January 4, 2023
Decades ago, health was divided into two industries: behavioral and medical. That divide created stigma and resistance as well as funding and coordination issues that continue to linger.
Stigma is a frequently used term, especially when examining the reasons attributed to the lack of access to care.
Understanding stigma
Stigma is an identifying mark or multi-faceted characteristic rooted in fear and misunderstanding.
In the context of behavioral health, there are three different types of stigma:
- Public: How others perceive those living with behavioral health disorders.
- Self: How persons with behavioral health challenges negatively internalize feelings about their own condition.
- Institutional: Systemic biases regarding behavioral health that negatively impact the livelihood and wellness of those affected by behavioral health conditions.
All three types of stigma are affected by stereotypes, prejudice and misinformation. These effects range from poor standards of care, low self-esteem and loss of opportunities due to systemic biases.
When providers understand the nuances of stigma in behavioral health, they have the ability to drive change for patients and the communities they serve. Learning about stigma helps to dictate the approach to patient care and as well as the actions that can reduce the stigma. Knowledge is the power necessary to create positive changes on a societal and personal level — leading to effective change at an institutional level.
Stigma in health care creates a ripple effect
Oftentimes, physical ailments get overlooked if providers believe the ailments are symptoms of a behavioral condition. The lingering effect of these physical symptoms can lead patients to utilize physical health care services more frequently, contributing to the financial burden of increased health care costs.
Behavioral health doesn't exist separately from physical conditions like diabetes or high blood pressure — there is a connection between the two. Wellness in behavioral health positively impacts physical health and vice versa. Poor physical health potentially results in behavioral health concerns.
Marginalized groups are disproportionally impacted
Certain groups of people feel the impact of stigma more than others. These groups include young people, men, military veterans, health care workers and ethnic minorities. Health inequities in minority and under-resourced populations can also contribute to a greater impact of stigma — resulting in a higher incidence of poor health and various diseases.
Health care utilization is a potential reason for the disparities between prevalence and debilitating behavioral health concerns. Studies show that individuals experiencing these health disparities are less likely to use behavioral health resources. The reasons behind this are multi-layered and include:
- Lack of adequate health insurance
- Limited access to quality care
- Mistrust of the health care system
- Stigma on all levels (public, individual and institutional)
Collaborative Care: bridging the gap and stigma reduction
Medical providers see many patients with co-occurring behavioral health complaints. When health services are not integrated, much of the onus falls on the patient for follow-through. When referring patients to outside clinicians, often measurement-based outcomes are unknown to the medical team. Unsurprisingly, the rate of accessing care is low in these situations.
While the behavioral health stigma seems daunting to take on in health care settings, there is an approach that is shown to reduce stigma and improve patient outcomes. Collaborative Care is an evidence-based type approach to integrative care, bridging the gap between physical and behavioral health.
The Collaborative Care Model includes the following components:
- Population-based behavioral health interventions: Data on standard screening tools, prescription practices and referrals provide direction for strategies.
- Patient-centered care: After the provider initiates a referral, the behavioral health clinician contacts the patient. Patients set treatment goals with their clinician. Rescreening at regular intervals measures progress towards desired goals.
- Communication: Medical providers receive regular updates and treatment recommendations from the behavioral health team.
- Reimbursement: Medical practices that provide Collaborative Care may bill for services. Reimbursement shifted from fee-for-service to a value-based model.
Medical practices may find implementing a Collaborative Care model challenging or complicated. Partnering with an experienced behavioral health group takes the guesswork out of it.
Benefits of Collaborative Care
Preliminary research indicates that the Collaborative Care Model reduces stigma in the following ways:
- Collaborative Care removes the distinction between behavioral and physical health.
- Providers receive coaching on how to make behavioral health referrals in an approachable way for patients.
- The model reduces barriers to access by reaching patients where they already receive medical care.
- Clinics that serve under-resourced populations (e.g., Federally Qualified Health Centers and Rural Health Clinics) successfully utilize this model.
- Patient-centered care is responsive. Interventions are not rigid in nature and change to meet the needs of the patient.
- Collaborative Care models are cost-efficient and more effective at improving patient outcomes compared to traditional care.
When implemented the right way, Collaborative Care has the potential to redefine the meaning of primary care. Looking to the future, Collaborative Care provides the tools needed for practices to adopt prevention settings and catch behavioral health illnesses earlier. This, in turn, allows for better health outcomes for all.
Concert Health provides behavioral health services to primary care providers and organizations across the country. Our care is centered on Collaborative Care, an evidence-based model proven to improve behavioral health conditions, such as depression and anxiety, within primary care and women’s health settings. We can do more together. Contact us to start the conversation.