Uniting to advance behavioral health equity
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Uniting to advance behavioral health equity
The landscape of the American workforce is changing. Not only is the way we work evolving, but the workforce is becoming more diverse. And with behavioral health conditions on the rise—and projected to contribute to $16 trillion in lost productivity by 2030— behavioral health has come to the forefront of employer concerns. Stark disparities exist across racial, geographic and socioeconomic groups and have been further highlighted by the COVID-19 pandemic. For employers to meet the behavioral health needs of their employees, it’s crucial for all of us to address these disparities. Together, we can adopt a broader and more mindful approach to behavioral health, reducing stigma, building trust and making it more equitable for all. Advancing behavioral health equity is one of four priority areas of focus in Blue Cross and Blue Shield companies’ National Health Equity Strategy.
What do we mean by “behavioral health”? Over time, a broader definition of behavioral health has emerged to include a full continuum of conditions, from the most severe mental health disorders to the everyday stressors—financial debt, social media pressure and work/life balance, to name a few. Behavioral healthcare encompasses a broad scale of prevention, intervention, treatment and recovery support services.
Behavioral health equity: scale of impact
Behavioral health disparities are having a serious impact on diverse groups, especially people of color. This is an issue that desperately needs to be addressed, given that people of color are projected to account for over half of the U.S. population by 2050. The first step in providing support for your workforce is grasping the extent of these disparities.
- RECEIVING CARE – Only 1 in 3
- STARTING AND STARTING AND STAYING IN TREATMENT – 20-50% less likely
- UNDERDIAGNOSIS – 30-40% lower
- GEOGRAPHIC IMPACT – 80% lacking
- SOCIOECONOMIC STATUS – 35% earning <$40K
- CHRONIC CONDITIONS AND COMORBIDITIES – 2X as likely
Impact on employers
The persistence of behavioral health disparities among diverse segments of the workforce could have significant impacts on businesses. Depression is one condition in particular that has massive cost implications both to the well-being of the workforce – especially people of color and other disadvantaged groups – and to organizations.
- $1T in lost productivity
- $560 higher monthly costs
Understanding behavioral health disparities
Advancing behavioral health equity involves understanding the root causes of these disparities. Our first Health Equity mini-eMagazine has more information about social determinants of health (SDoH) and how they affect health equity overall. Below are some key influencing factors specific to behavioral health disparities.
ZIP CODE AND ACCESS TO TREATMENT: As rurality increases, the percentage of counties with behavioral health resources decreases.
STIGMA: Stigma can be particularly strong within Black and Hispanic communities.
LITERACY AND EDUCATION: Historical adversity in encounters with the healthcare system has led to socioeconomic disparities in the Black community.
PROVIDER BIAS AND INEQUALITY OF CARE: Research shows that behavioral health conditions may be underdiagnosed among racial and ethnic minorities.
Understanding the root causes of inequity is crucial to shared impact. We all have a role to play in the journey towards better.”
– Dr. Adam Myers Senior Vice President and Chief Clinical Transformation Officer, Blue Cross Blue Shield Association
Did you know? 63% of Black adults believe that a mental health condition is a sign of personal weakness, which could lead those with a mental health challenge to worry about discrimination.
What we can do together
Collaborate with your health plan partner
Advancing behavioral health equity takes all of us. Your health plan partner can help.
• Ask your health plan partner how they are confronting gaps in behavioral healthcare for disadvantaged populations.
• Ensure steps are being taken with providers to increase cultural awareness, address unconscious bias and improve behavioral health outcomes.
• Inquire about key community organizations that may serve the needs of your employees.
Normalize behavioral healthcare
It’s important to make behavioral healthcare business as usual within the workplace.
• Educate senior leaders and frontline managers on behavioral health, including various barriers to care that populations face, and the importance of speaking openly about mental health with their workforce.
• Encourage starting the mental health conversation from employee onboarding—especially in benefits conversations—and continuing beyond. Send regular reminders about all available resources.
