Pandemic's mental health crisis shows California needs to reinvent health care

After 24 months of living through a pandemic, the link between our mental and physical health is clearer than ever. 

What began as a virus of the respiratory system soon caused overwhelming disruption in the structures that ground us — our work, education, social and family connections. 

While vaccines afford significant immunity from the worst physical effects of the virus, the trauma of widespread death, illness and isolation is considerably harder to inoculate against.

Even before COVID-19, our organizations were working to reimagine health care in California, recognizing the inseparability of physical and behavioral health and the need for a strong primary care foundation in the Golden State.

The jaw-dropping data on how COVID-19 has affected our behavioral health gives more urgency to this mission. During the pandemic, 4 in 10 U.S. adults have reported symptoms of anxiety or depression — a four-fold increase from 2019.

Even greater numbers of women, people of color, youth and people with poor physical health reported struggling with mental health. For many, greater trouble sleeping and increased consumption of alcohol and drugs have affected both physical and mental health. Rates of opioid deaths have increased during this time period as well. 

As this crisis reminds us, mental and physical health can’t be separated. But they remain so, and one reason is how health care is paid for. In commercial insurance and publicly funded Medicare and Medicaid, dollars usually flow toward healing physical sickness, not promoting behavioral health.

Children’s behavioral health is one example. Adolescence is when most mental health conditions appear, and early screening and detection offer the best opportunities to begin treatment. Yet the most severe and costly problems often don’t manifest until later in life. As a result, our myopic health care system hasn’t made identifying youth mental health challenges a priority.

Business-as-usual in health care has also reinforced inequities. Certain populations including many communities of color, experience disproportionately poor access when seeking preventive care and make first contact with health providers when diseases have advanced. Our health system has also reinforced societal stigmas that discourage patients from talking about behavioral health challenges until they’ve reached a crisis. 

A groundbreaking 2021 report from the National Academy of Sciences, Engineering and Medicine shares our vision that high-quality primary care must account for the mental health of a person, not just their physical health needs. The report found that when mental health care is a routine part of a medical visit, patients had improved quality of care overall.

To confront old ways of thinking and chart a new course, our organizations are kicking off a conversation about integrating physical and behavioral health to envision a new health care experience in California. We see a future where emotional well-being is considered equally as important to your health as your blood pressure. Other states have already begun to implement new methods of integrating primary and behavioral health care, and California can do the same.

Success will require a seismic shift in thinking across our health care system – and that’s why we are opening this conversation to all – from competitors in the health care space to “disruptors” in the technology field. Together, we’ll need to put in place the payment, workforce training and technology tools needed to scale existing behavioral integration models. Business as usual must be a thing of the past.

The calls to address equity and to treat our minds as essential to health as our hearts has never been stronger. Collaboration among competitors in the health care industry is essential to achieve our shared goals for healthier bodies and minds. Unless we work together to align the way we pay for care with our goals of integrating behavioral health into primary care, we won’t be able to create the health system we deserve – and won’t be ready to meet our mental health needs in the next public health crisis.

Shruti Kothari leads industry initiatives for Blue Shield of California, a nonprofit health plan. Christopher Koller is president of the Milbank Memorial Fund, a nonpartisan foundation.