Studies from the National Alliance of Mental Illness (NAMI) showed that 1 in 5 adults and 1 in 6 youth age 6-17 experience mental illness each year. However, only 43 percent of those adults, and 50 percent of those affected children, receive care. The pandemic has worsened these numbers as grief, unemployment, isolation and more trigger new mental health issues.
While those numbers are alarming, Harsh Trivedi, MD, MBA, sees them as an opportunity to create lasting and positive change. As President and CEO of Sheppard Pratt, Dr. Trivedi is leading the fight for better mental health care in America. Sheppard Pratt is the largest private, nonprofit provider of mental health, substance abuse, developmental disability, special education, and social services in the country.
Moreover, Dr. Trivedi is a nationally renowned expert in healthcare, hospital systems, care delivery, population health and behavioral health. He currently serves on the American Hospital Association (AHA) Board of Trustees, the board of the National Association for Behavioral Healthcare and the AHA COVID-19 Pathways to Recovery Task Force.
Dr. Trivedi took part in our recent HORIZON discussion, “Scanning the Spectrum of Mental Health in America,” and provided insight on what he sees as critical to the future of mental and behavioral health care in our country.
Sheppard Pratt cares for patients across a wide demographic… what have you seen over the last six months in terms of access to care?
As we talk about equity, there’s a conversation taking place nationally about disparity in terms of access to medical care. The important part of this conversation is that we’re seeing the exact same lack of access to care when it comes to mental health care and substance abuse services.
We have more than 380 sites across Maryland, from hospitals to outpatient centers to schools and residential sites. What we are seeing is incredible amounts of trauma, multi-generational trauma, and the current trauma that has been inflicted. We are seeing how some are struggling to access care, and we are trying to reach folks in their own homes where they feel safe through telehealth. When COVID first started, people really thought ‘we’re going to manage through this, and in two or three months we’ll be fine’. Right now, what’s concerning is the sheer amount of time this has gone on without having a light at the end of the tunnel. A lot of folks we’ve been seeing have been white knuckling for months and are now hitting the wall. It’s not just the ones we’ve been taking care of all along, there are people with no history of mental illness that are not just getting therapy but needing hospitalization for their mental health.
The other thing we’ve been seeing is people who have been sober 10, 20, or 30 years that are now falling back into substance abuse. We’re also seeing greater amounts of domestic violence and child abuse incidents. Bringing it back to the national conversation, less than 3 percent of March’s CARES Act funding has gone to mental health care, and given our current mental health crisis, it is not sufficient to help those in need.
The extra demand you’re seeing is also creating demand on staff, has there been anything done as an organization to help staff?
We spend a lot of time thinking about this, especially because we have staff who have been coming in every single day. A number of efforts have been centered around how do we help with resilience and what kind of wellness solutions can we offer. On nursing units, we’ve empowered nurses to create a ‘zen den’, and create space where they can modify lighting, furniture, add aromatherapy or music so they can step away from things going on in the unit when they are able.
We have many employees that are working from home and have empowered our leaders to have proactive conversations about work flexibility. The fact that school is still virtual for most of our employees, and for some, we know they can’t work and do virtual learning at the same time. We’ve created flexible work plans to accommodate that. Right now in our state there are also conversations regarding cancelling bus lines, so we’re looking at what transportation solutions we can come up with to support our staff. During early COVID times, we have prepared a quarter million meals and given out over 200,000 diapers, and we are working daily on basic things like ensuring people have a roof over their head, and if they’re homeless, providing what they need to make it to next day. But mostly importantly, we want to continue providing access to meaningful mental health care.
How can we leverage this moment for meaningful change when it comes to social determinants of health?
While COVID-19 presents challenges, it also provides opportunities. Reflecting back on loneliness, one of the positives that could come out of this is that even the most introverted people I know actually find they do need interaction with others. They need social exchange and have learned that just being with a book isn’t good enough, for instance.
From a design perspective, how we use space has changed. We are in the middle of building a new hospital, and it makes me think about what has changed in the workforce and to consider who do we really need in those locations to ensure the interaction that we need. As we think about social determinants to health, one opportunity I see is developing patient-centered spaces and asking the question, ‘Do these projects only have to be on the grounds of a hospital?’ There are examples of building innovative mental health solutions with housing, treatment, supermarket, pharmacy all in a spot, for instance. I think right now there is a willingness to have those conversations and to rethink these types of things. In line with that thinking, I would also argue there are likely dollars that we don’t need to be spending on offices and square feet that isn’t used for multiple hours a day. So, can you say goodbye to those in order to afford functional space and what does that functional space look like?
What do you think mental healthcare will look like in 2030?
There will still be a drive to consumer-driven healthcare. We’ve seen it across other sectors, and it should be afforded to persons with psychiatric issues as well. Also, with the increased incorporation of technology, how do we do it in a way that works with those receiving the care? What we are realizing more and more is as we design spaces, we do have to think about what allows it to be transformative for care. How do use space for different types of programs, depending on time of day and the patient population there? Is it moving nurses to be more mobile, seeing what can become modular, and adapting to changing needs of space even within same day?
The long tail effects of the pandemic are causing an increase in mental illnesses, particularly anxiety and depression. How do you see this prevalence changing mental healthcare and any stigmas around it?
I believe a silver lining to this pandemic is that it is shifting how we talk about mental health, and there appears to be a greater willingness to discuss the importance of mental health care. Hopefully over time, these public discussions will decrease the stigma surrounding receiving mental health care in this country. This pandemic is also changing how we can provide care. We are seeing a loosening of restrictions on telehealth. This has had a tremendous impact on the care we provide and has enabled a greater access to care because we can now meet those in need where they are, and for many, in the comfort of their homes through telehealth. We have also been able to create a Virtual Crisis Walk-In Clinic, which provides those in crisis with urgent, online psychiatric evaluations and triage. This allows us to quickly and safely provide life-saving care while also freeing up hospital emergency departments to focus on their COVID responses.
In current Sheppard Pratt facilities, what aspects of design do patients like the most? Staff?
Moses Sheppard, our founder, envisioned an environment that treated patients with dignity and respect, and one where all patients had access to natural light, fresh air, and windows. These directives are reflected in the design aspects of our hospital campuses and continue to this day. This is precisely why all patients stay above ground, and each patient gets privacy and a window to our campus or a courtyard. This makes for a better experience for both the patient and our staff who care for them.
What part of new hospital do you think will have the biggest effect on patient care?
Our new hospital is going to have a positive impact on patient care. Its location alone will expand regional access to care due to its proximity to transportation hubs and Washington D.C. The hospital programs will also promote access by offering specialized services, like eating disorder services. Additionally, the new hospital will provide more psychiatric urgent care, a service that was not previously offered in the area. This will have a positive impact on hospitals in the region by easing the strain placed on their emergency departments. Further, this hospital, as part of the larger Sheppard Pratt organization, will have access to the hundreds of programs and services we offer throughout the state and virtually.