How health systems are finding ways to handle ongoing rise in behavioral health woes

The 1 in 4 people nationwide struggling with mental health issues or addiction. … The 30% increase in suicides since 2000. …The 1 in 3 girls nationally reporting that they’ve seriously considered suicide. …

Hackensack Meridian Health CEO Robert Garrett could list the statistics that he calls “brutal” all day.

But he’d rather not.

He’d prefer to change the conversation about behavioral health issues across the state, beginning with beefing up access to services that his and other hospital systems have admittedly struggled with over the years.

Dr. Sunil Khushalani. (LinkedIn)

He’s joined in that goal by leaders such as Dr. Sunil Khushalani, medical director for the behavioral health service line for Atlantic Health System.

“While there’s a greater awareness of the need for taking care of behavioral health issues … one of the biggest challenges in any hospital system is access to behavioral health care,” he said. “Across the state’s (health care system), we are nowhere near being able to cope with demand.”

Khushalani said that has led to severe wait times for behavioral health services across the state, as well as people crowding into last-resort emergency room settings to get care.

Overcoming that requires hospital systems reaching patients sooner. That often starts with the hospital system-affiliated family doctor.

“It’s actually there that upwards of 80% of care is delivered,” Khushalani said. “So, we’re trying to see what we can do to enhance those primary care practices’ behavioral health resources.”

One of the most striking trends in behavioral health for hospital systems is the amount of younger patients presenting with mental health issues. When you’re seeing cases of suicide in individuals as young as 7 and 8 years old, Garrett said, there’s no doubting how much this is a crisis in the state.

Again attempting to reach patients earlier in their health care journey, Hackensack Meridian Health is part of a statewide collaboration of entities expanding screening during annual pediatric health visits to sooner identify mental health concerns.

In general, every patient coming into contact with a Hackensack Meridian care site is screened now for possible social determinants of health that can flag them as high-risk for certain behavioral health issues.

At the same time, the hospital system is expanding access by adding beds for inpatient psychiatry and addiction services at facilities and further building out outpatient services.

“It’s fair to say that demand is continuing to go up and that COVID exacerbated trends existing before the pandemic,” Garrett said. “We believe there’s going to be a need for additional expansion in this area.”

‘Urgent care is a better alternative’

Hackensack Meridian Health has a few years of experience now operating a medically integrated urgent care center with behavioral health services. It was a first not only in New Jersey, but the whole U.S.

By the sounds of it, it’s not likely to be the last.

In late 2019, the hospital system announced it would be blending behavior health into an urgent care center in Neptune. Prior to this, every patient seeking immediate care for a behavioral health issue would be steered to emergency rooms.

“We think urgent care is a better alternative,” Hackensack Meridian Health’s Robert Garrett said. “You can be seen by a midlevel provider. If a psychiatrist isn’t immediately available, you can get linked with one through telehealth. And, if they need it, patients can also be transferred to our inpatient psychiatry hospitals as well.”

The local experiment has helped ease the burden on stressed hospital emergency departments that were especially stressed during the pandemic years. And it has accomplished what the hospital system wanted for its behavioral health patients: to get them seen sooner.

“When you’re bringing behavioral health care patients into the same overcrowded emergency department setting as patients experiencing cardiac events or those who had a stroke in the past 30 to 50 minutes, it’s a challenge to compete against those significant health issues,” Garrett said.

Garrett added that the model shows significant promise, and would likely be employed more by the health system and others in the future.