
Beyond this, by using a whole-person approach, integrative care approaches can decrease the experience of care fragmentation. In the clinical setting, this means recognizing the role depression, anxiety, substance use disorder and trauma play in affecting health outcomes, particularly in communities of color where these conditions are often overlooked or misdiagnosed. Preliminary research suggests that integrated care can also reduce stigma and cultural barriers in underserved racial and ethnic populations of color.
A key element in successful primary care integration lies in establishing trust between patients and their primary care providers. As the demand for services increase, we need to invest in increasing service capacity, develop service providers who render care with cultural humility, and make sure our workforce includes appropriate representation of the communities we serve.
But integration goes beyond embedding behavioral health into medical settings. Health care entities need to collaborate with community-based organizations, such as faith-based programs, social service agencies, school-based clinics and college counseling centers, to co-design solutions to do the vital work of culturally appropriate outreach and engagement. Community-based care management programs and the use of peer counselors are among the innovative ways by which folks can be engaged and the expertise of providers based in specialty clinics disseminated throughout the community.
These community relationships – along with those among families – remain important facets of life in many historically marginalized communities. If we want to partner with these communities in meaningful ways, we have to stop looking at problems from an overly reductive, individualistic approach and cease to assign predetermined solutions. We need to step out of our offices, learn about the communities we serve, understand what matters to them and develop culturally aware clinical solutions in a true spirit of collaboration and partnership. And in that sense, integration of high-quality behavioral health care is a crucial component in creating sustained change.
Manish Sapra, M.D., is the executive director of the behavioral health service line at New York-based Northwell Health.
Opinions expressed by the author do not necessarily reflect the policy of the AHA and are an independent viewpoint of an expert in the health care field.