From the stigmas surrounding conditions like depression and anxiety, to a health care system that too often treated the head and body separately, stubborn barriers have kept people with mental health conditions from accessing high quality care. However, in recent years there are signs that things are shifting. The pandemic opened the doors to more conversations about mental and behavioral health, and there’s growing recognition of the importance of integrating physical and behavioral health care—even if that recognition isn’t always reflected in practice. Recently, we spoke with Victoria Malott, managing director of behavioral health, about the trends she’s seeing, and how Evolent Health Services supports its members and clients in the behavioral health space.
How far along have we come in destigmatizing mental health?
In recent years, there has been a lot more conversation about mental health issues, which is great. While I do think talking about it has helped reduce the stigma, it’s also become in some ways assumed that everyone has anxiety or depression, and that those are the only mental health conditions that are “acceptable.” So, one of the challenges we now face is educating clients and members that mental health isn’t a blanket diagnosis; there is a broad spectrum of mental health diagnoses, including disordered eating, seasonal affective disorder, body dysmorphia and more. We still have a way to go before people feel comfortable talking about some of these other conditions.
What trends have you seen with behavioral health or mental health since the pandemic?
One of the trends we saw that started during the pandemic was how much utilization changed. Since the pandemic began, utilization of all behavioral health services has gone down. However, length of stay for inpatient behavioral health services has gone up. One of the reasons for this was that people tend to view behavioral health care as an elective. During the public health emergency, people weren’t going out and seeking elective services or care. They didn’t see behavioral health care as an urgent need as they did for other types of physical health conditions. The length of stay seemed to have gone up because by the time people sought care, they were in such emergent situations that they required inpatient treatment over a longer period of time.
The other trend we saw was around substance use. Alcohol sales increased more than 200% during the pandemic, especially during the first 18 months. At the same time, use of detoxification centers and similar care significantly decreased. It indicated the sense of hopelessness people felt being stuck in their homes without access to something fulfilling, and it was compounded by the instability of the world. Substance abuse was increasing, seeking treatment was going down. We still haven’t seen either of these trends fully recover to pre-pandemic levels across all the clients that we support for behavioral health.
How does Evolent help support members from an overall behavioral and mental health perspective?
Beyond the services that we offer such as utilization management and care management, we spend a lot of time educating our clients about behavioral health issues and trends. Evolent provides credible and dependable resources to assist with that education. We really try to show our value by understanding what's going on nationally and then in the Medicaid space specifically. In addition, we often find that our partners aren’t able to take on the role of informing members about behavioral health, so we serve as member educators as well, which is something we are proud to do.
Additionally, what differentiates how Evolent supports our partners is the integration of our behavioral health team in the overall care team. Most other companies have separate behavioral health and physical health teams with different organizational structures. At Evolent, our behavioral and physical health teams do meetings, rounds and processes together. We are fully integrated and that’s where we really excel in what we do.
What’s an example of Evolent driving success in this space?
Some of the most successful experiences we tend to have are when our physical and behavioral health teams refer back and forth to each other. Because we have an integrated approach, we might have a member in an inpatient physical health bed, being put through our Transition Care program prior to discharge, and we will discover that they’re not managing their diabetes because their depression is unmanaged. At that point, we can quickly engage the behavioral health care manager to talk to the member about their depression and triage that need along with their physical health needs.
What is one thing that you think could drive the greatest impact in behavioral health?
If we could figure out better ways to demonstrate that addressing behavioral health improves outcomes, whether financial or clinical, we could drive home the need to focus on behavioral health care. We need more data showing the positive overall impact of improving behavioral health care accessibility and utilization. The field is starting to make progress, but it’s been a challenge.
Victoria Malott, LCSW
Victoria Malott, LCSW is the Managing Director, Behavioral Health at Evolent with more than 15 years of experience as a social worker with a master’s degree from The University of Texas - Austin. Victoria has experience in delivering clinical services in a wide variety of settings, including inpatient and outpatient treatment centers. During her clinical work, she focused on treatment of people who had experienced trauma, with a focus on children and adolescents who have been impacted by domestic and sexual violence. She has spent the last 10+ years in health plan operations developing and administering behavioral health utilization and care management programs for Medicaid and Commercial populations. Victoria is passionate about reducing mental health stigma and advocating for timely access to care.