Patient Engagement in Mental Healthcare: When Will We Get There?

Dec. 18, 2013
When we talk about patient engagement, we usually refer to primary care regarding one’s physical health. But real-world results have shown us that patient engagement strategies can be applied to mental healthcare as well. The key to making that happen is paying more attention to this area of healthcare.

When we talk about patient engagement, we usually refer to primary care regarding one’s physical health, with the idea that getting patients more actively involved in their own health will ultimately lead to healthier people, lower costs, and thus, a more efficient healthcare system.

So now, thanks to provisions in the Affordable Act, we are starting to witness the notion of patient engagement making waves in many healthcare organizations all over the world, as health system leaders recognize its importance; a recent survey of stakeholders by the National eHealth Collaborative (NeHC) found that 96 percent of respondents strongly agreed that engaging consumers in their care is critical to transformation.

However, despite this being a growing trend in terms of physical care, patient engagement is not a concept as widely recognized throughout the mental health sector.

But starting in 2014, health insurers will be required to cover mental health services at parity with general physical services. Consequently, as the healthcare system moves towards a patient-centered model, and in anticipation of the flood of mental health patients into the healthcare system, stakeholders are looking to restructure mental healthcare. One area for improvement is communication between providers and mental health patients, and this includes getting patients involved in their own care.

Before I get into the potential benefits that patient engagement could have in mental health clinical settings, it would be wise to take a look at how behavioral health can be overlooked and even forgotten all across the healthcare spectrum, because this is the main issue at hand. In fact, I think a big reason why patient engagement strategies aren’t used in behavioral health settings is because up until now, mental health isn’t even considered on the same level of importance as physical health.

It’s about time that changes, as one in four American adults, or 57.7 million people, suffer from a mental disorder.

And over the last decade, there have been a striking number of articles in professional journals and the mainstream press attesting to the high prevalence of psychiatric disorders in the nation's elderly population. Although adults 60 years of age and older constitute 13 percent of the U.S. population, their use of inpatient and outpatient mental health services falls far below expectations, according to Mental Health and Aging’s  website,

To this end, elders account for only 7 percent of all inpatient psychiatric services, 6 percent of community mental health services, and 9 percent of private psychiatric care; and less than 3 percent of all Medicare reimbursement is for the psychiatric treatment of older patients.

It is estimated that 18 to 25 percent of elders are in need of mental healthcare for depression, anxiety, psychosomatic disorders, adjustment to aging, and schizophrenia. Yet, statistics suggest that they receive proper care and treatment for these mental illnesses. It is also a worrying reality that the suicide rate of the elderly stands at an alarming 21 percent, the highest of all age groups in the U.S. Every day, 17 older individuals kill themselves.

Back to the engagement piece of this puzzle—we have seen many popular and effective patient engagement strategies that health systems use, including educating the patient, defining his or her role, and giving him or her increased control.

With that in mind, I ask, “Can these patient engagement strategies work in a mental healthcare setting?” For the Tienen, Belgium-based Broeders Alexianen mental healthcare clinic—a medium-sized hospital with five treatment units, and part of a chain of mental healthcare hospitals known as “de broeders van liefde,” the answer is yes.

At the psychiatric clinic, each patient at admission fills in a set of self-rating questionnaires (which are standard clinical assessments) on a computer. QuestLink, a cloud-based patient engagement product from the Minneapolis, Minn.-based healthcare software provider, Vital Health Software, then analyzes the data, and a report of the results is given to the therapists.

These psychologists discuss the results with their individual patients and together with the patient and the therapeutic team, an individual treatment plan is set up; treatment goals are mutually agreed upon. Before the implementation of QuestLink, only a limited number of patients received a diagnostic examination, and most of the time, the results were only given to the treatment team and psychiatrist —not directly to the patient. Further, patients are frequently part of staff meetings in each department, and regarding their own care, can even get to the level of “complete self-management/user control” when the patient decides everything.

Undoubtedly, an organization with active patient engagement can see very tangible benefits, both in terms of improvements to quality of care as well as potential cost reductions. While there are many methods to engage patients, some—such as the Broeders Alexianen clinic— are showing real-world results.

Take a look at recent endeavors the industry has made in terms of patient engagement pertaining to physical healthcare. One example finds a recent study at Dartmouth-Hitchcock Medical Center (DHMC) and the Geisel School of Medicine at Dartmouth which revealed that an interactive web-based patient engagement multimedia program lowered anxiety, sedation medication requirements, and shortened procedure times for first-time colonoscopy patients.

Another example points to the Albuquerque, N.M.-based New Mexico Orthopedics, which recently installed a complete patient self-service system, giving patients have the ability to engage with their own medical records using kiosks, their computers, tablets, or mobile apps.

So going forward, I see no reason why these patient engagement strategies can’t be replicated and expanded on in mental health clinics in the U.S. It’s time for this area of healthcare to become less overlooked and paid more attention to, instead of forgotten. When this happens, patient engagement in mental health clinics could become a trend, rather than an anomaly.

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