The state of mental health care

Since the pandemic, mental health care services are in higher demand today than ever before. Sadly, 57% of insured Americans who sought behavioral health care from January 2019 to April 2022 did not receive treatment. Adolescents and adults alike are struggling. Recently, Cigna stated that employers have meaningfully increased their demand for behavioral health solutions but also expressed frustration with the highly fragmented landscape. Similarly, UnitedHealth Group saw behavioral care use increase double digits in the last year. The priority now for Cigna, and other insurance companies, is to help employers and other customers increase access, affordability, and effectiveness of behavioral programs and solutions. The ecosystem’s move to telehealth, improvements in credentialing, and the emergence of new modalities should aid in this effort as they offer more opportunities for care.

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Therapy is unique in healthcare; it can be as high quality over video visits as in person. And the market is responding to this fact. Following COVID-19, care providers moved to products like Zoom that are HIPAA compliant and secure to continue providing mental health services to clients. At the same time, therapy became more reimbursable as companies like Alma and Headway created credentialing infrastructure and streamlined processes.

Historically, licensed therapists haven’t taken insurance for their services because it's difficult to become credentialed. Therapists have two options to accept insurance: they can join a provider panel or offer services as an out-of-network provider. An out-of-network therapist must provide clients with an itemized bill that the client can submit to their insurance. To join a provider panel, a therapist must apply to a specific insurer’s preferred panel and wait months for approval. It’s arduous work before even seeing a client, never mind the extra work of submitting and processing claims thereafter.

The catch-22 is most insurance companies require an official mental health diagnosis before approving treatment and some require treatment/progress notes for reimbursement. This hinders care because some patients who require therapy don’t have an official diagnosis. Not only does this undermine client confidentiality, but it can lead to over-diagnosing. These diagnoses stay on a client’s medical record and can potentially affect their future coverage. Anecdotally, UnitedHealthcare was just fined $500,000 in Washington state for failing to provide mental health coverage in a manner that is comparable to—and not more restrictive—than coverage for physical health conditions. It’s clear why mental health professionals and patients alike have historically avoided insurance.

Fortunately, companies like Alma and Headway have simplified this credentialing process. Therapists can get up and running in six weeks and clients can access a marketplace of qualified providers. Credentialing and telehealth have made mental health care more accessible, particularly talk therapy. These changes in tools and infrastructure are leaps toward closing the gap between supply and demand. In addition, new modalities aim to provide alternative and specialized care, also increasing supply.

New modalities & treatments

Psychedelics

Two substances that are historically associated with recreational use—ketamine and psilocybin—have gained a lot of attention lately for their promise in treating mental health conditions. Ketamine was originally developed as an anesthetic in the 1970s and was classified as a Schedule III controlled substance in 1999. This classification, combined with studies that have shown ketamine’s ability to alleviate depression symptoms, led to new clinics that specialize in and offer ketamine-assisted therapy.

Psilocybin, on the other hand, is a naturally occurring psychedelic compound found in certain mushrooms that gained popularity in the 60s but were criminalized shortly thereafter, in the 70s. Since then, researchers have studied psilocybin’s therapeutic potential and landmark studies have demonstrated its efficacy in treating depression, anxiety, and PTSD. The interest in psilocybin’s medical application has prompted cities and states across the US to reconsider its legal status. Oregon in particular allows regulated medical use of psilocybin and granted a manufacturer license for the drug this year.

There’s still much we have to learn about how these two therapies work, the most effective treatment protocols and standards, and their long-term effects. Startups like Mindbloom are leading the charge to help practitioners understand Ketamine’s medical applications. The company participated in the largest-ever clinical study on ketamine therapy that tracked 1,200+ Mindbloom clients over 4 sessions. The results were promising; 89% of clients reported improvement in their depression and anxiety symptoms after 4 sessions

Neurotech

In the last two decades, researchers have made strides toward using neurostimulation to treat mental health conditions. In 2008, the FDA approved a Transcranial Magnetic Stimulation (TMS) device for use in depression treatment, setting the stage for neurotech in mental health.

TMS is a non-invasive neurostimulation technique that can be used to treat a variety of mental health conditions. To complete a TMS session, a coil is placed against the scalp and delivers localized magnetic pulses to the scalp. The parameters for the treatment can be adjusted based on the patient and condition. The stimulation can modulate neural activity and is typically administered in a series of sessions, lasting as little as 10 minutes, over several weeks.

TMS has many benefits. It’s generally well tolerated, has low side effects, isn’t invasive, and doesn’t require anesthesia. Recent protocols have shown symptom improvement in patients with depression in as little as five days.

Image of what tFUS may look like via Brainbox

Image of what tFUS may look like via Brainbox