While people everywhere need mental health care now more than ever, access to care is severely limited. That’s largely because the dominant form of treatment for anyone with mental health needs is individual therapy, and that system doesn’t work for several reasons. For starters, there are simply not enough licensed therapists to treat everyone in need, and not enough therapists are located in the same areas as the people who need the care. Therapists are offered unsustainably low reimbursement rates by health insurance networks, so they’re incentivized to offer care out-of-network, increasing the out-of-pocket costs to individuals. Most people can’t afford out-of-network therapy rates, and both in-network and out-of-network therapists typically have long wait times for an appointment. In this therapy-first model where one-on-one contact with a therapist is the only option, people aren’t directed to different levels of care based on the severity of their symptoms or even their personal preference for care setting or modality.
While therapy has decades of research behind it and we know it works, there are alternatives. Modern Health is proud to be leading the effort in finding and testing alternatives that can improve access to mental health care while achieving the comparable clinical effectiveness of therapy. Some care approaches we’re currently offering and rigorously testing include:
As a provider of mental health benefits to employees, how do we know when to offer clinical therapy to a member and when to offer an alternative? That’s the question we address in our first peer-reviewed research study, presented at the Society of Behavioral Medicine Annual Meeting in April 2021. The study, Stepped Care for Mental Health: Care Recommendations and Utilization Through Modern Health, describes our approach to matching members with the right level of care: Everyone who needs care undergoes a series of clinically validated assessments, then through our “stepped care” model, we offer options for the appropriate level of care for each member’s needs. Under this system, a person with more intensive mental health needs is matched to more rigorous help (like the clinical therapy described above) than a person experiencing situational stress (who might be paired with one-on-one coaching plus self-serve digital resources, for example). In this way, stepped care can achieve better health outcomes at a lower cost for more people.
A stepped care approach is only successful if we appropriately match members with the right level of care, and if the members make use of their care after matching. By analyzing data from 23,140 eligible employees and their dependents, we found:
Our next study takes a closer look at one of these non-therapy care options: one-on-one coaching with an accredited, certified coach. Modern Health utilizes coaching to expand the pool of providers that can give effective mental health services to more people at a lower cost. A growing body of peer-reviewed research suggests that low-intensity interventions are effective in treating depression and mental health needs and result in increased access to care, even when these interventions are not delivered by therapists. However, there is limited evidence on the real-world effectiveness of coaching delivered through employee benefits for mental health and workplace outcomes. That’s the research gap we wanted to address in our second peer-reviewed study, Effectiveness of Evidence-Based Telecoaching Delivered Through an Employer-Sponsored Mental Health Benefits Platform, recently published in the journal Telemedicine and e-Health.
At Modern Health, members with clinical-level severity or complexity receive treatment from licensed therapists. We pair members whose mental health needs do not surpass a clinically severe threshold with certified coaches trained in evidence-based approaches (like Cognitive Behavioral Therapy). For this study, we examined data from 1,228 employees who utilized these evidence-based coaching services and did not have a clinical need for therapy.
Finally, our third paper, Real World Engagement and Effectiveness of a Stepped Care Digital Mental Health Benefit during the COVID-19 Pandemic, provides further evidence for coaching as a clinically effective mental health intervention. We analyzed a sample of 991 adults who registered for Modern Health during the COVID-19 pandemic and had elevated depressive symptoms at registration. After offering participants one-on-one coaching, therapy, or a combination of coaching and therapy, we found one-on-one coaching had a comparable impact on individual clinical well-being as one-on-one therapy. This is exciting news for coaching as an emerging clinical treatment modality that can address the worldwide shortage of therapists while offering a non-stigmatizing choice for members . This research is being presented at the American Public Health Association conference in October 2021.
In our first full year of research at Modern Health, we’ve demonstrated that the benefit is effective in matching members with the right level of care using a stepped care model, and that members utilize their benefits after matching. We’ve contributed to the body of empirical evidence on the effectiveness of coaching for mental health, showing that it can bring improvement and recovery in depressive symptoms plus improvements in workplace outcomes. Finally, our research has demonstrated that when offered a benefit program featuring both coaching and therapy, employees saw clinical improvements from coaching on par with those of therapy. These outcomes suggest that mental health services based on a stepped care model are clinically effective in improving employee well-being while serving as a scalable way to effectively meet global mental health care needs.
If you have any questions about our research program or would like to learn more about Modern Health, please drop us a line at firstname.lastname@example.org.
Dr. Cynthia Castro Sweet is the senior director of clinical research at Modern Health.