We need a mental health
‘supply chain’ to address crisis
The U.S. is in the midst of a child mental health crisis. National organizations like the American Academy of Pediatrics have released advisories calling for urgent action. The Seattle Times reports a surge in families seeking care for their children. I see the strain in my own social circles, with fellow parents swapping the names of therapists and routinely calling mental health practices to check for openings.
While exacerbated by COVID-19, the current crisis reflects a longer standing issue in our mental health system. As the director of a mental health policy center, I work with researchers, policymakers, insurance companies, service providers and families, and I see the lack of a coherent path from innovation to delivery in mental health services. To use a metaphor from the manufacturing world, the mental health system lacks a coherent supply chain. Until mental health policymaking solves its supply chain problem with fixes at each link, our children will continue to suffer.
An efficient supply chain ensures the development and distribution of products to customers. Each link in the chain — from idea, to prototype, to production, to delivery — is overseen by a supply chain manager who ensures that all suppliers are doing their jobs.
The first step in any supply chain is the development of ideas to address a need. In our mental health system, innovation is driven by federally funded researchers at academic institutions. This system has often neglected critical aspects of wellness like social support, secure housing and a client’s sense of purpose, according to Thomas Insel, former director of the National Institute of Mental Health. He and others argue that academia must embrace more complex, collaborative and holistic research, engaged with diverse communities. Fortunately, research funders are beginning to offer grants to incentivize such collaborations, but we need more. For example, to align scholars’ research and policy goals, research institutions in the United Kingdom include social impact as part of promotion and tenure decisions.
The second link in a supply chain, prototyping, involves designing a product to be attractive to the end-user. But our current supply chain applies mental health science clumsily, making it difficult to implement. Without adequate planning, well-meaning efforts to require or encourage the use of a mental health innovation almost always fail. For instance, three states (California, Virginia and West Virginia) recently attempted to encourage Medicaid to adopt new substance use treatments. But even with financial incentives, organizations found it a “struggle” to get the program adopted.
The prototyping phase of the mental health supply chain must design policies that can address the unique needs of a state or local context. Policymakers can promote buy-in and help offset potential implementation problems by including clients, service providers, researchers and others in policy design. For instance, in rural Grays Harbor County, our team found a collaborative design approach involving public health, treatment services, the local jail, and clients that broke through years of stalemate in adopting an opioid overdose/recidivism prevention program. Within a year, the county was offering treatment inside the jail and reentry services to prevent re-offense and overdose.
Following prototyping, the supply chain moves a product idea into production. Producing a mental health innovation means creating a health care system that adequately implements, tracks and improves services. Too many health care systems have little idea of the approaches mental health providers are using in treatment, whether clients are improving, and how to improve poor performance. A number of states, including Washington, are instituting more robust methods of tracking. Along with Hawaii and Pennsylvania, our state is moving toward universal tracking of providers’ Medicaid treatments through billing codes, making it easier to see, for instance, if a child with a trauma diagnosis is receiving the recommended treatment. This allows states to assess where improvements are most needed.
Finally, the most crucial step in the chain is the one most visible to parents and teens struggling to find help — delivery. Demand for therapy is so high that some parents are paying out of pocket, drawing experienced practitioners out of the insurance networks that support our most vulnerable. A mental health supply chain manager might look to boost the supply of mental health services by increasing insurance reimbursement rates or training other professionals to deliver aspects of care.
Establishing an efficient mental health supply chain will not be easy. It will require financial investments and novel collaborations across professional boundaries. But by fixing the supply chain now, we can protect our children’s well-being long into the future.
