Many healthcare proposals have been advanced in recent years with the label of being “patient-centered.” They are certainly welcome since we have long been provider-centered in our healthcare delivery systems. This applies to the clinical orientation of healthcare professionals and to the operational priorities of business executives in healthcare.
The main question in an evolving patient-centered world is whether our services and processes have been designed with the convenience of the provider or the patient in mind.
Unfortunately, many of our current patient-centered solutions largely provide lip service to this idea. Patients ask: Can you deliver my healthcare quick and easy, cheap and convenient, painless and with good results? Patients don’t start with the current system of healthcare and question how to reform it. They start with simple expectations and hope to get them met.
There are times when very serious problems have relatively simple solutions. Pre-clinical conditions like pre-diabetes and pre-hypertension can be stopped in their progression with lifestyle changes. People taking a daily aspirin can prevent deadly heart attacks. People with congestive heart failure can learn to weigh themselves daily and adjust their diet to ensure that they do not go into a medical crisis. It turns out that we have similar examples in the behavioral health field. However, the difference is that the magnitude of the need for behavioral health is many times greater than that for any other health concern. Behavioral healthcare conditions are the highest cost, most prevalent, and most disabling in the U.S.1
While our actual spending on behavioral healthcare conditions is greater than for any other class of health disorders, the larger concern is that most behavioral conditions are not recognized or treated, and the universe of conditions is quite large. The Centers for Disease Control and Prevention (CDC) estimates that 50% of the people in the U.S. will develop a behavioral healthcare condition in their lifetime. Yet in behavioral healthcare, we are hopelessly overmatched by the prevalence of problems if the only solution is to build a professional workforce to care for all the people with behavioral healthcare conditions.
The good news is that we can significantly help many people without growing the professional workforce.
As both an alternative and a supplement to the professional workforce, we can expand two existing solutions:
1) non-professional, peer services, and
2) web/mobile or digital self-care tools.
These are truly patient-centered services—cheap, convenient, and effective—and they are both scalable. Widely available peer services, focused on every source of psychological suffering, are not in place today, but are quite feasible since we have a long history of providing peer support. Digital services are a burgeoning industry that can help people with various levels of psychological distress at low cost, and the financial industry is already pushing this solution closer to maturity.
Empathic peer support
People without professional degrees who have overcome behavioral health problems have a great deal to offer those who struggle as they once did. The evolution of peers helping peers with mental health problems actually started in the public sector with a focus on helping people with serious mental illnesses. The stories are inspiring, and the adoption by public governmental agencies and mental health organizations is accelerating, and they all recognize that the road to recovery and resiliency is not possible for many people without the guidance of a peer. Medications are fine, but peer support can be grand. We need to reduce symptoms and increase functionality at the same time.
There is no current groundswell of activity to get more peers certified to help others with less serious disorders. Yet this should happen to the extent that we recognize half the population needs some type of support. Many people lead very productive lives, despite intense anxiety, self-hatred, loneliness, and personal isolation, and we need to establish ways to help these people apart from weekly visits to a psychotherapist. The good news is that we can, but the demand has not yet reached a level to produce new models for empathic peer support.
Another important point is that the mental health field has gone through a process of certifying peers as well prepared to offer support and guidance. This is in contrast to the many internet communities that have evolved in recent years for peer support—often without certification, oversight, structure, or protection for the most vulnerable. It is important to start by identifying people who might have a healing impact on others, rather than just a way to aggregate communities of people who may have commonalities.
The first misconception people have when non-professional solutions are introduced is that this will only be beneficial for people with mild to moderate problems. This misconception is rooted in a failure to understand how people with behavioral health conditions actually improve. The medical model trains us to think that in order to get a positive clinical result we need a specific dose of treatment to guarantee that response—often called a dose-response model. Take X milligrams of this medication to eliminate that pathogen. This has never been shown to be true for psychosocial treatments like psychotherapy and motivational interviewing.