When you have an intractable and worsening problem — such as the huge unmet need for behavioral health services — what do you do? You tap into the energy and rule-changing creativity of entrepreneurs.
While many of us in health care wring our hands about the undersupply and maldistribution of behavioral health professionals, the entrepreneurs simply use this fact as a jumping-off point. They are creating all kinds of workarounds to address the corollary challenges of access, affordability, language and cultural barriers, and stigma. Their tools are digital and online technologies.
The premise is that they can make a return on investment by helping low-income, highly complex, disenfranchised patients get the mental health support they need — and reduce or contain costs for the health care system at the same time.
We invited 12 young companies to the CHCF Innovation Showcase in early February to present their solutions to an audience of safety-net providers and payers who must find ways to meet the needs of the patients who are their responsibility.
Many of the technologies that were presented make geography irrelevant by enabling patient/provider contact at any distance. Others use apps and other programs that can serve very large groups of patients in real time. Language need not be a barrier (although most startups acknowledge they have not yet extended their services beyond English).
A variety of apps connect patients with a virtual community of support, which can be crucial for people struggling with mental and behavioral health problems. This became clear in my own family in the months before and after my brother died, when my mother was suffering from depression. She wasn’t comfortable taking prescribed medication. What worked for her was reaching out to the families of other patients and creating a supportive community. They cooked together and drove each other to appointments. In the end, this is what treated my mother’s depression.
The entrepreneurs work around the problem of stigma in mental illness by offering privacy. Patients can receive therapy anywhere on a phone or an iPad or on Skype. They can do it in a park or on a hike or even on the road. No one needs to know they are getting help.
Just as importantly, these innovations are designed to cut out expense. The truth is that behavioral health care does not have to be high cost and labor intensive. It does not have to depend primarily on face-to-face sessions with psychiatrists and psychologists. We do not have to pump out pharmaceuticals for everything — if more-appropriate and effective kinds of support are readily accessible.
The entrepreneurs who presented their ideas at the CHCF Innovation Showcase are focused on making that happen, and I was struck by how socially minded many of them are. These companies are determined to make a difference in the way we do behavioral health, not solely because the business opportunities are there, but because these services can make a big difference to so many people. When you think about reducing costs and increasing access, behavioral health is in the nexus of that space. In fact, if you want health care to be more affordable, you have to start with behavioral health.
Sandra R. Hernández, MD, is president and CEO of the California Health Care Foundation. Prior to joining CHCF, Sandra was CEO of The San Francisco Foundation, which she led for 16 years. She previously served as director of public health for the City and County of San Francisco. She also cochaired San Francisco’s Universal Healthcare Council, which designed Healthy San Francisco. It was the first time a local government in the US attempted to provide health care for all of its constituents.
In February 2018, Sandra was appointed by Governor Jerry Brown to the Covered California board of directors. She also serves on the Betty Irene Moore School of Nursing Advisory Council at UC Davis and on the UC Regents Health Services Committee. Sandra is an assistant clinical professor at the UCSF School of Medicine. She practiced at San Francisco General Hospital in the HIV/AIDS Clinic from 1984 to 2016.
Sandra is a graduate of Yale University, the Tufts School of Medicine, and the certificate program for senior executives in state and local government at Harvard University’s John F. Kennedy School of Government.