It’s a well-known fact that, even in high-income countries like the United States, mental health resources are insufficient to address the overall mental health need. Waiting time to see a mental health specialist is usually from several weeks to several months. In practice, this means that there are fewer specialists able to see potential and existing mental health patients, and fewer resources to manage access and cost barriers for those who need help the most. The COVID-19 pandemic has exposed and, to an extent, exacerbated this problem—indicating more clearly that mental wellness exists on a spectrum, and even people who are not dealing with clearly identifiable disorders could benefit from support.
A Harvard T.H. Chan School of Public Health Executive and Continuing Professional Education program, titled Mental Health Care Leadership: Certificate of Specialization, aims to address these problems by helping organizations use and leverage limited resources more effectively. The program is in its second module, called Scaling Up Mental Health Care Services, and addresses implementation, deployment, scaling, and dealing with pushback, among others. The first module introduced the population health approach to mental health; the third program, Mental Health Care Champions Peer Learning Collaborative, will enable participants to share experience and expertise together.
“We want mental health experts to enhance their knowledge and skills to take a system-wide approach rather than to look at just the problems directly facing them explains Shekhar Saxena, professor of the practice of Global Mental Health at the Department of Global Health and Population, former director of the Department of Mental Health and Substance Abuse at the World Health Organization, and program director.
What It Means to Leverage Financial and Human Resources in Mental Health Care
The financial challenges for mental health care organizations can be substantial on a systems level. “Even higher income countries devote a much smaller proportion of financial resources to mental health care compared to other parts of health care,” explains Saxena—and even though the United States recently increased mental health care spending, it still can be insufficient.
One of the solutions to this problem is to help organizations gain access to more financial resources—but this is a long-term strategy that likely won’t be implemented right away. The program focuses on mental health resources that organizational leaders may not be utilizing as effectively as they could, including: formal and informal governmental and community based resources.
In the meantime, explains Saxena, there are also opportunities to provide psychological and social interventions, which means getting away from a strict focus on diagnosis in the field—in other words, not needing to tie mental health care to a specific clinical diagnosis like depressive disorder or post-traumatic stress disorder (PTSD), which is what’s currently used by professionals and health insurance systems for treatment, payment, and coverage.
This also means leveraging existing resources both within the health care community and outside it so that individuals who want to help have the correct training to offer individual or group support. This could open up the ability for more people embedded in communities to offer assistance, including:
- Community health workers
- Peer support workers
- General health workers: doctors, nurses, medical assistants, etc.
- HR chief wellness officers
- School psychologists and counselors
- Social welfare officers and support workers
- Business managers
- Nonprofit workers
- Lay people, including family members
In this way, people in schools, workplaces, nonprofits, support centers, and elsewhere in the community can be primed to help those with a mild to moderate mental health need.
What This Mental Health Systems-Level Approach Could Look Like
This sounds, in theory, like a positive solution, but it can be challenging both to conceptualize and implement. Looking at this more practically, a more optimized system of mental health care resources could mean that more highly trained, mental health professionals focus on the patients with the highest need.
Since those people who need more help may have less paying capacity (in other words, they may not have the funds available to justify intensive inpatient or outpatient support), the systems-level work focuses on helping defray those costs. “We want to begin developing a system where the needs are matched with the resources rather than the paying capacity,” explains Saxena.
Meanwhile, other resources—including hundreds of thousands of peer counselors all over the country—can assist people who may have less intense mental health issues. This can look like individual or group support sessions, for example. People who are unemployed or jobless, isolated older individuals, young people who are facing general challenges, people who are suffering from chronic illnesses, and people with mild depression and/or anxiety may find support from these community resources.
Often, Saxena finds that when leaders start local programs and funnel money into them, they haven’t necessarily thought about longevity either in terms of human or financial resources. This is one of the major reasons these programs may not have been sustainable in the long-term. “They have a bunch of money, they start something, the money runs out, and then nothing remains,” he says. The second module of the program will be structured in a way that allows for open discussion and dialogue—experts bringing their own background and learning from each other as well as the faculty—to enable optimum solutions for specific contexts and scenarios.
“The course is going to talk about how to train the second level of human resources, how to integrate this within the existing system rather than to separate it as a project, how to utilize the available funding mechanisms to make that happen, and how to integrate it within government or insurance programs,” says Saxena.
Harvard T.H. Chan School of Public Health offers Scaling Up Mental Health Care Services, an online course to help health care leaders address the mental health needs of their communities with knowledge, skills, and support.