Dr. Judith Beck recently wrote the foreword for Hypochondria: What’s Behind the Hidden Costs of Healthcare in America by Hal Rosenbluth and Marnie Hall. She recently chatted with Hal about his experience of Illness Anxiety Disorder (IAD) and the role of increased access to mental health treatments like CBT in improving the US healthcare system.
Hal, how important is it to democratize access to mental health support? How can the healthcare system improve access to Cognitive Behavioral Therapy (CBT) and other forms of mental health treatments? What tools should healthcare professionals be leveraging that they are not?
Today mental health treatment is a luxury. It’s expensive and even more troubling, the demand for mental health services exceeds the available supply of providers. Meaning that a limited number of people can access mental health professionals and the rest are priced out despite having a critical need. Healthcare professionals can leverage multiple preliminary screening surveys that would help to identify the need for mental health services, such as the GAD-7 for anxiety, the PHQ-9, which is generally used to screen for depression, and so on. One of the key reasons I started New Ocean Health Solutions was to make tests similar to these preliminary surveys more accessible by offering them through a convenient digital app that also has resources to assist patients in managing care or getting care aligned prior to telehealth visits. For example, this could assist in providing an initial diagnosis of illness anxiety disorder with referrals to CBT professionals.
Personal health monitoring tools can be helpful in easing the burden on the healthcare system, which is something I talk a lot about in my book. These tools are becoming more available to the public, but we need to continue to find ways to drive down costs, create access to emerging technologies, and advocate for more adoption of accessible health monitoring technology as one way to ease the strain on our healthcare system. Democratizing access to healthcare has been a mission of mine from Take Care Health, which created walk-in retail clinics, to my current business, New Ocean, a digital coaching platform that helps people manage their whole health and lifestyle support needs.
What advice do you have for those struggling with IAD, whom should they seek out and what resources can help them mitigate their IAD?
First, I’d say you’re not alone, there are many tactics and tools to manage IAD that have all helped me, in various ways, have a happy and productive life. You have to find what works best for you; no two people are the same. Consider seeking mental health support. The treatment which research has shown to be most effective for illness anxiety is CBT. Though I have not specifically seen a CBT therapist, many of the principles that drive CBT have been helpful to me as I process my illness anxiety. Through CBT people can learn techniques to change their beliefs and the way they cope with their physiological and psychological symptoms.
You describe in your book how those with illness anxiety disorder (IAD) are a heavy burden on the healthcare system. How would increased access to CBT help soften that pressure?
CBT can be highly effective for treating IAD. The real challenge is widely incorporating CBT and mental health services into regular medical care. Interestingly, many pediatric practices have installed social workers to assist patients in accessing mental health services that sit outside their health systems. If this idea was implemented on a larger scale throughout the healthcare system, it could be a game changer for mental health and treating IAD effectively. In practice, this might look like a social worker, or similar professional, meeting with a patient with IAD prior to their appointment with a doctor, freeing up the system, decreasing multiple claims, and lessening the hefty cost they potentially present. Alternatively, medical professionals (nurses, nurse practitioners, physician assistants, and doctors (if they are willing and can make the time) could learn brief CBT techniques to use with patients who have IAD. I know that the Beck Institute for Cognitive Behavior Therapy has been training medical professionals for the past 30 years with excellent results.
How can telehealth improve individuals’ ability to access their healthcare needs? How can telehealth improve?
First, convenience and flexibility are key. That was the model behind retail clinics; we wanted to provide health and wellness on every corner so that people could walk in with a problem and walk out with a prescription, medicine, and a solution all in one trip. Now telehealth expedites this process and allows people to meet providers without having to leave their home.
If the individual does in fact need to schedule an in-person visit or receive a referral to a specialist, telehealth appointments allow for timely intervention and swift action. People want quick access to medical professionals and we should be trying to give it to them.
That said, telehealth still has other areas that need investment. Namely, telehealth providers need to improve connectivity in rural areas, create more user-friendly platforms that offer one click to connect, and offer a broader assortment of mental health tools. Importantly, telehealth needs to create efficient and easy ways to use electronic medical record (EMR) systems.
My team at Walgreens built the first step-by-step EMR with integrated check in, exam, check out and billing which allowed clinicians to help a patient in 15 minutes or less. Unfortunately, most EMR’s are overly complex and do not work with clinicians but against them. Our EMR flow was built with input from clinicians and patients, to help maximize the time spent with the clinician as opposed to the system itself.
I said in my forward that your recent book, “Hypochondria: What’s Behind the Hidden Costs of Healthcare in America,” should be required reading for anyone who wants to better understand the workings of the U.S. healthcare system. What are some other books that should be required reading for those looking to learn more about the healthcare system?
“Feelin’ Alright: How the Message in the Music Can Make Healthcare Healthier.” Stephen Klasko’s decades of experience in healthcare have inspired him to write his most recent book which presents a more accessible, equitable, and high-quality future for healthcare, one that leverages new technology and empowers the consumer.