• Implement Employee Resource Groups (ERGs) as a part of Diversity, Equity and Inclusion (DEI) strategies. These groups can help raise mental health awareness and create a forum for employees to support one another, allowing them to bring more of their full selves to work.
• Implicit bias training may also be an important aspect for leaders and people managers. In all your efforts, make sure you are providing tools to create a psychologically safe environment that builds trust through listening and cultural humility.
Make accessing care less cost prohibitive
Collaborate with your health plan partner and others to break down barriers to make care more affordable and accessible.
• Explore limiting or eliminating office visit copays and offering no-cost screenings.
• Drive awareness of outside local resources—many of which are available at little or no cost.
• Consider providing access to screenings, counseling and care on-site and offering paid time off for behavioral healthcare.
Expand coverage for virtual care
Embrace virtual care to help ensure all employees have equitable access to quality healthcare.
• Virtual behavioral healthcare is not only convenient, but it also helps those with high levels of anxiety to overcome stigma and feel more comfortable expressing themselves in the comfort of their own home.
• People also feel safer due to the ongoing COVID-19 pandemic. Be sure to highlight the benefits and effectiveness of virtual care options.
IN ON HEALTH EQUITY:
Anthem, Inc. is providing culturally sensitive websites to reduce behavioral health disparities Depression and other mental health disorders don’t discriminate. The same can’t always be said for the systems meant to identify people at risk and connect them with treatment.
To tackle this problem, Anthem, Inc. developed Take Action for Health, a free, interactive website focused on eliminating health disparities for the Black community. Developed and tested in collaboration with researchers and community partners, like 100 Black Men of America and the National Urban League, the site has been visited by nearly 30,000 people to date. A similar site, Taking Action Por Salud, works to improve the health and well-being of Latinos and Latinas, with input from collaborators like the National Hispanic Medical Association and Beckman Research Institute of City of Hope. Both sites provide access to culturally relevant information and a private, online depression risk screening tool, helping break down some of the barriers to getting support and treatment.
Creating new possibilities for the mental health of Independence Blue Cross members In Philadelphia, over 25% of the city’s Black residents live below the poverty line. Among Hispanic residents, this number climbs to 40%, compared to 12.6% of white residents. Estimates show that those of the lowest socioeconomic status are up to 3X more likely to have a mental health disorder, but few of them will ever receive care due to issues of access, stigma and affordability.
To help close these gaps in care, Independence Blue Cross has partnered with Penn Medicine, a world-renowned academic medical center in Philadelphia, to launch an innovative integrated care program aimed at addressing access issues and stigma around behavioral healthcare. Here, mental health clinicians work side-by-side with primary care providers, screening patients at risk for depression, anxiety and other behavioral health conditions while providing the necessary care within the primary care practice. To date, the program has seen a more than 50% remission rate for patients with mild depression and anxiety and better control of chronic physical conditions like hypertension and diabetes in those that participated in the program. The program has also been expanded from 8 to 18 primary care practices within the Penn Medicine system. With mental health expertise and services integrated into these practices, patients can be quickly connected to well-coordinated, whole-person care. Penn is now working to expand this highly successful program for Independence Blue Cross members.
Join the movement to advance behavioral health equity
Use data to inform more equitable support
Gaining a thorough understanding of behavioral health disparities and their root causes is the first step toward achieving more equitable care. Better data is crucial for pinpointing disparities, improving outcomes and addressing unconscious bias. Ask your health plan partner how you can work together to improve the collection of data that will help drive education, accessibility and equity within your workforce. Employers can also utilize ERGs to help identify and raise awareness of behavioral health challenges that certain groups are facing.
Make it safe to express mental health concerns in the workplace
Train your leaders to be empathetic, trustworthy and humble listeners. Encourage them to be open about their own behavioral health concerns (to the extent they are comfortable) to help eliminate taboos around the subject.
Reach out, to better reach everyone
Collaboration is key in the effort to advance behavioral health equity. Approach your health plan partner for concrete, actionable solutions to these challenges, and ask if they know of any local community resources to further support the overall health of your workforce. If we come together, we can address these disparities, build trust with employees, reduce barriers to care and normalize the importance of behavioral health.