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Behavioral health has experienced a swell of public interest in recent years and moved rapidly to the forefront of the CHRO agenda. In a recent webinar honoring World Mental Health Day, Alethea Varra, PhD, VP of clinical care at Lyra Health, and Andrew Davies, CEO of ICAS World, a Lyra company, sat down to discuss the state of mental health globally and what business leaders can do to promote employee well-being.
What makes behavioral health care high quality, and how can we know when we’re delivering it? How do you define global benchmarks for good mental health treatment?
According to Davies, it all comes down to whether mental health care is effective for the patient. Quality care will produce positive change in a person’s life. This sounds simple, but to gauge whether those positive changes are happening, you need access to data on patient outcomes. Concrete measurement of outcomes hasn’t been widely practiced in behavioral health, although that is starting to shift. Hopefully the trend toward measurable results will make it easier to identify quality care.
Davies went on to explain that good mental health care depends on two factors: access and finding the right kind of treatment. Patients should be able to see a mental health provider with ease in their local community or online, and have no trouble finding a provider who specializes in their particular treatment needs. Currently, this is not the universal reality across the globe; quality mental health care often depends heavily on geographic location.
For treatment to be effective, the patient’s context matters. Much has been made about achieving “parity” of care across countries and cultures. But Varra explains that people often think of parity as “topographical parity”—meaning the same programs, resources, and protocols available in all places around the world. She encourages behavioral health providers to instead focus on “functional parity.”
Functional parity takes into consideration a list of complex factors that affect a patient’s life and mental health:
Suicide is a prime example of a mental health concern that calls for different responses in different contexts. In the Western world, standard protocol dictates that local authorities be notified immediately when a suicide threat exists. Paramedics and law enforcement will take the patient to a clinical care setting. However, in countries where suicide is considered a criminal offense, local authorities could very well take the patient to jail rather than a health care provider. The risk of suicide for patients in these contexts must be handled much differently.
In fact, says Davies, “In certain parts of the world, certain languages, certain cultures don’t have words for mental illness in the same ways that we do in the Western world.” Some languages have no words for “depression” or “anxiety.” Patients from these cultures will more likely present with physical symptoms such as fatigue or headaches and may not recognize the underlying psychological cause.
Whatever the mental health challenge, the person’s daily context will likely influence how it develops, presents, and should be treated. But, cautioned Davies, don’t focus so much on “differences” that you lose sight of the commonalities. People from all walks of life share many of the same experiences on their mental health journeys.
The panelists also weighed in on the role of stigma in perpetuating mental health struggles worldwide. “Stigma is global,” Davies said. “Everywhere in the world there is stigma and prejudice [around] mental health issues.” Whether that’s due to religious beliefs, social systems of shame and honor, cultural attitudes about showing weakness, or even the belief that those with a mental illness are “cursed,” stigma can have a chilling effect on the desire to seek treatment.
Some regions and cultures have a stronger mental health stigma than others, and some may be more overt or more subtle. In American culture, for example, subtle stigma exists in the form of masculine stereotypes against showing emotion and in the glorification of overwork and burnout.
But cracks in the stigma are beginning to show, particularly in the U.S. and parts of Europe, as celebrities and community role models talk openly about their own mental health. The internet, with its possibilities for anonymity and its removal from face-to-face interaction, allows more people to feel comfortable sharing their mental health experiences.
“I think in a decade or two decades from now we’re going to look back at this period of time and say this was the transition period,” says Varra. She believes the tide of stigma is turning and will usher in an era of better functional parity in mental health care worldwide. “That being said, I think we have a huge amount of work in front of us,” she added, with some countries farther along in the process than others.
Business leaders can play a crucial role in changing their organization’s approach to mental health. Recent guidelines from the World Health Organization and U.S. Surgeon General call upon employers to take steps like providing training to managers, creating psychological safety, fostering collaboration, and implementing evidence-based interventions for mental health at work.
Managers and leaders are uniquely positioned to change the dialogue and attitudes about mental health. Stigma in the workplace is reduced when those at the top are vocal about the importance of mental health. Awareness campaigns and a full roster of resources for mental wellness can help to normalize the topic.
It’s important to recognize that mental health has a practical benefit to your company. Mentally healthy employees are likely to be more productive and deliver better results. In addition, a happier workforce creates a more positive work culture.
Varra encourages those who oversee mental health resources in the workplace to “dare to ask for more” from their benefits providers. Push for shorter wait times to see mental health practitioners. Find out if your network is making good patient-provider matches. Ask for information about the types of care offered by providers and request data on patient outcomes to ensure that you’re sending employees to providers who get results. In other words, hold your mental health benefits to the same high standard as your physical health benefits.
Varra also encourages business leaders to get creative in how they position mental health resources. Some employees may hesitate to seek help because of stigma, but would feel comfortable accessing mental health coaching services, for example. Consider protocols to trigger mental health check-ins with employees who ask for support around sensitive life issues. An employee reaching out for legal support regarding finances or a divorce may not proactively state that they need mental health services, but their request for other services can be an inroad to offering additional types of support.
To learn more about supporting global workforce mental health, watch the webinar.