In 2020, there were an estimated 14.2 million adults in the United States with serious mental illness (SMI). We sat down with Vicki Grubaugh, LCSW, Director of Behavioral Health & SUD Clinical Strategy at UnitedHealthcare Community & State to understand more about the landscape, the current challenges, and the role health plans serve in helping people struggling with mental illness.
Here’s a look into our conversation and how our health plans partners are thinking about serious mental illness.
Defining Serious Mental Illness & The Challenges
What do we mean when we say serious mental illness?
When we use the term “serious mental illness” (SMI), we’re referring to a mental health condition that significantly impacts an individual’s ability to function in their daily life. This can include difficulties with relationships, work, or other important daily activities. It’s important to note that there is no clear distinction between SMI and milder mental health conditions—this is because it’s often based on clinical assessments. Therefore, the threshold for what constitutes a serious mental illness is determined by the duration and impact of the condition on the individual’s life.
When a mental health condition begins to significantly affect an individual’s functioning and ability to achieve their goals, that’s when it may be time to seek professional help or consider interventions, such as therapy, support groups, or medication.
From where you sit, what are the challenges health plans are facing when it comes to SMI?
There are several challenges facing mental health care in the US, including the lack of true parity in how mental health is perceived—there’s still stigma out there. And when large systems like behavioral health and primary care aren’t integrated and speaking to each other, those silos create challenges in treatment. Other common challenges we’re working to overcome include:
- Integration between behavioral health and primary care
- A shortage of behavioral health providers, leaving primary care to try and meet patient needs without all the tools and expertise required
- Difficulty coordinating care between different organizations and systems
- Continued uncertainty in healthcare
- Changing regulatory requirements
- Patient engagement and trust
Further, there’s a major engagement challenge. Coupled with the lack of trust that exists between patients, providers, and plans, it’s difficult to provide the critical services people need.
The Impact of Stigma & Trust in Mental Health
How do stigma and trust factor into SMI treatment?
Stigma can make it difficult for people with SMI to be validated and feel believed when they seek help. This is because there is often no simple test to prove their condition, unlike other chronic conditions (e.g. diabetes). Historically, people with mental health conditions have been treated as character flaws or as if it’s their own fault, leading to self-stigma and an unwillingness to acknowledge their symptoms or seek help.
Naturally, this treatment can lead to trust issues within the healthcare system. And often times when a trust barrier is built, people stop engaging with the system to support their healthcare.
Opportunities for Better SMI Care Coordination
Where are the biggest opportunities to impact SMI care and treatment?
There are several opportunities where we can make a huge difference, including:
- Understanding the stages of change and when to engage
- Working to build meaningful relationships with providers and case managers
- Connecting with community partners who have established trust with members
Plus, empowering people to take charge of their lives and seek treatment is crucial. That’s why a community-based partner like Reema can be so valuable—the navigation assistance as well as the resources provided are a great way to guide members to the care they need while building a trusting relationship, which will have incredibly powerful downstream impacts on health.
What is the role of community-based organizations in SMI from a health plan perspective?
The role of community-based organizations in SMI is huge because they are the start of baseline trust and credibility for a lot of people. When you meet someone who understands your situation and has experienced similar things, you build an immediate connection. So the way you talk about shared identity means a lot when it comes to engaging members with SMI.
Further, community-based organizations understand neighborhoods and local systems in a way that others can’t. They know how the buses work, they understand that 3 miles can be the difference between getting treatment or not, and they are more aware of the resources that might be available to members locally. So community-based partnerships and local knowledge can’t be taken for granted.
Community-based organizations understand neighborhoods and local systems in a way that others can’t.
Organizations like Reema can also work quickly and creatively in ways that large health plans might not be able to by leveraging networks differently to get results that help members now. Huge healthcare organizations may want to be able to provide services like this, but simply can’t because of size and speed constraints.
The Future of Serious Mental Illness: Looking Ahead
We know there's pressure to do things differently: where is that coming from?
There is pressure coming from all sides, but a lot is coming from states—for healthcare providers to do more in terms of preventing and treating SMI. The real challenge is that the healthcare system isn’t structured to prioritize prevention and there is a lot of variability in how people experience their SMI.. So the focus is on preventing exacerbation and improving quality of life for people with mild to moderate conditions, not just those with severe mental illness.
States are looking for more comprehensive prevention and behavioral health programs to support people before they experience acute illness or significant impact in functioning.
The real challenge is that the healthcare system isn’t structured to prioritize prevention and how people experience SMI.
How does health equity factor into SMI?
It’s important to collect data to address disparities in healthcare. Having data readily available makes it harder to ignore problems, so a focus on collecting more data from more populations is necessary.
We also know the importance and impact of taking a hyperlocal approach. By working within communities to address the specific barriers and challenges within those communities, we’re able to help more people. By making incremental progress we’ll be able to reduce disparities.
If you could solve a challenge around SMI today, what would that be?
To wave a magic wand and achieve true parity between mental health and medical treatment would be the dream. There are disparities and a lack of access on both sides, so prevention really is the key. Putting more energy and resources into preventing adverse childhood experiences, empowering parents and families, and changing the trajectory of care to prevent exacerbation of illness. There’s a lot more that can be done on the front end to change the course of treatment and improve overall outcomes.
This blog was written with insights from Vicki Grubaugh, LCSW, Director of Behavioral Health & SUD Clinical Strategy at UnitedHealthcare Community & State. Thank you Vicki for your contributions to this article and for pushing the serious mental illness conversation forward.
